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Paraproteins are produced by a wide spectrum of haematological conditions, most commonly by plasma cell dyscrasias. Paraprotein production is frequently incidental in patients with renal disease but can directly cause renal impairment through a variety of underlying pathological processes. Diagnosis is usually through the detection of a monoclonal protein, either in the serum or urine. Monoclonal...
The thrombotic microangiopathies are a group of conditions characterized by microvascular bed thrombosis, haemolytic anaemia and thrombocytopenia. Renal involvement, due to occlusion of glomerular capillaries and renal arterioles by platelet-fibrin thrombi, is a common though not universal finding. Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are examples of thrombotic...
Renal dysfunction frequently complicates liver disease and, when present, adversely affects prognosis. While a number of conditions can affect both the liver and the kidney acutely (e.g. paracetamol), many hepatotoxic insults (e.g. alcohol or viral hepatitis) cause more problems associated with cirrhosis. This review focuses mainly on the renal dysfunction associated with this chronic liver damage...
Large numbers of people are now surviving longer following treatment for cancer. The field of surveillance for late-effects of cancer treatment has grown out of this. The long-term effects of cancer treatment may include almost any organ system, but endocrine sequelae are most common. This article describes the late endocrine effects that may occur following treatment for cancer and discusses the...
Multi-system autoimmune diseases, including systemic lupus erythematosus (SLE) and vasculitis, are inflammatory conditions of unknown cause. Renal involvement can occur in a variety of forms and usually represents a severe disease manifestation. SLE is frequently complicated by renal involvement (lupus nephritis). The main renal manifestation of vasculitis is pauci-immune, necrotizing, crescentic...
Women with renal disease should be counselled about the risks pregnancy may pose to them and their fetus before they conceive. Although worse baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised whether their medication needs to be modified, whether they are likely to suffer irreversible renal damage, and that they have a higher risk...
This article reviews the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). This can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease, so...
The glomerular basement membrane (GBM) is the vital barrier between blood and glomerular filtrate. Diseases that damage it generally cause haematuria initially, but as architecture becomes disordered proteinuria becomes an increasing feature. Inflammatory glomerulonephritis most commonly does this, but genetic abnormalities of GBM components are another important mechanism.Alport’s syndrome, a hereditary...
The outcomes of kidney transplantation have improved dramatically over recent decades such that kidney transplantation is now the treatment of choice for end-stage renal failure. This success is attributable to improvements in histocompatibility testing, organ procurement and preservation, as well as more effective and safer immunosuppression. Kidneys are usually obtained from deceased donors, but...
Secondary glomerular diseases are common worldwide and can manifest in many ways. Bacterial and viral infections, especially hepatitis and HIV, can cause a variety of patterns of glomerular injury often presenting with nephrotic syndrome, as can tumours and drugs. Diabetes and systemic lupus erythematosus are also important causes. Identifying underlying agents leads to specific treatments and can...
Diabetic nephropathy (DN) is a common complication of diabetes mellitus. It has a major impact on patient morbidity and mortality, and therefore a profound impact on the delivery of healthcare in this country. It affects more than one-third of patients with type 1 diabetes and an ever-increasing proportion of patients with type 2 diabetes, and is now the single most common cause of end-stage renal...
Chronic kidney disease (CKD) is accompanied by tubulo-interstitial atrophy and fibrosis, regardless of the underlying cause. Disorders of the renal vasculature, the glomeruli or urinary drainage all culminate in chronic tubulo-interstitial damage, the severity of which is the histological feature that correlates best with progression to end-stage renal failure (ESRF). However, there are diverse conditions...
Renal transplantation is the preferred form of renal replacement therapy. It restores quality of life and increases longevity for individuals with end-stage renal failure (ESRF). Unfortunately, only 30% of patients who develop ESRF are fit enough to be listed for transplantation, because of excessive co-morbidities. The rejection process blighted initial attempts at human transplantation, but the...
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