Renal complication in systemic immune and haematological diseases (lupus, Henoch-Schönlein nephropathy, haemolytic uremic syndrome, amyloidosis, myeloma)
1. Big picture
This topic is about secondary kidney disease: the kidney is damaged because of a systemic immune disease or hematological disease, not because the disease started primarily in the kidney.
The examiner wants you to recognize five classic patterns:
| Disease | Main renal pattern | Key clue |
|---|---|---|
| Systemic lupus erythematosus (SLE) | Immune-complex glomerulonephritis | Young woman + proteinuria/hematuria + low complement + anti-dsDNA |
| Henoch-Schönlein purpura / IgA vasculitis | IgA nephropathy-like nephritis | Palpable purpura + abdominal pain + arthralgia + hematuria |
| Hemolytic uremic syndrome (HUS) | Thrombotic microangiopathy | AKI + thrombocytopenia + microangiopathic hemolytic anemia |
| Amyloidosis | Nephrotic syndrome | Heavy proteinuria + edema + enlarged kidneys ± systemic amyloid clues |
| Multiple myeloma | Cast nephropathy / light-chain kidney disease | Older patient + AKI + anemia + bone pain + hypercalcemia + monoclonal protein |
Core oral-exam sentence:
“In systemic immune and hematological diseases, renal involvement may present as nephritic syndrome, nephrotic syndrome, acute kidney injury, chronic kidney disease, or thrombotic microangiopathy. The key is to identify the systemic pattern, confirm renal involvement by urine, renal function, serology and often biopsy, then treat both the kidney injury and the underlying systemic disease.”
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