The kidney in sytemic disease

The kidney in sytemic disease

Hypertension:.

Diabetes mellitus: This is a common cause of renal disease and accounts for a large number of patients who need dialysis..

Multiple myeloma: Many patients with multiple myeloma will develop renal complications such as proteinuria, acute or chronic renal failure and amyloidosis. There are several contributing factors to the development of ARF, including hypercalcaemia and dehydration. The mechanism of development of ‘myeloma kidney’ is via a direct toxic effect on renal tubular cells and blockage of the tubules and collecting ducts by the paraprotein. In addition, patients may develop amyloidosis and renal tubular acidosis as complications of multiple myeloma.

Amyloidosis: This condition may be systemic or confined to the kidneys and is an important cause of glomerular disease. It can cause proteinuria, nephrotic syndrome and renal failure.

Henoch–Schonlein¨ purpura (HSP): This systemic vasculitis causes a purpuric rash, abdominal pains, joint pains and a glomerulonephritis that is indistinguishable from IgA nephropathy. This is unsurprising, as HSP is characterised by tissue deposition of IgA containing immune complexes..

Systemic lupus erythematosus: This multisystem connective tissue disease commonly affects the kidneys. SLE is the great mimicker of almost every type of glomerulonephritis from minimal change disease, to membranous nephropathy, to proliferative glomerulonephritis.

Systemic sclerosis: This connective tissue disorder can cause acute or chronic renal disease due to the damage caused to the renal arterioles. The only treatment known to be of benefit is ACE inhibitors..

ANCA-associated vasculitis: This includes Wegener’s Granulomatosis and Polyarteritis Nodosa which can cause rapidly progressive glomerulonephritis, with acute renal failure. Early treatment with immunosuppression regimes such as plasmapheresis, high dose steroids and cyclophosphamide can improve renal function.