immunology of the kidney

Question 1

what are the functions of the mesangial cells ?

Answer 1

contractile 
phagocytic 
proliferating 
laying down collagen 
secreting mediators

Question 2

what are the mechanisms in which glomerular injury happens ?

Answer 2

immunologically mediated :
in situ immune complex
circulating immune complex
other mechanisms of glomerular injury

Question 3

what are the diseases associated with in situ immune complex deposition ?

Answer 3

1. anti-glomerular basement membrane nephritis
2. membranous glomerulonephritis
3. antibodies against planted non-glomerular antigen

Question 4

what is the pathogenesis in anti glomerular BM nephritis ?

Answer 4

antibodies are directed against BM

Question 5

what is the immunofluroscense pattern in AGBM ?

Answer 5

linear diffuse pattern

binds along the entire length

Question 6

what syndrome is commonly associated with AGBM ?

Answer 6

Goodpasture syndrome , which affects the lungs

Question 7

what is the pathogenesis in membranous GN N?

Answer 7

antibodies reacting with an antigen located on basal surface of epithelial cells

Question 8

what do antibodies in membranous GN cross-react with ?

Answer 8

proximal tubules brush surface antigens

Question 9

what is the immunofluroscense patter in membranous GN ?

Answer 9

diffuse , granular deposits

due to sub epithelial deposits

Question 10

what is the pathogenesis in Ab against planted non-glomerular antigen ?

Answer 10

cationic ions bind to anionic sites

viral or bacterial products

Question 11

what is the immunofluorescence pattern in ab against planted non-glomerular ?

Answer 11

granular heterogenous pattern

Question 12

what is the mechanism of injury in circulating immune complexes ?

Answer 12

a type 3 hypersensitivity reaction

where an Ab-Ag complex is trapped within the glomeruli allowing for the activation of complement

Question 13

what is the immunofluorescence pattern in circulating immune complexes ?

Answer 13

dense granular deposits

Question 14

what is the fate of circulating immune complexes ?

Answer 14

single attack ( eg: post streptococcal )
showers of antigen ( e.g SLE, HBV )

Question 15

what type of injury is seen in minimal change disease ?

Answer 15

epithelial cell injury

Question 16

what does the morphological picture of glomerular injury reveal ?

Answer 16

hypercellularity
BM thickening
hyalinisation and sclerosis
other additional alterations

Question 17

what is an example of hypercellularity ?

Answer 17

acute diffuse GN

Question 18

what are the different clinical presentations of glomerular injury ?

Answer 18

nephritic syndrome
nephrotic syndrome
chronic GN
asymptomatic heamturia and proteinuria

Question 19

what are the primary and secondary GN that present with nephrotic syndrome ?

Answer 19

minimal change nephrotic 
membranous nephropathy 
focal segmental glomerulosclerosis 
diabetic nephropathy 
renal amyloidosis

Question 20

what are the primary and secondary GN that present with nephritic syndrome ?

Answer 20

IgA nephropathy 
anti-glomerular BMD 
thin BM nephropathy 
Lupus nephritis 
membranous proliferative GN 
post streptococcal GN

Question 21

what is the other name for post streptococcal GN ?

Answer 21

acute proliferative GN

Question 22

what is the most characteristic feature in the history of a post streptococcal patient ?

Answer 22

attack of streptococcal pharyngitis

Question 23

what type of casts would we find with acute proliferative GN ?

Answer 23

red cell casts

Question 24

what does the immunofluorescence of acute proliferative GN look like ?

Answer 24

diffuse granular deposits og IgG IgM and C

Question 25

what are the types of cresenteric or rapidly progressive GN ?

Answer 25

type 1 - linear deposits type 2 - immune complex type 3 - pauci-immune

Question 26

what is the presentation of RPGN ?

Answer 26

nephritic syndrome

Question 27

what is the other name for minimal change disease ?

Answer 27

lipid nephrosis

Question 28

what is the most common cause of nephrotic syndrome in children ?

Answer 28

Minimal change disease

Question 29

what are the events that may come before the onset of minimal change disease ?

Answer 29

respiratory tract infection immunization in association with atopy ( genetic tendency to develop allergic diseases)

Question 30

which disease in adults is associated with minimal change disease ?

Answer 30

Hodgkin's disease or NSAIDs therapy

Question 31

what is the most common cause of nephrotic syndrome in adults ?

Answer 31

membranous GN

Question 32

why does focal segmental GN present with nephrotic syndrome ?

Answer 32

due to effacement of podocytes and escape of proteins

Question 33

what is the immunofluroscense like in focal segmental glomerulosclerosis ?

Answer 33

IgM and C3

Question 34

which glomerular lesions will present with a mixture of nephritic and nephrotic syndrome ?

Answer 34

lupus nephritis Ig A nephropathy membrenoproliferative nephritis Henoch-Schonlein purpra

Question 35

what is the other name for IgA nephropathy ?

Answer 35

Berger's disease

Question 36

what is the most common clinical presentation of IgA nephropathy ?

Answer 36

a young child experiencing an episode of gross hematuria that occurs within 1 or 2 days of a non-specific URTI

Question 37

what is the hallmark of Bergers disease ?

Answer 37

deposition of IgA in the mesangium

Question 38

when are fatty casts seen ?

Answer 38

as a complication of nephrotic syndrome

Question 39

when are granular casts seen?

Answer 39

non specific

Question 40

when are RBC casts seen ?

Answer 40

disease affecting the glomerulus

Question 41

when are epithelial cell casts seen ?

Answer 41

tubular injury

Question 42

when are WBC seen ?

Answer 42

interstitial nephritis pyelonephritis parenchymal infection

Question 43

when are waxy casts seen ?

Answer 43

chronic kidney failure