Lupus Nephritis Flashcards
Lupus nephritis is inflammation of the kidney due to systemic lupus erythematous (SLE). What % of patients with SLE develop lupus nephritis?
1 - 5%
2 - 25%
3 - 50%
4 - 75%
3 - 50%
if left untreated is lupus nephritis dangerous?
- yes
- can lead to CKD and renal failure
Systemic lupus erythematous (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body. Typically connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) is affected. Which type of hypersensitivity is SLE?
1 - type I hypersensitivity
2 - type II hypersensitivity
3 - type III hypersensitivity
4 - type IV hypersensitivity
3 - type III hypersensitivity
- antigen-immune complexes form and form clumps throughout the body
- lead to tissue damage and inflammation
What is a typer III hypersensitivity?
1 - IgE mediated
2 - cell mediated hypersensitivity
3 - IgG mediated cytotoxic
4 - immune complex mediated
4 - immune complex mediated
- antigen-immune complexes form and form clumps throughout the body leading to tissue damage and inflammation
Although the exact cause of Systemic lupus erythematosus (SLE) is unknown, it is though that susceptible genes and environmental factors may be triggers that initiate SLE. If a cell becomes damaged and undergoes apoptosis the contents are release. Typically what is important that is released from these cells?
1 - DNA
2 - histones
3 - nuclear proteins
4 - all of the above
4 - all of the above
- as these are all from the nucleus of the cell they are called nuclear antigens
- patients with SLE are less able to clear the nuclear antigens so they float around in the circulation
In Systemic lupus erythematous (SLE) cells undergoing apoptosis release their contents, specifically those contents from the nucleus are referred to as nuclear antigens. How can the release of nuclear antigens then cause a type III hypersensitivity?
1 - immune cells recognise the antigens as foreign invades
2 - immune cells target all self cells randomly
3 - nuclear antigens initiate the release of cytokines
4 - all of the above
1 - immune cells recognise the antigens as foreign invades
- triggered by susceptible genes and/or environmental factors
In Systemic lupus erythematous (SLE) cells undergoing apoptosis release their contents, specifically those contents from the nucleus are referred to as nuclear antigens, which immune cells recognise as foreign antigens. Which cell is then able to bind to these antigens and then produce anti-nuclear antibodies (ANA) against these nuclear antigens?
1 - B cells
2 - NK cells
3 - T cells
4 - Monocytes
1 - B cells
- MHC-II bind with antigens
- they produce ANA antibodies
Are antinuclear antibodies (ANA) present in all cases of Systemic lupus erythematous (SLE)?
- yes
Once ANA bind with the nuclear antigens in the circulation, what are they called?
1 - antibody complex
2 - immune mediated complexes
3 - antigen-antibody complexes
4 - B cell complexes
3 - antigen-antibody complexes
- these complexes can get stuck in blood vessels or any tissues
Antigen-antibody complexes can travel around the body and get stuck in blood vessels or any tissues. Once lodged in some tissues, what do these complexes cause?
1 - local inflammatory reaction
2 - complement pathway activation
3 - cells become damaged and undergo apoptosis
4 - all of the above
4 - all of the above
Which of the following have been identified as triggers for Systemic lupus erythematous (SLE)?
1 - smoking
2 - UV radiation
3 - genetic susceptibility
4 - microorganisms (virus, bacteria)
5 - medications
6 - sex hormones (estrogen specifically)
7 - all of the above
7 - all of the above
Lupus nephritis can be subdivided based on where it occurs in the kidneys and the inflammatory reaction. Where is the most common location in the kidneys where the antigen-antibody complexes can become deposited?
1 - bowmans capsule
2 - capillary walls (endothelium) of the glomerulus
3 - basement membrane
4 - mesangial cells
2 - capillary walls (endothelium) of the glomerulus
- can occur in all 4 areas, but this is the most common
Lupus nephritis can be subdivided based on where it occurs in the kidneys and the inflammatory reaction. The inflammation associated with lupus nephritis can be focal, affecting nephrons in one area of diffuse, affecting the whole kidney. Typically how does lupus nephritis present?
1 - nephrotic syndrome
2 - glomerular nephritis
3 - acute tubular necrosis
4 - all of the above
1 - nephrotic syndrome
Lupus nephritis typically presents as nephrotic syndrome. This is associated with proteinuria due to damage of the nephrons. What is the diagnostic cut off for proteinuria that demonstrates a nephrotic syndrome?
1 - >1.5g/day
2 - >3.5g/day
3 - >5.5g/day
4 - >7.5g/day
2 - >3.5g/day
Lupus nephritis typically presents as nephrotic syndrome. This is associated with proteinuria due to damage of the nephrons, >3.5g/day. Which proteins can be lost due to proteinuria?
1 - coagulation factors
2 - immunoglobulins
3 - albumin
4 - all of the above
4 - all of the above
Lupus nephritis typically presents as nephrotic syndrome. Which of the following is NOT a hallmark of lupus nephritis?
1 - hyperglycaemia
2 - hypoalbuminaemia
3 - hyperlipidaemia
4 - lipiduria
5 - proteinuria
6 - oedema
1 - hyperglycaemia
Although typically lupus nephritis typically presents as nephrotic syndrome, it is less likely, but can present as a nephritic syndrome. What can be detected in the urine that identifies it is nephritic rather than nephrotic syndrome?
1 - glucose
2 - ketones
3 - blood
4 - proteins
3 - blood
- called haematuria
