CME: CLINICAL PRACTICE AND ITS BASIS

It is difficult to name a multisystem disease that does not in some way affect the kidneys either directly as part of the disease process or as a result of treatment. In this review, ‘ multisystem diseases’ are taken to mean those conditions characterised by systemic vasculitis unless otherwise specified. These rare diseases may present to almost any hospital physician, frequently with non-specific signs and symptoms, usually associated with an acute phase response (raised C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR) or plasma viscosity). Recognition of renal involvement by the detection of blood and protein on urine dipstick, even in the presence of a normal creatinine, provides both a clue to multisystem involvement and an early diagnostic opportunity with a renal biopsy.