Renal Immunology

Question 1

AKI criteria

Answer 1

Increase in SCr by 50% within 7 days or increase in SCr by 0.3 mg/dl within 2 days or oliguria.

Question 2

CKD criteria

Answer 2

GFR < 60 ml/min for 3 mo or kidney damage for > 3 mo

Question 3

How does ischemic acute kidney injury lead to ARF?

Answer 3

IAKI leading to metabolic acidosis and ATP depletion can cause ARF.

Question 4

DAMPs are released from (2)

Answer 4

Dying parenchymal kidney cells

ECM degredation

Question 5

CRP function

Answer 5

Similar to IgM and can activate complement upon binding DAMP.

Question 6

5 DAMPs discussed

Answer 6

HMGB1
Uric acid
HSP
S100
Hyaluranons

Question 7

What cell is predominant in early stages?

What about later stages?

Answer 7

Th17

Th1

Question 8

M1 Mo play a key role in:

Answer 8

AKI

Question 9

M2 Mo play a key role in:

Answer 9

Tissue repair

Question 10

How are M1 Mo induced?

Answer 10

PAMP/DAMP binding TLR.

Question 11

How are M2 Mo induced?

Answer 11

IL-4 and IL-13

Question 12

What promotes differentiation of M1 Mo?

Answer 12

INF-gamma

Question 13

What controls issue repair and fibrosis by M2 Mo?

Answer 13

IL-10

TGF-beta

Question 14

How do CD4+ become activated to be Th17 and cause inflammation?

Answer 14

TGF-beta differentiates T cell to Th17 and IL-17 causes the inflammation

Question 15

Role of CCL20/MIP-3

Answer 15

Secreted by Th17.

Recruits monocytes, Th1 and Th17 cells.

Question 16

Anti-inflammatory role of Tregs

Answer 16

Activates TGF-beta and IL-10

Question 17

What is seen in bx of patients with glomerulonephritis?

Answer 17

Complement proteins

Question 18

Hypersensitivity reactions in AKI

Answer 18

Type II - ab-mediated injury

Type III - complement activation downstream of immune complex

Question 19

How does IgG or IgM activate a type II sensitivity reactions at the glomerulus?

Answer 19

IgG/M activate complement leading to anti-GBM ab-meidated GN

Question 20

Host vs graft responses (4)

Answer 20

Histocompatibility Ags
Hyperacute rejection
Acute rejection
Chronic rejection

Question 21

Autograft
Isograft
Allograft
Xenograft

Answer 21

Same person
Between twins (same genetics)
Same species
Different species

Question 22

Problems with xenograft

Answer 22

Susceptible to rapid attack by naturally occurring Abs and complement.

Question 23

How to improve chances of xenograft survival:

Answer 23

Insert human genes

Question 24

4 key concepts in transplant

Answer 24

Condition of allograft
Donor-host antigenic disparity
Strength of host anti-donor response
Immunosuppressive regimen

Question 25

What occurs with mechanical trauma and ischemic reperfusion injury to graft? (2)

Answer 25

``` Clotting cascade (fibrin and WBCs) Kinin cascade (vasodilation, SM contraction, increased vascular permeability) ```

Question 26

ABO matching is not important for: (3)

Answer 26

Corneal transplant Heart valve transplant Bone/tendon grafts

Question 27

Group A Abs present Ags present Donor

Answer 27

Abs present: Anti B Ags present: A Donor: A or O

Question 28

Group B Abs present: Ags present: Donor:

Answer 28

Abs present: Anti A Ags present: B Donor: B or O

Question 29

Group AB Abs present: Ags present: Donor:

Answer 29

Abs present: none Ags present: A/B Donor: A, B, AB, O

Question 30

Group O Abs present: Ags present: Donor:

Answer 30

Abs present: Anti A/B Ags present: none Donor: O

Question 31

How to match donor and recipient?

Answer 31

Add donor cells to recipient serum. Add complement and dye. If dye penetrates cell, then Abs are present (bad match)

Question 32

How are HLA expressed?

Answer 32

Codominantly

Question 33

Genes of HLA II

Answer 33

DR, DP, DQ

Question 34

Immune events in allograft rejection (5)

Answer 34

``` APCs activate CD4 and CD8. Local and systemic immune response. Cytokines activate/recruit immune cells. Development of WBCs Allograft rejection ```