Renal Immunity

Question 1

What is a major Acute Kidney Injury (AKI) cause?

Answer 1

Sterile inflammation

Question 2

An AKI can lead to renal failure. Renal failure is abrupt ____ in kidney function

Answer 2

Decrease

Question 3

When a normal cell dies by injury, what does it release?

Answer 3

DAMPs

- Damage - Associated Molecular Patterns

Question 4

DAMPs are usually released due to?

Answer 4

ECM degradation

Question 5

What 2 things can bind DAMPs released from dying cells?

Answer 5

1. C-reactive protein

2. Toll-like receptors

Question 6

When C-reactive protein binds DAMPs, what does that activate?

Answer 6

Classical complement pathway

Question 7

When Toll-like receptors bind DAMPs, what does that cause?

Answer 7

Renal inflammation

Question 8

_____ activate immune mechanism of an AKI

Answer 8

DAMPs

Question 9

Once the complement pathway is activated, what chemoattractants are generated?

Answer 9

C3a and C5a

Question 10

What do C3a and C5a induce?

Answer 10

1. Leukocyte filtration

2. Membrane Attack Complex activation

Question 11

C3a and C5a cause leukocyte filtration and MAC activation. What leukocytes infiltrate?

Answer 11

Neutrophils

Monocytes

Question 12

What do Neutrophils release to cause tissue damage?

Answer 12

Proteases and Free radicals

Question 13

What do Monocytes differentiate into?

Answer 13

M1 Macrophages

Question 14

With an Early AKI, what inflammatory mediators dominate?

Answer 14

Th17 and Th1

Question 15

With a Late AKI, what inflammatory mediator dominates?

Answer 15

Th1

Question 16

What does Th17 secrete?

Answer 16

IL-17 (pro-inflammation)

Question 17

IL-17 induces expression of what chemokine?

Answer 17

CCL20

Question 18

What cells does IL-17 then keep recruiting?

Answer 18

Neutrophils
Monocytes
Th17
Th1

Question 19

What does Th1 secrete?

Answer 19

IFN - gamma

Question 20

IFN - gamma secreted by Th1 cells activates?

Answer 20

M1 macrophages

Question 21

What do M1 macrophages release to cause more inflammation?

Answer 21

IL-6 and TNF-alpha

Question 22

What antibody does IFN-gamma also activate?

Answer 22

IgG

Question 23

TRegs ____ AKI progression

Answer 23

Prevent!

Question 24

Why is the kidney susceptible to complement-induced damage?

Answer 24

Its high filtration rate favors deposition of immune complexes

Question 25

What is a major barrier of successful kidney implantation?

Answer 25

Genetic Incompatibility

Question 26

What antigens are the targets for transplant rejection?

Answer 26

HLA

Question 27

What are the 2 reasons transplants can be rejected?

Answer 27

1. Host Versus Graft Disease (HVGD) | 2. Graft Versus Host Disease (GVHD)

Question 28

Host Versus Graft Disease

Answer 28

Host's immune system attacks the graft

Question 29

Graft Versus Host Disease

Answer 29

Graft's immune cells attack recipient

Question 30

Autografts

Answer 30

Grafts from own person's body

Question 31

Isografts

Answer 31

Grafts between identical twins

Question 32

Allografts

Answer 32

Grafts between same species

Question 33

Xenografts

Answer 33

Grafts between different species

Question 34

Which type of graft is the most susceptible to rapid attack?

Answer 34

Xenografts

Question 35

4 key concepts in Kidney Transplantation

Answer 35

1. Condition of Allograft 2. Donor-host Antigenic disparity 3. Strength of host Anti-donor response 4. Applied immunosuppression

Question 36

If the Allograft is damaged, what can it release and cause?

Answer 36

Releases DAMPs -- causes clots and tissue damage

Question 37

A RBC type A has A antigens on its surface. What antibodies does it have?

Answer 37

Anti-B

Question 38

ABO matching is NOT important for what 3 things?

Answer 38

1. Cornea transplant 2. Heart valve transplant 3. Bone and tendon grafts

Question 39

Describe how they test for Class I HLA compatibility

Answer 39

1. Add a specific HLA antibody to donor and recipient 2. Add complement 3. Add dye 4. If the dye is inside the cell, that HLA antigen is present!!!! = You want this response for both donor and recipient for each specific HLA antigen

Question 40

What are the 3 types of HVGD rejections?

Answer 40

1. Hyperacute 2. Acute 3. Chronic

Question 41

How soon will a Hyperacute graft rejection occur?

Answer 41

Within minutes

Question 42

What causes a Hyperacute graft rejection?

Answer 42

Pre-existing antibodies and complement activation

Question 43

How soon will an Acute graft rejection occur?

Answer 43

Within days to weeks

Question 44

What causes an Acute graft rejection?

Answer 44

Cytotoxic T cells activated by APCs | - Also can be triggered by donor DCs -

Question 45

How soon will a Chronic Graft rejection occur?

Answer 45

Months to years

Question 46

What causes a Chronic graft rejection?

Answer 46

``` Vascular injury (ischemia) Macrophages ```

Question 47

What usually causes a GVHD rejection?

Answer 47

The DONOR T cells are activated in the new tissue!

Question 48

What antigens do the donor T cells attack with a GVHD?

Answer 48

Minor H antigens because the HLA ones are matched

Question 49

What symptoms may a GVHD rejection include?

Answer 49

Jaundice, rash, diarrhea

Question 50

With a HVGD, both innate and adaptive immune response become active. Which is the strongest?

Answer 50

Adaptive

Question 51

Hyperacute rejection is what type of sensitivity?

Answer 51

Type 2

Question 52

Acute rejection is what type of sensitivity?

Answer 52

Type 4

Question 53

Chronic rejection is what type of sensitivity?

Answer 53

Type 3 and 4

Question 54

Graft versus Host rejection is what type of sensitivity?

Answer 54

Type 4