Zehra Eren M.D. Nephrology Department

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

 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

 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

 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

 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)

 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

 Diabetic kidneys generally increased in size  Light microscopy -mesangial expansion -glomerular basement membrane thickening -glomerular sclerosis

Kimmelstein-Wilson nodules

 glomerular hyperfiltration  hyperglycemia and the increased production of advanced glycation end products  increased plasma prorenin activity  hypoxia-inflammation  activation of cytokines

 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

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

Infection-Related Glomerulonephritis

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

 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)

 Microangiopathic hemolytic anemia  Thrombocytopenic purpura  Acute renal failure  Fever  Neurologic dysfunction

Renal involvemen in cancer and its treatment

 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