Systemic diseases and the kidney

Dr I.Sagiv M.D

Nephrology & Hypertension services

Hadassah-Hebrew university medical centerJerusalem

Outline Diabetes Liver Disease SLE Vasculitis Scleroderma Multiple myeloma

(dysproteinemias) Pre-eclampsia Cancer HTN

Diabetic nephropathy

Diabetic nephropathy

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

Diabetic nephropathy

Diabetic nephropathy-Therapy

Control blood sugar HgA1c 6.5-7-7.5

Control Hypertension <130/80

ACE inhibitors/ARB’s

Diet

Liver Disease & Kidney

Glomerulonephritis assciated with: HBV (membranous)

HCV (cryoglobulinemia)

Hepato-renal syndrome

Hepato-renal syndrome

Reversible & functional renal failure.

Advanced hepatic failure (acute/chr) with cirrhosis and portal HTN.

Vasoactive abnormalities:

Splanchnic vasodilatation Renal vasoconstriction GFR

Hepato-renal syndrome-Therapy

Vasopressors

Liver transplantation

Systemic lupus erythematosus

Lupus nephritis III

Lupus nephritis IV

Lupus nephritis crescentic

Lupus nephritis- Therapy Immunosuppressants:

Steroids Azathioprine (Imuran) Cyclophosphamide Mycophenolate (cellcept) Biologic agents

Systemic sclerosis (scleroderma)

Scleroderma renal crisis

Leading cause of death (in the past).

ACE inhibitors

Multiple myeloma (& dysproteinemias)

Multiple myeloma

Hypertension

Hypertension & kidney disease