1. Systemic diseases and the kidney Dr I.Sagiv M.D Nephrology & Hypertension services Hadassah-Hebrew university medical center Jerusalem

2. Outline Diabetes Diabetes Liver Disease Liver Disease SLE SLE Vasculitis Vasculitis Scleroderma Scleroderma Multiple myeloma (dysproteinemias) Multiple myeloma (dysproteinemias) Pre-eclampsia Pre-eclampsia Cancer Cancer HTN HTN

5. Diabetic nephropathy

7. Stage I: Hyperfiltration 0-5yr Stage II: GMB thickened no proteinuria 2-7yr Stage III: microalbuminuria ~7yr Stage IV: proteinuria ~15yr Stage V: ESRD ~25yr

8. Diabetic nephropathy

14. Diabetic nephropathy-Therapy Control blood sugar HgA1c 6.5-7-7.5 Control Hypertension <130/80 ACE inhibitors/ARB’s Diet

15. Liver Disease & Kidney Glomerulonephritis assciated with: Glomerulonephritis assciated with: HBV (membranous) HBV (membranous) HCV (cryoglobulinemia) HCV (cryoglobulinemia) Hepato-renal syndrome Hepato-renal syndrome

16. Hepato-renal syndrome Reversible & functional renal failure. Advanced hepatic failure (acute/chr) with cirrhosis and portal HTN. Vasoactive abnormalities: Splanchnic vasodilatation Renal vasoconstriction GFR

22. Hepato-renal syndrome-Therapy Vasopressors Liver transplantation

23. Systemic lupus erythematosus

27. Lupus nephritis III

28. Lupus nephritis IV

29. Lupus nephritis crescentic

30. Lupus nephritis- Therapy Immunosuppressants: Steroids Azathioprine (Imuran) Cyclophosphamide Mycophenolate (cellcept) Biologic agents

34. Systemic sclerosis (scleroderma)

37. Scleroderma renal crisis Leading cause of death (in the past). ACE inhibitors

38. Multiple myeloma (& dysproteinemias)

41. Multiple myeloma

50. Hypertension

51. Hypertension & kidney disease