Systemic diseases and the kidney Dr I.Sagiv M.D Nephrology & Hypertension services

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

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

5. Diabetic nephropathy

7. 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

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: • HBV (membranous) • HCV (cryoglobulinemia) • 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