08.1 Secondary glomerular disorders

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Questions and Answers

What is the primary cause of renal injury in multiple myeloma nephropathy?

Nephrotoxic light chains produced by plasma cells (correct)

Direct effects of diabetes on kidney function

Autoimmune response against renal tissue

Clonal proliferation of red blood cells

Which diagnostic test is most relevant for assessing renal impairment in multiple myeloma?

Urinary creatinine clearance

Bence-Jones protein urine assessment (correct)

Molecular genetic testing

Serum creatinine levels

Which condition is directly associated with the clinical progression of diabetic nephropathy?

Proteinuria and hypertension (correct)

Acute tubular necrosis

Nephrotoxicity from medications

Chronic glomerulonephritis

What management strategy can be employed for patients with diabetic nephropathy?

Hypertension control and managing blood glucose levels Signup and view all the answers

Which pathology is least likely to be considered a secondary glomerular disorder?

Focal segmental glomerulosclerosis Signup and view all the answers

What is a common complication of multiple myeloma related to renal health?

Hypercalcaemia Signup and view all the answers

What typically characterizes primary glomerular disorders as opposed to secondary glomerular disorders?

Of idiopathic origin Signup and view all the answers

Which therapeutic approach is most likely required for severe renal impairment in multiple myeloma?

Dialysis Signup and view all the answers

What is the primary mechanism by which diabetic nephropathy leads to kidney damage?

Formation of advanced glycation end-products and oxidative stress Signup and view all the answers

Which histological finding is specific to diabetic nephropathy?

Nodular sclerosis (Kimmelstiel-Wilson lesions) Signup and view all the answers

Which of the following treatments is specifically indicated for nephroprotection in diabetic nephropathy?

SGLT2 inhibitors Signup and view all the answers

What is the role of RAAS blockade in the management of diabetic nephropathy?

Reduce proteinuria and alleviate glomerular pressure Signup and view all the answers

Which symptom is most characteristic of end-stage renal disease (ESRD) related to diabetic nephropathy?

Need for dialysis Signup and view all the answers

In the diagnostic approach for diabetic nephropathy, which assessment is vital for differentiating it from non-diabetic kidney disease?

Fundoscopy for retinopathy Signup and view all the answers

What is the common consequence of persistent hyperglycaemia in diabetic nephropathy?

Podocyte effacement and glomerular damage Signup and view all the answers

Which complication is specifically associated with the advanced stages of diabetic nephropathy?

End-stage renal disease requiring dialysis Signup and view all the answers

Study Notes

Secondary Glomerular Disorders

Secondary glomerular disorders are kidney diseases caused by systemic conditions, not intrinsic renal problems.
Two key examples are multiple myeloma nephropathy and diabetic nephropathy.
Understanding these disorders is crucial for clinical practice and exams.

Learning Objectives

Explain how multiple myeloma damages kidneys and why Bence-Jones protein urine assessment is important.
Understand the natural history, pathophysiology, and clinical progression of diabetic nephropathy.
Describe the diagnostic process and management strategies for diabetic nephropathy.

Key Concepts

Primary Glomerular Disorders: Intrinsic kidney diseases, often idiopathic (unknown cause).
Secondary Glomerular Disorders: Kidney diseases caused by systemic issues like multiple myeloma, diabetes, or lupus.
Multiple Myeloma: A blood cancer characterized by plasma cells producing harmful light chains (nephrotoxic).
Diabetic Nephropathy: A specific kidney disorder from diabetes; damaging effects on the kidneys, leading to proteinuria, high blood pressure and gradual kidney failure.

Clinical Applications - Multiple Myeloma

Case Study: A 70-year-old with back pain, fatigue, anemia, high calcium levels, and Bence-Jones proteins in urine.
Diagnostic Approach: Serum protein electrophoresis, free light chain assays, and urine Bence-Jones protein tests.
Treatment Options: Chemotherapy to reduce plasma cells, bisphosphonates for high calcium and rehydration. Dialysis may be necessary for severe kidney problems.

Clinical Applications - Diabetic Nephropathy

Case Study: A 55-year-old with 15-year history of uncontrolled type 2 diabetes, proteinuria, and reduced kidney function.
Diagnostic Approach: Monitoring albumin-to-creatinine ratio (ACR) and eGFR, differentiating from other kidney issues.
Treatment Options: Tight blood sugar control (HbA1c < 53 mmol/mol), RAAS blockers (ACE inhibitors or ARBs), and possibly SGLT2 inhibitors.

Pathophysiology of Multiple Myeloma

Excess free light chains overwhelm proximal tubules.
Light chain accumulation causes inflammation and cell death.
Tubular damage leads to cast formation and interstitial fibrosis.

Pathophysiology of Diabetic Nephropathy

Persistent high blood sugar causes advanced glycation end-products (AGEs).
Damage to the glomeruli leads to mesangial expansion, thickening of the basement membrane, and podocyte damage.
These changes cause hyperfiltration, hypertension, and progressive kidney damage.

Pharmacology

Multiple Myeloma: Chemotherapy and bisphosphonates are treatments.
Diabetic Nephropathy: RAAS blockers (ACE inhibitors or ARBs) reduce proteinuria and blood pressure. SGLT2 inhibitors can improve blood sugar control and offer potential benefits to kidneys and heart.

Differential Diagnoses

Lupus Nephritis: Immune complex-mediated glomerular disease.
Amyloidosis: Systemic disease with amyloid deposits in kidneys.

Investigations and Diagnostics

Multiple Myeloma: Serum protein electrophoresis, urine tests for Bence-Jones proteins.
Diabetic Nephropathy: Albumin-to-creatinine ratio (ACR) and 24-hour creatinine clearance.

Key Diagrams and Visuals (Diagram descriptions)

Diagrams illustrate the mechanisms of kidney damage in multiple myeloma and diabetic nephropathy, showing the accumulation of proteins (light chains) and the effects of these proteins/processes on kidney tissue structures.

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Description

Test your knowledge on secondary glomerular disorders caused by systemic conditions like multiple myeloma and diabetes. This quiz covers key concepts, diagnostic processes, and management strategies important for clinical practice. Enhance your understanding of how these disorders affect kidney function.