immunology of the kidney Flashcards
what are the functions of the mesangial cells ?
contractile phagocytic proliferating laying down collagen secreting mediators
what are the mechanisms in which glomerular injury happens ?
immunologically mediated :
in situ immune complex
circulating immune complex
other mechanisms of glomerular injury
what are the diseases associated with in situ immune complex deposition ?
- anti-glomerular basement membrane nephritis
- membranous glomerulonephritis
- antibodies against planted non-glomerular antigen
what is the pathogenesis in anti glomerular BM nephritis ?
antibodies are directed against BM
what is the immunofluroscense pattern in AGBM ?
linear diffuse pattern
binds along the entire length
what syndrome is commonly associated with AGBM ?
Goodpasture syndrome , which affects the lungs
what is the pathogenesis in membranous GN N?
antibodies reacting with an antigen located on basal surface of epithelial cells
what do antibodies in membranous GN cross-react with ?
proximal tubules brush surface antigens
what is the immunofluroscense patter in membranous GN ?
diffuse , granular deposits
due to sub epithelial deposits
what is the pathogenesis in Ab against planted non-glomerular antigen ?
cationic ions bind to anionic sites
viral or bacterial products
what is the immunofluorescence pattern in ab against planted non-glomerular ?
granular heterogenous pattern
what is the mechanism of injury in circulating immune complexes ?
a type 3 hypersensitivity reaction
where an Ab-Ag complex is trapped within the glomeruli allowing for the activation of complement
what is the immunofluorescence pattern in circulating immune complexes ?
dense granular deposits
what is the fate of circulating immune complexes ?
single attack ( eg: post streptococcal ) showers of antigen ( e.g SLE, HBV )
what type of injury is seen in minimal change disease ?
epithelial cell injury
what does the morphological picture of glomerular injury reveal ?
hypercellularity
BM thickening
hyalinisation and sclerosis
other additional alterations
what is an example of hypercellularity ?
acute diffuse GN
what are the different clinical presentations of glomerular injury ?
nephritic syndrome
nephrotic syndrome
chronic GN
asymptomatic heamturia and proteinuria
what are the primary and secondary GN that present with nephrotic syndrome ?
minimal change nephrotic membranous nephropathy focal segmental glomerulosclerosis diabetic nephropathy renal amyloidosis
what are the primary and secondary GN that present with nephritic syndrome ?
IgA nephropathy anti-glomerular BMD thin BM nephropathy Lupus nephritis membranous proliferative GN post streptococcal GN
what is the other name for post streptococcal GN ?
acute proliferative GN
what is the most characteristic feature in the history of a post streptococcal patient ?
attack of streptococcal pharyngitis
what type of casts would we find with acute proliferative GN ?
red cell casts
what does the immunofluorescence of acute proliferative GN look like ?
diffuse granular deposits og IgG IgM and C
what are the types of cresenteric or rapidly progressive GN ?
type 1 - linear deposits
type 2 - immune complex
type 3 - pauci-immune
what is the presentation of RPGN ?
nephritic syndrome
what is the other name for minimal change disease ?
lipid nephrosis
what is the most common cause of nephrotic syndrome in children ?
Minimal change disease
what are the events that may come before the onset of minimal change disease ?
respiratory tract infection
immunization
in association with atopy ( genetic tendency to develop allergic diseases)
which disease in adults is associated with minimal change disease ?
Hodgkin’s disease or NSAIDs therapy
what is the most common cause of nephrotic syndrome in adults ?
membranous GN
why does focal segmental GN present with nephrotic syndrome ?
due to effacement of podocytes and escape of proteins
what is the immunofluroscense like in focal segmental glomerulosclerosis ?
IgM and C3
which glomerular lesions will present with a mixture of nephritic and nephrotic syndrome ?
lupus nephritis
Ig A nephropathy
membrenoproliferative nephritis
Henoch-Schonlein purpra
what is the other name for IgA nephropathy ?
Berger’s disease
what is the most common clinical presentation of IgA nephropathy ?
a young child experiencing an episode of gross hematuria that occurs within 1 or 2 days of a non-specific URTI
what is the hallmark of Bergers disease ?
deposition of IgA in the mesangium
when are fatty casts seen ?
as a complication of nephrotic syndrome
when are granular casts seen?
non specific
when are RBC casts seen ?
disease affecting the glomerulus
when are epithelial cell casts seen ?
tubular injury
when are WBC seen ?
interstitial nephritis
pyelonephritis
parenchymal infection
when are waxy casts seen ?
chronic kidney failure
