Chronic kidney injury pt2 Flashcards
where does B cell activation occur
in secondary lymphoid organs (spleen and lymph nodes)
where do B cell mature
in the bone marrow
how are T cells activated
by antigen presenting cells
where do APCs present foreign antigens
on MHC class 2 complexes
how do B cells recognise antigen
in its native form (3D shapes, protein, lipids, sugars, chemicals)
how do T cells recognise antigen
require a APC
CD8+ =
kill infected cells
CD4+ =
Help B cells
where do T cells have an education
the thymus gland
MHC 1 facts (4)
- expressed on all nucleated cells
- co-receptor CD8
- internally infected cells
- Cytotoxic T cells kill infected cell
MHC 2 facts (3)
- expressed on B-cells, dendritic cells and macrophages (APCs)
- CD4 co-receptor
- T helper cells respond to external proteins
pathology of transplant rejection
T cells respond to foreign MHC and reject it
alloreactivity =
T cells binding to foreign MHC on foreign dendritic cell in a peptide independent fashion
polymorphism=
having multuple alleles of a gene within a population
most polymorphic gene in genome=
MHC
how do cytotoxic T cells kill target cells
release of perforin-granzyme complex at immunological synapse forming a secretory domain and kill by apoptosis
Th1 subset =
enable macrophages to kill intracellular cargo
Th2 subset=
cells orchestrate expulsion of parasites
2 types of B cell activation
T-cell independant
T cell dependant
which type of B cell activation takes longer
T cell dependant
which type of B cell activation produces low affinity antibodies that are not versatile
T cell independant
what does T cell independent B cell activation involve
Toll like receptors or cross linking of multiple epitopes to BCRs
what is formed in T cell dependant B cell activation
Germ centre within a follicle
which B cell activation form B cells that can differentiate into memory or plasma cells
T cell dependent B cell activation
once a transplant donor has been deemed medically and clinically suitable what has to happen
attend a independent assessment
what does the independent assessor have to ensure (4)
- capacity for consent
- understands risk
- own will
- no reward
3 tests to evaluate compatibility of organ donors
blood type
crossmatch
HLA testing
what blood type is the universal donor
O
what blood type is the universal recipient
AB
HLA =
Human leukocyte antigen - tissue typing
how many antigens play a major role in organ rejection
6
what are the 6 antigens playing a role in rejection
A
B
DR
(2 for each letter)
how do you get HLAs
inherit from parents 3 from mum 3 from dad
crossmatch=
a test done prior to transplantation to determine if the body already has antibodies against the donor antigens
how is a crossmatch done
mixing blood from donor and recipient
what is a positive crossmatch
if the recipient’s cells attack and kill the donor cells
what is a negative cross match
the pair is compatible
what are the antigens of ABO blood groups made up of
sugars
what does blood group O mean
the surface of the RBC has no antigens present -so no IgM antibodies against A or B
when are ABO IgM antibodies produced
first years of life
what are the antigens of Rh made up of
proteins
what is rhesus positive
has a D antigen (RhD) on RBC surface
what antibody is produced against AB
IgM
what is rhesus disease a type of
haemolytic disease of the new born
what antibodies will a Rh- mother produce against the a Rh+ baby
IgG
what can happen in subsequent pregnancies after a Rh- gives birth to Rh+
IgG antibodies pass the blood placental barrier into the foetus destroying RBCs
screening of blood prior to transfusion (8)
- ABO and RhD
- Alloantibodies on RBCs
- Syphilis antibodies
- Hep B
- Hep C
- Hep E
- Human T-lymphotropic virus
- indirect antiglobulin test
what information based on donor history prior to transfusion (4)
malaria
T-cruzi
west nile virus
CMV
indirect antiglobulin test=
serological crossmatch between patients plasma and transfusion -at 37 degrees
polycystic kidney disease most common form
autosomal dominant polycystic kidney disease
what characeterises PKD (3)
renal cysts
extrarenal cysts
intracranial aneurysms
long term conditions of PKD (5)
- hypertension
- CVD
- chronic renal failure
- intracranial aneurysm
- ESRD
diagnosis of PKD (7)
- family history (PKD/ cerebrovascular)
- renal cysts
- hypertension
- abdo/ flank pain
- haematuria
- palpable kidney
- dysuria, uregency, suprapubic pain
which part of the nephron do renal cysts develop from
tubular portion
pathophysiology og PKD
renal cysts compress normal renal architecture and progressively cause renal impairment
2 types of PKD
PKD1
PKD2
most patients with PKD have
PKD1
in which form of PKD do most patient have adequate renal function at 70
PKD2
mean onset of ESRD in PKD1
54
investigations of PKD (7)
- renal ultrasound
- CT scan
- MRI
- urinalysis
- serum electrolytes, urea, creatinine
- lipid profile
- ECG
Treatment of PKD
Tolvaptan
antihypertensives
antibiotics for infection
Tolvaptan=
selective and competitive arginine vasopressin receptor 2 antagonist
what is the effect of Tolvaptain in PKD
blocks V2 receptors in renal collecting ducts preventing water absorption increasing urine volume
treatment of infected cysts with antibiotics with
ciprofloxacin
