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REM Exam 2 > 3.3 Immunology: Immune mediated renal disease > Flashcards

3.3 Immunology: Immune mediated renal disease Flashcards

1
Q

Type I

A

Anti-Parasite immune response. IgE mast cells. Anaphalaxis. Test: IgE skin test

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2
Q

Type II

A

Normal Ab response. Antigen is not soluble. Neutrophils and macrophages. IgM and IgG

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3
Q

Type III

A

Normal Ab response. Antigen is soluble; Complement and FC receptor mediated recruitment Activates Leukocytes.

Immune complexes of circulating antigens and IgM or IgG antibodies deposited in vascular basement membrane

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4
Q

Type IV

A

Normal cell mediated response (T-Cell)

CD4 T cells: Delayed type hypersensitivity

CD8 CTLs: T cell mediated cytotoxicity

  1. Macrophage activation cytokine mediated inflammation
  2. Direct target cell killing cytokine mediated inflammation
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5
Q

Common causes of renal failure

A

DM, HTN, Immunologic

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6
Q

What type of Hypersensitivies are involved in immune mediated renal disease?

A

II,III,IV

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7
Q

What part of nephron is involved in immune mediated renal disease?

A

Glomerulus more than tubules

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8
Q

Nephrotic syndrome vs. Nephritic Syndrome

A

Nephrotic syndrome: Increased permeability of GBM due to cytokine release: Proteinuria

Nephritic syndrome: Inflammation of glomerulus and neutrophil activation: Hematuris

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9
Q

Innate host defenses

A

Inflammation; neutrophils attracted

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10
Q

Adaptive immune response

A

activated LN draining kidney

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11
Q

Pro-inflammatory cytokines

A

IL-1, IL-6,TNF

Hot t-BONE stEAK
Important interleukin cytokines:

IL-1: fever (hot)
IL-2: T cell stimulator
IL-3: Bone marrow stimulator (sim to GM-CSF)
IL-4: IgE (class switching from IgG), B cell growth
IL-5: IgA, eosinophils
IL-6 aKute renal failure

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12
Q

GM makes classic cars

A

IgG and IgM activate the classic complement pathway (Ag:Ab complexes –> C1…)

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13
Q

How does activation of immunologic cells occur?

A

Injury to renal tissues–>Necrosis–>PRR+DAMP–>Activation of PRR expressing renal cell

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14
Q

What are immune complexes?

A

Ab+ antigens=immune complex

Mechanism for removal of antigens for body

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15
Q

What is the most common mechanisms of immune injury in renal disease?

A

Immune complexes

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16
Q

Preformed immune complexes?

A

Ab to circulating antigens

collect between vasc endothelium and glomerular BM

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17
Q

In situ immune complexes

A

Ab to antigens trapped to epithelial of glomerular space bind to these antigens

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18
Q

MEchanism of IC

A

Deposit on vessel, kidney glomeruli–>Activate complement–>Recruitment of phagocytes–>Inflamm response–>Enzymes release from neutrophils damage

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19
Q

IC disease (4)

A

Serum sickness nephritis, Post infectious glomerulonephritis, IgA nephropathy (Henoch-schonlein purpura), Lupus nephritis (SLE)

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20
Q

C3a, C5a

A

Anaphylaxis, activation of complement

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21
Q

ACID

A

Types of hypersensitivity:

Type I: Anaphylactic and Atopic
Type II: Cytotoxic (antibody-mediated)
Type III: Immune complex
Type IV: Delayed (cell mediated) T cell

22
Q

Post infectious glomerulonephritis. Associated ab?

A

10-14 days post strep throat
ab to ASO, DNAase B, Hyaluronidase

Urine dysmorphi red blood cells, RBC casts; little protein

23
Q

IF of post infectious glomerulonephritis with granular appearance

A

granular, lumpy humpy, antibody IgG is not directed against a component of kidney

24
Q

IgA nephropathy

A

Characterized by glomerular IgA deposits; Antigen not known- often follows pharnygitis

Complement by alt pathway

25
Q

Systemic Lupus Erythematous

A

Autoimmune, chronic inflamm disorder, immune complex mediated, nuclear antigens (ANA; anti-dsDNA)

26
Q

Lupus Nephritis

A

Granular Ig deposits
Ab reacts with kidney antigen
Ag-Ab complexes aggregated with C3, C4, C1q

27
Q

Antibody mediated disease: Anti-GBM disease (good pasture) Characteristic

A

Glomerulonephritis+ pulmonary hemorrhage

28
Q

Goodpasture IF

A

Linear staining of BM

29
Q

Antigen of goodpasture

A

Type IV collagen

30
Q

Triggers for goodpasture

A

Genetics, exposure to hydrocarbons or influenza infection

31
Q

ANCA associated Nephropathies

A

Small vessel vasculitidies: Anti-neutrophil cytoplasmic antibodies

Churg-Strauss syndrome (p-ANCA- perinuclear)
Wegeners granulomatosus (c-ANCA- cytoplasmic)
Microscopic polyangitis (p-ANCA)
32
Q

Mechanism of ANCA

A

ab to PR3 or to MPO activate neutrophils to relase reactive oxygen species, lysosomal enzymes and chemokines which initiate an inflammatory response and damage endothelial cells

33
Q

Myeloma Kidney

A

Monoclonal immunoglobulin deposition disease.

Uncontrolled prolif of a single clone of B cells resulting in synthesis and secretion of monoclonal Ig or Ig fragments.

34
Q

Bence Jones Proteins

A

Monoclonal light chains

35
Q

Myeloma kidney lesions

A

Interstitial protein casts located in distal nephron and collecting tubules.

Casts are surrounded by macrophages
Casts block system leading to tubular atrophy, interstitial fibrosis and calcification
Casts consist of B-J proteins coaggregated with Tamm Horsfall proteins (uromodulin) produced by cells in loop of henle

36
Q

T cell mediated disease

A

Minimal change nephrotic syndrome.

Tubulointerstitial nephritis

37
Q

Minimal change nephrotic syndrome

A

No immunoglobulin or complement seen on IF.

Common in kids

Respond to steroids and cyclophosamide

38
Q

Tubulointerstitial Nephritis

A

inflammatory change due to infection or drugs

Oliguria and acute renal impairment

Interstitial tissue infiltrated granulocytes, mononuclear cells and eosinophils

Granuloma formation suggests T cell mediated etiologies–>Type IV

Presence of IgE and eosinophilia hints at Type I Hypersens

39
Q

Circulating immune complexes

3 diseases

A

Serum sickness
Postinfect GN
Lupus nephritis

40
Q

Insitu immune complex formation 3 disease

A

Membranous GN
IgA nephropathy
Henoch Schonlein nephritis

41
Q

Ab mediated

A

goodpasture syndrome

42
Q

Anti-neutrophil cytoplasmic antibody

A

Wegener granulomatosis, microscopic poly angitis, churg strauss vasculitis

43
Q

T-Lymphocyte mediated

A

Tubulointerstial nephritis

44
Q

Type IV collagen

A

Good pasture

45
Q

Tubular BM protein

A

Interstitial nephritis

46
Q

Tumor antigens

A

Membranous nephropathy

47
Q

Thyroid antigens

A

Membranous nephropathy

48
Q

Autologous antigens

A

Lupus nephritis

49
Q

Foreign Serum

A

Serum sickness

50
Q

Food antigens

A

IgA nephropathy

REM Exam 2 (10 decks)

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