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Block 34 metabolic -Ellen > Chronic kidney injury pt2 > Flashcards

Chronic kidney injury pt2 Flashcards

1
Q

where does B cell activation occur

A

in secondary lymphoid organs (spleen and lymph nodes)

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2
Q

where do B cell mature

A

in the bone marrow

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3
Q

how are T cells activated

A

by antigen presenting cells

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4
Q

where do APCs present foreign antigens

A

on MHC class 2 complexes

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5
Q

how do B cells recognise antigen

A

in its native form (3D shapes, protein, lipids, sugars, chemicals)

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6
Q

how do T cells recognise antigen

A

require a APC

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7
Q

CD8+ =

A

kill infected cells

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8
Q

CD4+ =

A

Help B cells

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9
Q

where do T cells have an education

A

the thymus gland

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10
Q

MHC 1 facts (4)

A
  • expressed on all nucleated cells
  • co-receptor CD8
  • internally infected cells
  • Cytotoxic T cells kill infected cell
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11
Q

MHC 2 facts (3)

A
  • expressed on B-cells, dendritic cells and macrophages (APCs)
  • CD4 co-receptor
  • T helper cells respond to external proteins
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12
Q

pathology of transplant rejection

A

T cells respond to foreign MHC and reject it

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13
Q

alloreactivity =

A

T cells binding to foreign MHC on foreign dendritic cell in a peptide independent fashion

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14
Q

polymorphism=

A

having multuple alleles of a gene within a population

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15
Q

most polymorphic gene in genome=

A

MHC

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16
Q

how do cytotoxic T cells kill target cells

A

release of perforin-granzyme complex at immunological synapse forming a secretory domain and kill by apoptosis

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17
Q

Th1 subset =

A

enable macrophages to kill intracellular cargo

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18
Q

Th2 subset=

A

cells orchestrate expulsion of parasites

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19
Q

2 types of B cell activation

A

T-cell independant

T cell dependant

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20
Q

which type of B cell activation takes longer

A

T cell dependant

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21
Q

which type of B cell activation produces low affinity antibodies that are not versatile

A

T cell independant

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22
Q

what does T cell independent B cell activation involve

A

Toll like receptors or cross linking of multiple epitopes to BCRs

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23
Q

what is formed in T cell dependant B cell activation

A

Germ centre within a follicle

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24
Q

which B cell activation form B cells that can differentiate into memory or plasma cells

A

T cell dependent B cell activation

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25
Q

once a transplant donor has been deemed medically and clinically suitable what has to happen

A

attend a independent assessment

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26
Q

what does the independent assessor have to ensure (4)

A
  • capacity for consent
  • understands risk
  • own will
  • no reward
27
Q

3 tests to evaluate compatibility of organ donors

A

blood type
crossmatch
HLA testing

28
Q

what blood type is the universal donor

A

O

29
Q

what blood type is the universal recipient

A

AB

30
Q

HLA =

A

Human leukocyte antigen - tissue typing

31
Q

how many antigens play a major role in organ rejection

A

6

32
Q

what are the 6 antigens playing a role in rejection

A

A
B
DR
(2 for each letter)

33
Q

how do you get HLAs

A

inherit from parents 3 from mum 3 from dad

34
Q

crossmatch=

A

a test done prior to transplantation to determine if the body already has antibodies against the donor antigens

35
Q

how is a crossmatch done

A

mixing blood from donor and recipient

36
Q

what is a positive crossmatch

A

if the recipient’s cells attack and kill the donor cells

37
Q

what is a negative cross match

A

the pair is compatible

38
Q

what are the antigens of ABO blood groups made up of

A

sugars

39
Q

what does blood group O mean

A

the surface of the RBC has no antigens present -so no IgM antibodies against A or B

40
Q

when are ABO IgM antibodies produced

A

first years of life

41
Q

what are the antigens of Rh made up of

A

proteins

42
Q

what is rhesus positive

A

has a D antigen (RhD) on RBC surface

43
Q

what antibody is produced against AB

A

IgM

44
Q

what is rhesus disease a type of

A

haemolytic disease of the new born

45
Q

what antibodies will a Rh- mother produce against the a Rh+ baby

A

IgG

46
Q

what can happen in subsequent pregnancies after a Rh- gives birth to Rh+

A

IgG antibodies pass the blood placental barrier into the foetus destroying RBCs

47
Q

screening of blood prior to transfusion (8)

A
  • ABO and RhD
  • Alloantibodies on RBCs
  • Syphilis antibodies
  • Hep B
  • Hep C
  • Hep E
  • Human T-lymphotropic virus
  • indirect antiglobulin test
48
Q

what information based on donor history prior to transfusion (4)

A

malaria
T-cruzi
west nile virus
CMV

49
Q

indirect antiglobulin test=

A

serological crossmatch between patients plasma and transfusion -at 37 degrees

50
Q

polycystic kidney disease most common form

A

autosomal dominant polycystic kidney disease

51
Q

what characeterises PKD (3)

A

renal cysts
extrarenal cysts
intracranial aneurysms

52
Q

long term conditions of PKD (5)

A
  • hypertension
  • CVD
  • chronic renal failure
  • intracranial aneurysm
  • ESRD
53
Q

diagnosis of PKD (7)

A
  • family history (PKD/ cerebrovascular)
  • renal cysts
  • hypertension
  • abdo/ flank pain
  • haematuria
  • palpable kidney
  • dysuria, uregency, suprapubic pain
54
Q

which part of the nephron do renal cysts develop from

A

tubular portion

55
Q

pathophysiology og PKD

A

renal cysts compress normal renal architecture and progressively cause renal impairment

56
Q

2 types of PKD

A

PKD1

PKD2

57
Q

most patients with PKD have

A

PKD1

58
Q

in which form of PKD do most patient have adequate renal function at 70

A

PKD2

59
Q

mean onset of ESRD in PKD1

A

54

60
Q

investigations of PKD (7)

A
  • renal ultrasound
  • CT scan
  • MRI
  • urinalysis
  • serum electrolytes, urea, creatinine
  • lipid profile
  • ECG
61
Q

Treatment of PKD

A

Tolvaptan
antihypertensives
antibiotics for infection

62
Q

Tolvaptan=

A

selective and competitive arginine vasopressin receptor 2 antagonist

63
Q

what is the effect of Tolvaptain in PKD

A

blocks V2 receptors in renal collecting ducts preventing water absorption increasing urine volume

64
Q

treatment of infected cysts with antibiotics with

A

ciprofloxacin

Block 34 metabolic -Ellen (8 decks)

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