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The Kidney in Sistemic Disease
Zehra Eren M.D.Nephrology Department
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LEARNING OBJECTIVESThe Kidney in: Congestive heart failure Liver disease Diabetes Mellitus Systemic Vasculitis İnfections Systemic Lupus Erythematosus Dysproteinemias and amyloidosis Hemolytic Uremic Syndrom /Thrombotic Thrombocytic Purpura Cancer and its treatment
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Renal Function In Congestive Heart Failure
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Heart Failure
Definition-complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability to supply blood to adequatly meet the metabolic needs of bodily tissues-it is characterized by specific symptoms, such as dyspnea and fatigue, and signs, such as fluid retention
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Cardiorenal syndrome interactions between heart disease
and kidney disease the interaction is bidirectional as
acute or chronic dysfunction of the heart or kidneys can induce acute or chronic dysfunction in the other organ
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Classification of Cardiorenal syndrome
Type 1 (acute) — Acute HF results in acute kidney injury (AKI, previously called acute renal failure)
Type 2 — Chronic cardiac dysfunction (eg, chronic HF) causes progressive chronic kidney disease (CKD, previously called chronic renal failure)
Type 3 — Abrupt and primary worsening of kidney function due, for example, to renal ischemia or glomerulonephritis causes acute cardiac dysfunction, which may be manifested by HF
Type 4 — Primary CKD contributes to cardiac dysfunction, which may be manifested by coronary disease, HF, or arrhythmia
Type 5 (secondary) — Acute or chronic systemic disorders (eg, sepsis or diabetes mellitus) that cause both cardiac and renal dysfunction.
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Renal Function In Liver Disease
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Acute RI
Hepatorenal syndrom
Cronic RI
Post transplantation
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Hepatorenal syndromDefinitiondevelopment of acute kidney injury in a patient who usually has advanced liver disease due to cirrhosis, severe alcoholic hepatitis, or (less often) metastatic tumor, but can occur in a substantial proportion of patients with fulminant hepatic failure from any cause
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DIABETIC NEPHROPATHY (DN)
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DIABETIC NEPHROPATHY
Definitionprogressive decline in glomerular filtration rate (GFR) in context of long-standing diabetes, usually accompanied by nephrotic range proteinuria and other end-organ complications, such as retinopathy
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DN PATHOLOGY
Diabetic kidneys generally increased in size
Light microscopy
-mesangial expansion
-glomerular basement membrane thickening
-glomerular sclerosis
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DN PATHOLOGY
Kimmelstein-Wilson nodules
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DN Pathogenesis glomerular hyperfiltration hyperglycemia and the increased
production of advanced glycation end products
increased plasma prorenin activity hypoxia-inflammation activation of cytokines
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Risk factors for progression family history of diabetes black race higher systemic blood pressures evidence of hyperfiltration early in course
of disease poor glycemic control smoking obesity and older age
No one factor is predictive in the individual patient
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Renal Involvement in Systemic Vasculitis
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Types of vessels in the Chapel Hill Consensus Conference nomenclature system
Large vessels: aorta and its major branches and the analogous veins Medium vessels: main visceral arteries and veins and their initial branchesSmall vessels: intraparenchymal arteries, arterioles, capillaries, venules, and veins
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2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides
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Renal angiogram in polyarteritis nodosa
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Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)
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Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)
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Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)
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Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)
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Infection-Related Glomerulonephritis
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Lupus Nephritis
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Lupus Nephritis An abnormal urinalysis (hematuria and/or
proteinuria) with or without an elevated plasma creatinine concentration is observed in up to 75 percent of patients with systemic lupus erythematosus
The most frequently observed abnormality is proteinuria
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Classification revised by the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS)
Class I – Minimal mesangial lupus nephritis Class II – Mesangial proliferative lupus nephritis Class III – Focal lupus nephritis (active and chronic;
proliferative and sclerosing) Class IV – Diffuse lupus nephritis (active and chronic;
proliferative and sclerosing; segmental and global) Class V – Membranous lupus nephritis Class VI – Advanced sclerosis lupus nephritis
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Renal Amyloidosis and Glomerular Diseases with Monoclonal
Immunoglobulin Deposition
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Noninfiltrated purpuric macule
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Renal İnvolvementn in Hemolytic- Uremic Syndrome (HUS) /
Thrombotic- Thrombocytopenic Purpura (TTP)
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Clinic presentation of HUS/TTP
Microangiopathic hemolytic anemia Thrombocytopenic purpura Acute renal failure Fever Neurologic dysfunction
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Etiology and pathogenesis of microangiopathy
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Peripheral blood smear from a patient with HUS
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Renal involvemen in cancer and its treatment
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SUGGESTED READING Goldman's Cecile Medicine, Goldman L, Schafer AI
Case files Internal Medicine, Toy Patlan
Current Medical Diagnosis and Treatment, Maxine A. Papadakis, Stephen J. McPhee, Eds. Michael W. Rabow, Associate Ed.
Current Diagnosis & Treatment: Nephrology & Hypertension Edgar V. Lerma, Jeffrey S. Berns, Allen R. Nissenson