The Kidney in Sistemic

Disease

Zehra Eren M.D.Nephrology Department

LEARNING OBJECTIVES

The 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

Renal Function In

Congestive Heart Failure

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

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

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.

Renal Function In Liver Disease

Acute RI

Hepatorenal syndrom

Cronic RI

Post transplantation

Hepatorenal syndrom

Definition

development 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

DIABETIC NEPHROPATHY (DN)

DIABETIC NEPHROPATHY

Definition

progressive 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

DN PATHOLOGY

Diabetic kidneys generally increased in size

Light microscopy

-mesangial expansion

-glomerular basement membrane thickening

-glomerular sclerosis

DN PATHOLOGY

Kimmelstein-Wilson nodules

DN Pathogenesis

glomerular hyperfiltration

hyperglycemia and the increased

production of advanced glycation end

products

increased plasma prorenin activity

hypoxia-inflammation

activation of cytokines

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

Renal Involvement in Systemic

Vasculitis

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 branches

Small vessels: intraparenchymal arteries, arterioles, capillaries, venules, and veins

2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides

Renal angiogram in polyarteritis nodosa

Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)

Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)

Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)

Definitions for vasculitides adopted by the 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides (CHCC2012)

Infection-Related

Glomerulonephritis

Lupus Nephritis

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

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

Renal Amyloidosis and Glomerular

Diseases with Monoclonal

Immunoglobulin Deposition

Noninfiltrated purpuric macule

Renal İnvolvementn in Hemolytic-

Uremic Syndrome (HUS) /

Thrombotic- Thrombocytopenic

Purpura (TTP)

Clinic presentation of HUS/TTP

Microangiopathic hemolytic anemia

Thrombocytopenic purpura

Acute renal failure

Fever

Neurologic dysfunction

Etiology and pathogenesis of microangiopathy

Peripheral blood smear from a patient with HUS

Renal involvemen in cancer and

its treatment

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