Immunological Aspects Of The Renal System

Question 1

Define AKI

Answer 1

No structural changes
Increase in SCr by 50%

Oliguria (decreased urine output)

Question 2

Define CKD

Answer 2

FGR <60ml/min

Kidney damage

Question 3

What does AKI lead to

Answer 3

Metabolic acidosis and ATP depletion which can lead to acute renal failure

Question 4

Majority of causes in AKI cause what which then leads to AKI

Answer 4

Hypoxia

Question 5

Sterile renal inflammation is induced by what

Answer 5

DAMPS

Question 6

CRP is like what and can activate what

Answer 6

Is like IgM and can activate complement pathways via the classical pathway which leads to inflammation (C3a/C5a)

Question 7

DAMPS and PAMPS activate what

Answer 7

TLR, NLR

Question 8

Necrosis from AKI triggers what

Answer 8

DAMPS

Question 9

Early stage AKI is mediated by what cells

What about late stage

Answer 9

Early - TH17

Late - Th1

Question 10

What is the role of M1 and M2 in AKI

Answer 10

M1 - AKI mediation

M2 - tissue repair

Question 11

What does DC cells lead to in AKI

Answer 11

TH1/TH17 differentiation

Question 12

What does M1 lead to in AKI

What about M2

Answer 12

Increased TNF-a
Increased IL-6

Increased Arginase - 1
Increased IL - 10

Question 13

What clears the early apoptotic cells

Answer 13

M2

Question 14

What does the T-Cell lead to for AKI and tissue repair

Answer 14

AKI:
Increased CD4, TH1 
Increased IFN - y
increased IL - 6 
Decreased IL - 4

Repair:
Ag-specific T-Cell expansion

Question 15

M1 is activated by what

Answer 15

PAMPS/DAMPS through binding to TLR’s

Question 16

M2 is activated by what

Answer 16

IL-4 and IL-13

Question 17

Th - 17 is activated by what, produces what, and then causes what

Answer 17

activated by TGFb Produces IL - 17 and produces inflammation

Question 18

M2 will do what, not what

Answer 18

Heal the tissue, not restore function

Question 19

What causes M1 to become M2

Answer 19

CSF - 1, (M-CSF), IL - 10

Question 20

What does CCL 20 do

Answer 20

Released from Th17 and used to recruit monocytes, Th1, and Th17

Question 21

Biopsies in any glomerulonephritis will have what

Answer 21

Compliment proteins

Question 22

C3b and C5b are important for what

Answer 22

Inflammation and forming MAC

Question 23

MAC leads to what

Answer 23

Apoptosis of cells

Question 24

In AKI, complement activation occurs downstream of what

Answer 24

Immune complex deposition (type III)

Or

Antibody mediated injury (type II)

Question 25

Type II and Type III hypersensitivites use what type of immune reactant

Answer 25

IgG or IgM

Question 26

In Type II, what does IgG and IgM do and where is this seen

Answer 26

Leads to cell lysis Seen in patients with GBM mediated response

Question 27

In type III, what does IgG and IgM do and where is this seen

Answer 27

AG/Ab complexes are deposited in tissues Compliment activation and inflammatory response which recruits neutrophils Seen in RA, lupus, and post-strep glomerulonephritis

Question 28

Why do transplants not work

Answer 28

Ag’s on donor tissue is targeted for rejection

Question 29

Acute rejection occurs when and is caused by what

Answer 29

Occurs days to weeks after transplantation and is caused by T-cells

Question 30

Chronic rejection occurs when and is caused by what

Answer 30

Occurs months or years after transplantation and is caused by vascular trauma, inflammatory products of T-cells and abs

Question 31

Define autograft

Answer 31

Grafts exchanged from one part to another part of the same individual

Question 32

Define isograft

Answer 32

Grafts exchanged between different individuals of identical genetic constitutions (identical twins)

Question 33

Define allograft

Answer 33

Grafts exchanged between nonidentical members of the same species

Question 34

Define xenograft

Answer 34

Graft exchanged between members of different species Very susceptible to rapid attack

Question 35

What does bradykinin cause

Answer 35

Vasodilation, SM contraction, increased vascular permeability

Question 36

What do fibrinopeptides cause

Answer 36

Increase local vascular permeability and attract neutrophils and macrophages

Question 37

Generally, an older person will fair how with a graft

Answer 37

Well, not able to mount an effective immune response

Question 38

Abs to A and B are on who

Answer 38

Individuals without these Ag on their RBCs

Question 39

ABO matching is not important for what

Answer 39

Non-vascular tissue

Question 40

Group A RBC has what Abs, Ags, and what donor allowed

Answer 40

Anti-B Abs Ag A Donor: A or O

Question 41

Group B RBC has what Abs, Ags, and what donor allowed

Answer 41

Anti-A Abs Ag B Donor: B or O

Question 42

Group AB RBC has what Abs, Ags, and what donor allowed

Answer 42

No Abs A/B Ags Universal recipient

Question 43

Group O RBC has what Abs, Ags, and what donor allowed

Answer 43

Anti A/B Abs No Ags Universal donor, only accepts O donations

Question 44

What will the Anti-whatever Abs do when come in contact with a recognized Ag

Answer 44

Activated the compliment pathway and cause apoptosis

Question 45

Least favorable donor is who

Answer 45

Mother

Question 46

If the dye is seen within the cells, then what has happened within anti-class I/II HLA abs Explain this process

Answer 46

Patient has AgB and AbA We need other donors to have AgB too Put into tube, AbB to match with AgB on possible donor cells. This will allow the MAC to form, causing dye to be inside the cells, telling us that the specific donor cells have AgB and thus can be transplanted

Question 47

Successful transplantation is dependent on what

Answer 47

Successful matching f HLA Ags

Question 48

What are the HLA Ags encoded by

Answer 48

HLA Class I and Class II on the short arm of the chromosome

Question 49

Why is HLA matching required

Answer 49

Due to the extreme polymorphisim of HLA