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 HemolyticUremic 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,

Case files Internal Medicine, Toy Patlan

Current Medical Diagnosis and Treatment,
Goldman L, Schafer AI
Maxine A. Papadakis, Stephen J. McPhee, Eds. Michael W. Rabow, Associate
Ed.

Current Diagnosis & Treatment:
Nephrology & Hypertension
S. Berns, Allen R. Nissenson
Edgar V. Lerma, Jeffrey