Immunological Aspects Of The Renal System

Question 1

What are DAMPs and what are some of them?

Answer 1

Molecular patterns/alarmins that induce sterile renal inflammation

HMGB1, uric acid, HSPs, S100 protein, hyaluronans

Question 2

What are the receptors that respond to PAMPs and DAMPs?

Answer 2

Toll-like receptors, NOD-like receptors, and C-type lectin

Question 3

What inflammatory response predominates in renal tissue injury in the early stages?

Answer 3

Th17 cells

Question 4

What inflammatory response predominates in renal tissue injury in the later stages?

Answer 4

Th1 cells

Question 5

What are M1 macrophages induced by?

Answer 5

PAMPs and DAMPs

IFN-gamma promote differentiation

Question 6

What induces alternatively activated M2 macrophages?

Answer 6

IL-4 and IL-13

Question 7

What causes fibrosis and stenosis in chronic states?

Answer 7

M2 cells

Question 8

What cytokines induce Th17 cells?

Answer 8

TGF beta and IL-6

Question 9

What cytokine do Th17 cells produce and what is its effect?

Answer 9

IL-17

Tissue inflammation

Question 10

What are seen in biopsies from patients with glomerulonephritis

Answer 10

Complement proteins

Question 11

What type 2 hypersensitivity reactions lead to kidney injury?

Answer 11

Patients with anti-glomerular basement membrane (GBM) antibody mediated GN

(Upon damage, positively charged Ags can be planted into the negatively-charged GBM regions)

Question 12

What are type 3 hypersensitivity reactions that lead to kidney injury?

Answer 12

Post-streptococcal glomerulonephritis, rheumatoid arthritis, and SLE

Question 13

What occurs downstream of type 2 and 3 hypersensitivity reactions?

Answer 13

Complement activation

Question 14

What’s the difference between type 2 and type 3 hypersensitivity reactions?

Answer 14

Type 2 = cell-bound antigen

Type 3 = soluble antigen

Question 15

How quickly does hyperacute rejection occur?

Answer 15

Immediately and caused by antibodies

Question 16

How quickly does acute rejection occur?

Answer 16

Days to weeks after transplantation and caused by T cells

Question 17

How quickly does chronic rejection occur?

Answer 17

Months or years after transplantation and caused by vascular trauma, inflammatory products of T cells, Abs

Question 18

What is an autograft?

Answer 18

Grafts exchanged from one part to another part of the same individual

Question 19

What is an isograft?

Answer 19

Grafts exchanged between different individuals of identical genetic constitutions (e.g. identical twins)

Question 20

What is an allograft?

Answer 20

Grafts exchanged between nonidentical members of the sam species

Question 21

What is a xenograft?

Answer 21

Graft exchanged between members of different species (from animals)

Question 22

What variables determine transplant outcome?

Answer 22

1. The condition of the allograft (better from a live donor)
2. Donor-host antigenic disparity
3. Strength of host anti-donor response (older recipient is better because weaker immune response)
4. Immunosuppressive regimen

Question 23

What can cause hyperacute allograft rejection?

Answer 23

Mechanical trauma and/or ischemia-reperfusion injury

They can release proinflammatory responses that would damage the graft

Question 24

What is ABO matching not important for?

Answer 24

Non-vascularized tissues like the cornea, heart valves, and bone/tendon grafts

Question 25

What antibodies do group A blood types have?

Answer 25

Anti-b

Question 26

What antibodies do group O blood types have?

Answer 26

Anti-A and anti-B

Question 27

Are class I or class II HLA Ags a stronger barrier to transplantation?

Answer 27

Class I

Question 28

What are the immune events in allograft rejection?

Answer 28

1. APCs trigger CD4+ and CD8+ T cells 2. Both a local and systemic immune response develop 3. Cytokines recruit and activate immune cells 4. Development of specific T cells, NK cells, or Macrophage-mediated cytotoxicity 5. Allograft rejection

Question 29

What is the difference between host v graft disease and graft v host disease?

Answer 29

Host v. Graft: a kidney is transplanted and the recipient’s T cells attack the transplant Graft v. Host: bone marrow is transplanted the T cells in the transplant attack the recipient’s tissues

Question 30

What type of hypersensitivity is hyperacute host vs. graft disease?

Answer 30

Type 2

Question 31

What type of hypersensitivity is acute host vs. graft disease?

Answer 31

Type 4

Question 32

What type of hypersensitivity is chronic host vs. graft disease?

Answer 32

Type 4

Question 33

Why does chronic graft rejection occur?

Answer 33

Due to the occlusion of blood vessels and subsequent ischemia of the organ Does not respond to immunosuppresive therapy

Question 34

What kind of hypersensitivity is Graft vs. Host disease?

Answer 34

Type 4