Immunological Aspects Of The Renal System Flashcards
Define AKI
No structural changes
Increase in SCr by 50%
Oliguria (decreased urine output)
Define CKD
FGR <60ml/min
Kidney damage
What does AKI lead to
Metabolic acidosis and ATP depletion which can lead to acute renal failure
Majority of causes in AKI cause what which then leads to AKI
Hypoxia
Sterile renal inflammation is induced by what
DAMPS
CRP is like what and can activate what
Is like IgM and can activate complement pathways via the classical pathway which leads to inflammation (C3a/C5a)
DAMPS and PAMPS activate what
TLR, NLR
Necrosis from AKI triggers what
DAMPS
Early stage AKI is mediated by what cells
What about late stage
Early - TH17
Late - Th1
What is the role of M1 and M2 in AKI
M1 - AKI mediation
M2 - tissue repair
What does DC cells lead to in AKI
TH1/TH17 differentiation
What does M1 lead to in AKI
What about M2
Increased TNF-a
Increased IL-6
Increased Arginase - 1
Increased IL - 10
What clears the early apoptotic cells
M2
What does the T-Cell lead to for AKI and tissue repair
AKI: Increased CD4, TH1 Increased IFN - y increased IL - 6 Decreased IL - 4
Repair:
Ag-specific T-Cell expansion
M1 is activated by what
PAMPS/DAMPS through binding to TLR’s
M2 is activated by what
IL-4 and IL-13
Th - 17 is activated by what, produces what, and then causes what
activated by TGFb Produces IL - 17 and produces inflammation
M2 will do what, not what
Heal the tissue, not restore function
What causes M1 to become M2
CSF - 1, (M-CSF), IL - 10
What does CCL 20 do
Released from Th17 and used to recruit monocytes, Th1, and Th17
Biopsies in any glomerulonephritis will have what
Compliment proteins
C3b and C5b are important for what
Inflammation and forming MAC
MAC leads to what
Apoptosis of cells
In AKI, complement activation occurs downstream of what
Immune complex deposition (type III)
Or
Antibody mediated injury (type II)
Type II and Type III hypersensitivites use what type of immune reactant
IgG or IgM
In Type II, what does IgG and IgM do and where is this seen
Leads to cell lysis
Seen in patients with GBM mediated response
In type III, what does IgG and IgM do and where is this seen
AG/Ab complexes are deposited in tissues
Compliment activation and inflammatory response which recruits neutrophils
Seen in RA, lupus, and post-strep glomerulonephritis
Why do transplants not work
Ag’s on donor tissue is targeted for rejection
Acute rejection occurs when and is caused by what
Occurs days to weeks after transplantation and is caused by T-cells
Chronic rejection occurs when and is caused by what
Occurs months or years after transplantation and is caused by vascular trauma, inflammatory products of T-cells and abs
Define autograft
Grafts exchanged from one part to another part of the same individual
Define isograft
Grafts exchanged between different individuals of identical genetic constitutions (identical twins)
Define allograft
Grafts exchanged between nonidentical members of the same species
Define xenograft
Graft exchanged between members of different species
Very susceptible to rapid attack
What does bradykinin cause
Vasodilation, SM contraction, increased vascular permeability
What do fibrinopeptides cause
Increase local vascular permeability and attract neutrophils and macrophages
Generally, an older person will fair how with a graft
Well, not able to mount an effective immune response
Abs to A and B are on who
Individuals without these Ag on their RBCs
ABO matching is not important for what
Non-vascular tissue
Group A RBC has what Abs, Ags, and what donor allowed
Anti-B Abs
Ag A
Donor: A or O
Group B RBC has what Abs, Ags, and what donor allowed
Anti-A Abs
Ag B
Donor: B or O
Group AB RBC has what Abs, Ags, and what donor allowed
No Abs
A/B Ags
Universal recipient
Group O RBC has what Abs, Ags, and what donor allowed
Anti A/B Abs
No Ags
Universal donor, only accepts O donations
What will the Anti-whatever Abs do when come in contact with a recognized Ag
Activated the compliment pathway and cause apoptosis
Least favorable donor is who
Mother
If the dye is seen within the cells, then what has happened within anti-class I/II HLA abs
Explain this process
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
Successful transplantation is dependent on what
Successful matching f HLA Ags
What are the HLA Ags encoded by
HLA Class I and Class II on the short arm of the chromosome
Why is HLA matching required
Due to the extreme polymorphisim of HLA
