Glomerulonephritis and Immune Responses Quiz

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Questions and Answers

What type of immune response is primarily involved in Goodpasture syndrome?

  • Type IV hypersensitivity
  • Type II hypersensitivity (correct)
  • Type I hypersensitivity
  • Type III hypersensitivity

Which of the following is a common secondary cause of glomerulonephritis?

  • Hypertension
  • Goodpasture syndrome
  • Diabetes Mellitus (correct)
  • Post-streptococcal infections

In glomerulonephritis, what is the role of complement proteins following immune complex deposition?

  • They bind directly to the glomeruli.
  • They initiate renal blood flow.
  • They recruit immune cells that release inflammatory cytokines. (correct)
  • They cause recessive genetic mutations.

Which type of hypersensitivity involves T-cell mediated injury in glomerulonephritis?

<p>Type IV hypersensitivity (C)</p> Signup and view all the answers

Which of the following conditions is NOT considered a primary cause of glomerulonephritis?

<p>Diabetes Mellitus (B)</p> Signup and view all the answers

What is the common characteristic of acute glomerulonephritis?

<p>Immediate immune response to an infection (C)</p> Signup and view all the answers

Which of the following best describes the pathophysiology involved in post-streptococcal glomerulonephritis?

<p>Immune complexes depositing in the glomerular basement membrane (C)</p> Signup and view all the answers

Chronic kidney disease (CKD) is closely associated with which one of the following conditions?

<p>Chronic glomerulonephritis (D)</p> Signup and view all the answers

What triggers the immune response leading to Type II hypersensitivity in Goodpasture syndrome?

<p>Antibodies targeting glomerular structures (C)</p> Signup and view all the answers

What is a consequence of endothelial cell injury in the glomeruli?

<p>Proteinuria and hematuria (D)</p> Signup and view all the answers

What effect does damage to the glomerular capillaries have on the glomerular filtration rate (GFR)?

<p>Reduces the GFR (D)</p> Signup and view all the answers

Which of the following is a risk factor specifically for acute glomerulonephritis?

<p>Recent streptococcal infection (B)</p> Signup and view all the answers

Which autoimmune disease is specifically associated with increased risk of glomerulonephritis?

<p>Goodpasture syndrome (C)</p> Signup and view all the answers

Which statement correctly describes glomerulonephritis transmission?

<p>Infections can lead to glomerulonephritis, but are not transmissible (C)</p> Signup and view all the answers

How does chronic inflammation impact kidney function in glomerulonephritis?

<p>Causes fibrosis and scar tissue formation (D)</p> Signup and view all the answers

Which risk factor is most closely associated with chronic glomerulonephritis?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

What is a likely consequence of immune injury to the glomerular filtration barrier?

<p>Loss of endothelial integrity (D)</p> Signup and view all the answers

Which of the following is NOT a risk factor for nephritic syndrome?

<p>Family history of diabetes (D)</p> Signup and view all the answers

What common clinical manifestation is associated with nephritic syndrome?

<p>Swelling of the face (A)</p> Signup and view all the answers

How do infections like streptococcal pharyngitis relate to nephritic syndrome?

<p>They are transmissible and trigger nephritic syndrome (A)</p> Signup and view all the answers

Which of the following can lead to chronic glomerulonephritis?

<p>Rheumatoid arthritis (D)</p> Signup and view all the answers

Which condition is classified under nephritic syndrome?

<p>IgA nephropathy (A)</p> Signup and view all the answers

What primary cause of nephrotic syndrome is most common in children?

<p>Minimal Change Disease (D)</p> Signup and view all the answers

Which of the following is NOT considered a risk factor for chronic nephrotic syndrome?

<p>Multiple sclerosis (C)</p> Signup and view all the answers

What is a possible pathophysiological change in chronic glomerulonephritis?

<p>Capillary obstruction (C)</p> Signup and view all the answers

Which statement about nephrotic syndrome is true?

<p>It results in hypoalbuminemia and edema. (D)</p> Signup and view all the answers

What is the mechanism by which Minimal Change Disease leads to proteinuria?

<p>Damage to podocytes resulting in loss of negative charge on GBM (A)</p> Signup and view all the answers

Which of the following conditions can lead to secondary nephrotic syndrome?

<p>Lupus (C)</p> Signup and view all the answers

How are streptococcal infections related to glomerulonephritis?

<p>They can lead to post-streptococcal glomerulonephritis. (A)</p> Signup and view all the answers

Which of the following infections are linked to nephrotic syndrome?

<p>HIV and hepatitis B (A), Hepatitis C and malaria (C)</p> Signup and view all the answers

What drug categories are considered modifiable risk factors for nephrotic syndrome?

<p>NSAIDs and antibiotics (B)</p> Signup and view all the answers

Which group is more likely to develop minimal change disease (MCD)?

<p>Infants and toddlers (A)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for nephrotic syndrome?

<p>Age (B)</p> Signup and view all the answers

What is a potential consequence of glomerular filtration barrier injury in nephrotic syndrome?

<p>Massive proteinuria (A)</p> Signup and view all the answers

Which autoimmune disease is associated with an increased risk of nephrotic syndrome?

<p>Systemic lupus erythematosus (SLE) (C)</p> Signup and view all the answers

Which of the following is NOT considered a modifiable risk factor for nephrotic syndrome?

<p>Genetic mutations (A)</p> Signup and view all the answers

What factor is likely to increase glomerular capillary pressure, contributing to nephrotic syndrome?

<p>Obesity (B)</p> Signup and view all the answers

What characterizes Nephritic Syndrome?

<p>Decreased glomerular filtration rate (C)</p> Signup and view all the answers

Which condition is commonly linked to Nephritic Syndrome due to immune-mediated injury?

<p>Glomerular Capillary Injury (B)</p> Signup and view all the answers

What is a likely cause of nephritic syndrome associated with throat infection?

<p>Post-Streptococcal Glomerulonephritis (C)</p> Signup and view all the answers

Which autoimmune disorder is characterized by immune complexes depositing in the glomerulus?

<p>Systemic Lupus Erythematosus (B)</p> Signup and view all the answers

What is a feature of the pathophysiology of nephritic syndrome?

<p>Increased permeability of the filtration barrier (D)</p> Signup and view all the answers

In which condition do immune complexes primarily involving IgA lead to inflammation in the glomeruli?

<p>IgA Nephropathy (D)</p> Signup and view all the answers

What mechanism contributes to glomerular damage in nephritic syndrome due to immune complex deposition?

<p>Complement system activation (B)</p> Signup and view all the answers

Which of the following conditions can lead to rapidly progressive glomerulonephritis?

<p>ANCA-associated vasculitis (C)</p> Signup and view all the answers

Flashcards

What is glomerulonephritis?

Inflammation of the glomerulus, the filtering unit within the kidneys. It can be acute or chronic and is a major cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD).

What are primary causes of glomerulonephritis?

Glomerulonephritis caused directly by problems with the glomeruli, without involvement of other diseases.

What are secondary causes of glomerulonephritis?

Glomerulonephritis caused by diseases affecting the body as a whole, like diabetes or lupus.

What is Type II hypersensitivity in glomerulonephritis?

An immune response where antibodies directly attack specific components of the glomerular basement membrane.

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What is Type III hypersensitivity in glomerulonephritis?

An immune response where immune complexes (antigen-antibody combinations) are deposited in the glomerulus, triggering inflammation.

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What is Type IV hypersensitivity in glomerulonephritis?

An immune response where T-cells directly attack glomerular cells, leading to damage.

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What is post-streptococcal glomerulonephritis (PSGN)?

A common cause of glomerulonephritis that occurs after a streptococcal infection of the throat or skin. It involves the deposition of immune complexes in the glomeruli.

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What is diabetic nephropathy?

A form of glomerulonephritis caused by diabetes, which is the most common cause of chronic glomerulonephritis.

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What is Immune Complex-Mediated Glomerulonephritis?

A type of immune response where the body's immune system attacks its own tissues, specifically targeting the glomeruli in the kidneys.

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How do antibodies contribute to Glomerulonephritis?

Antibodies directly attack glomerular structures, like the basement membrane, leading to inflammation and damage. This is seen in conditions such as Goodpasture syndrome.

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Explain how glomerular damage affects filtration.

Damage to the filtering units in the kidneys (glomeruli) can be caused by inflammation, leading to swelling and narrowing of the blood vessels. This reduces the kidneys' ability to filter waste and excess fluid.

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Is Glomerulonephritis contagious?

Glomerulonephritis is not directly contagious. However, infections can trigger immune responses that lead to the condition, although the infection itself is not directly transmitted to others.

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What is a common trigger for acute Glomerulonephritis?

A known risk factor for acute glomerulonephritis. Infections caused by this bacteria can trigger the immune system to attack the kidneys.

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What chronic condition significantly increases Glomerulonephritis risk?

This disease is a major risk factor for chronic glomerulonephritis, leading to progressive damage to the kidneys.

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Can certain medications increase Glomerulonephritis risk?

These medications can potentially increase the risk of developing Glomerulonephritis. It's important to discuss potential risks and alternatives with your doctor.

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How can chronic inflammation impact kidney function?

Chronic inflammation can lead to scarring and fibrosis in the kidneys, further impairing function and potentially leading to chronic kidney disease (CKD).

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Nephrotic syndrome

A kidney disorder characterized by massive protein loss in urine (proteinuria), low blood albumin (hypoalbuminemia), swelling (edema), and high blood fats (hyperlipidemia/hyperlipiduria). It arises from damage to the glomerular filtration barrier.

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Minimal Change Disease (MCD)

The most common cause of nephrotic syndrome in children, characterized by damage to the podocytes, leading to the loss of the negative charge barrier in the glomerular basement membrane, allowing albumin to leak into the urine.

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Focal Segmental Glomerulosclerosis (FSGS)

A condition that causes scarring (sclerosis) in parts of the glomeruli, often idiopathic but can be linked to HIV infection, obesity, and heroin use.

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Membranous Nephropathy

An autoimmune disorder caused by immune complexes depositing on the glomerular basement membrane, often associated with autoimmune diseases like lupus, cancer, or infections.

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Glomerulonephritis

An inflammation of the glomeruli in the kidneys, often caused by immune responses, infections (like post-streptococcal), toxins, medications, or ischemia.

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Secondary Glomerulonephritis

Causes of glomerulonephritis that arise from underlying conditions like diabetes, lupus, chronic infections, or immune complexes.

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Primary Glomerulonephritis

Causes of glomerulonephritis arising directly from immune responses, infections, toxins, medications, or ischemia, without an underlying condition.

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Post-Streptococcal Glomerulonephritis

Inflammation of the glomeruli triggered by bacterial infections, particularly Streptococcus, which can lead to post-streptococcal glomerulonephritis.

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What causes glomerulonephritis?

Infections like those caused by Streptococcus, autoimmune disorders like lupus, and even certain medications can trigger immune responses that lead to damage of the glomerulus.

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What is hematuria?

The appearance of blood cells in the urine, often giving it a reddish or brown color.

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What is oliguria?

Reduced urine output due to the kidneys' inability to properly filter waste and fluids.

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What is hypertension in the context of glomerulonephritis?

High blood pressure due to fluid retention caused by the kidneys' impaired filtering capacity.

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What are some modifiable risk factors for nephrotic syndrome?

Infections like HIV, hepatitis B, hepatitis C, and malaria are linked to nephrotic syndrome.

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How can drug use increase the risk of nephrotic syndrome?

Intravenous drug use can increase the risk of infections like HIV and hepatitis C, which are linked to nephrotic syndrome. Also, some medications like NSAIDs and antibiotics can harm the kidneys.

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What is the link between obesity and nephrotic syndrome?

Obesity can increase the risk of focal segmental glomerulosclerosis (FSGS), a common cause of nephrotic syndrome.

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How do hypertension and diabetes relate to nephrotic syndrome?

Chronic hypertension and diabetes increase the risk of diabetic nephropathy, which can present as nephrotic syndrome.

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What toxins can increase the risk of nephrotic syndrome?

Exposure to heavy metals like mercury can cause nephrotic syndrome.

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How does age influence the likelihood of different nephrotic syndrome causes?

Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children, while FSGS and membranous nephropathy are more common in adults.

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Is gender a risk factor for nephrotic syndrome?

Certain types of nephrotic syndrome, like membranous nephropathy, are more common in men.

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What genetic factors can contribute to nephrotic syndrome?

Genetic mutations linked to FSGS and congenital nephrotic syndrome include NPHS1, NPHS2, and ACTN4.

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What is Nephritic syndrome?

A group of kidney disorders marked by blood in the urine (hematuria), decreased urine output (oliguria), reduced kidney filtration rate (GFR), and high blood pressure (hypertension).

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What causes Nephritic syndrome?

Inflammation of the tiny blood vessels (glomeruli) in the kidneys caused by an immune system attack.

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How is Lupus involved in Nephritic syndrome?

A systemic autoimmune disease where antibodies attack various parts of the body, including the kidneys, causing immune complex deposition and inflammation in the glomeruli.

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What is IgA Nephropathy (Berger's Disease)?

A type of Nephritic syndrome where IgA antibodies form immune complexes that deposit in the glomerular mesangium (a supporting structure) causing inflammation.

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What is Goodpasture Syndrome?

A rare autoimmune disease where antibodies attack the basement membrane in the glomeruli, causing inflammation and damage.

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How do immune complexes cause damage in Nephritic syndrome?

Immune complexes (antigen-antibody combinations) are deposited in the glomeruli, activating the complement system and attracting inflammatory cells. These cells release damaging enzymes and reactive oxygen species, increasing the permeability of the filtration barrier, leading to inflammation and reduced GFR.

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What are the consequences of immune-mediated damage in Nephritic syndrome?

The increased permeability of the glomerular capillary wall allows blood cells and protein to leak into the urine, leading to hematuria (blood in urine) and proteinuria (protein in urine). Inflammation causes the tiny blood vessels in the glomeruli to become swollen and less efficient in filtering waste, leading to reduced glomerular filtration rate (GFR) and decreased urine output (oliguria). The inflammation and damage to the glomeruli also contribute to high blood pressure (hypertension) as the kidneys are unable to regulate fluid and electrolyte balance properly.

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Study Notes

Glomerular Disorders

  • Glomerulonephritis involves inflammation of the glomeruli, often leading to chronic kidney disease (CKD) and end-stage renal disease (ESRD).
  • Primary causes are those affecting the glomeruli directly
  • Secondary causes are systemic diseases affecting the glomeruli.
  • Immunological responses are a leading cause, including type II (antibodies attack components of the glomerular basement membrane) and type III (immune complex deposition) hypersensitivities.
  • Infections, like post-streptococcal glomerulonephritis (PSGN), can cause glomerulonephritis.
  • Ischemia, medications, toxins, free radicals, and vascular disorders like hypertension can also damage glomeruli.
  • Diabetes mellitus is a common cause of chronic glomerulonephritis, leading to diabetic nephropathy.
  • Systemic lupus erythematosus (SLE) can cause lupus nephritis.

Pathophysiology

  • Immune-mediated attack on the glomeruli is the key process, varying depending on the underlying cause.
  • Immune complex deposition in the glomerular basement membrane triggers inflammation, often following an infection like PSGN.
  • Complement proteins are activated, leading to recruitment of neutrophils and macrophages which release inflammatory cytokines further injuring the glomeruli.
  • Cell-mediated injury (type IV hypersensitivity) can also contribute to inflammation and glomerular damage.
  • Direct antibody attack (type II hypersensitivity) can damage glomerular structures, as seen in Goodpasture syndrome.
  • Endothelial injury leads to increased permeability of the glomerular capillaries allowing proteins to leak into urine.
  • Reduced glomerular filtration rate (GFR) occurs due to damage and swelling of glomerular capillaries.
  • Chronic inflammation can lead to fibrosis & scarring, further impairing kidney function.

Disease Transmission

  • Glomerulonephritis is generally not directly transmissible between individuals.
  • However, infections that trigger the immune response, like those causing PSGN, can be transmitted.

Risk Factors

  • Acute glomerulonephritis: Recent streptococcal infection, other bacterial/viral/parasitic infections, autoimmune conditions (like SLE and rheumatoid arthritis), medications/toxins, and vascular disorders (like hypertension).
  • Chronic glomerulonephritis: Diabetes, chronic infections, family history of autoimmune diseases, and genetic predisposition.

Nephrotic Syndrome

  • Nephrotic syndrome is characterized by massive protein loss (proteinuria), hypoalbuminemia, edema, and hyperlipidemia.
  • This occurs due to damage to the glomerular filtration barrier increasing its permeability to proteins.
  • Primary causes include minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and membranous nephropathy which occur predominantly in children compared to secondary causes such as diabetic nephropathy.
  • Secondary causes include diabetic nephropathy, lupus, infections, medications, and amyloidosis.

Nephrotic Syndrome Pathophysiology

  • Damage to the three filtration layers (fenestrated endothelium, glomerular basement membrane, and podocytes) results in increased glomerular capillary permeability.
  • Increased proteinuria leads to hypoalbuminemia, decreased oncotic pressure, resulting in fluid leakage into interstitial spaces.
  • This leads to edema and compensatory activation of the RAAS, promoting sodium and water retention which worsens the edema.
  • Loss of proteins stimulates hepatic production of lipoproteins causing hyperlipidemia, and some lipids appear in the urine (lipiduria).
  • Loss of anticoagulant proteins increases the risk of thrombosis including renal vein thrombosis.

Nephrotic Syndrome Transmission

  • Nephrotic syndrome itself is not contagious
  • Nevertheless, infections that trigger it, like HIV, hepatitis B/C, are infective

Nephrotic Syndrome Risk Factors

  • Modifiable risk factors include infections, drug use (NSAIDs, antibiotics), obesity, hypertension, and diabetes.
  • Non-modifiable risk factors include age, gender, genetics, and autoimmune diseases.

Nephritic Syndrome

  • Nephritic syndrome is characterized by hematuria (blood in urine), oliguria (reduced urine output), decreased glomerular filtration rate (GFR), and hypertension.
  • Causes include post-streptococcal glomerulonephritis (PSGN), systemic lupus erythematosus (SLE), IgA nephropathy, Goodpasture syndrome, and other conditions like rapidly progressive glomerulonephritis (RPGN), and Henoch-Schönlein purpura (HSP) .

Nephritic Syndrome Transmission

  • Nephritic syndrome itself is not transmitted, but underlying infections (e.g., streptococcal infections ) that cause it can be transmitted.

Nephritic Syndrome Risk Factors

  • Infections (like strep throat or skin infections), autoimmune diseases (SLE), age (children more susceptible to PSGN, adults to other types), genetic factors associated with autoimmune disorders, and family history of IgA nephropathy are important risk factors.

Clinical Manifestations (Nephritic/Nephrotic Syndrome)

  • Kidney function changes including hematuria (blood in urine), oliguria (decreased urine output), hypertension, edema, and proteinuria (protein in urine) are symptoms of both glomerular disorders.

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