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Questions and Answers
Which immunological mechanism is primarily involved in renal diseases?
Which immunological mechanism is primarily involved in renal diseases?
- Cellular mechanisms
- Hormonal imbalances
- Antibody-mediated effects (correct)
- Genetic mutations
What is the main structure affected by immunological diseases of the kidney?
What is the main structure affected by immunological diseases of the kidney?
- Glomerulus (correct)
- Renal pelvis
- Renal tubules
- Collecting ducts
Which syndrome is associated with proteinuria, hypoalbuminemia, and hyperlipidemia?
Which syndrome is associated with proteinuria, hypoalbuminemia, and hyperlipidemia?
- Nephritic syndrome
- Acute kidney injury
- Nephrotic syndrome (correct)
- Chronic kidney disease
Which type of antibody reaction involves in situ reactions with the glomerular basement membrane?
Which type of antibody reaction involves in situ reactions with the glomerular basement membrane?
Which clinical symptom is common to both nephrotic and nephritic syndromes?
Which clinical symptom is common to both nephrotic and nephritic syndromes?
What type of activation leads to platelet aggregation following antibody deposition?
What type of activation leads to platelet aggregation following antibody deposition?
Which condition is most commonly associated with nephrotic syndrome in children?
Which condition is most commonly associated with nephrotic syndrome in children?
Which pathogenetic mechanism is not typically associated with glomerular damage?
Which pathogenetic mechanism is not typically associated with glomerular damage?
Which of these is not a common clinical symptom of nephritic syndrome?
Which of these is not a common clinical symptom of nephritic syndrome?
Which underlying disorder contributes to 40% of nephrotic syndrome cases in adults?
Which underlying disorder contributes to 40% of nephrotic syndrome cases in adults?
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Study Notes
Renal Diseases
- Many renal diseases have underlying immunological mechanisms, with antibody-mediated effects being primarily involved.
- Cellular mechanisms are less important in immunological diseases of the kidney.
- The glomerulus is the most affected part of the kidney, likely due to its filter function.
Mechanisms of Renal Disease
- Circulating antibody-mediated renal diseases can occur through three mechanisms:
- Circulating immune complexes accumulate subendothelially on the capillary aspect of the glomerular basement membrane.
- Antibodies react in situ with the glomerular basement membrane.
- Antibodies react in situ with antigens of the visceral epithelial cells.
Effects of Antibody Deposits
- Antibody deposits can cause direct damage to epithelial or endothelial cells of the glomerulus due to:
- Complement activation.
- Pore formation.
- Antibodies can also bind to the FC receptors of:
- Monocytes.
- Macrophages.
- Granulocytes.
- Platelets.
- This leads to the activation, or in the case of platelets, aggregation of the cells.
Glomerular Damage
- Glomerular damage can cause two distinct symptom complexes:
- Nephrotic syndrome.
- Nephritic syndrome.
Nephrotic Syndrome
- Clinical symptoms:
- Periorbital edema.
- Pleural effusion.
- Ascites.
- Hypertension.
- Hypoalbuminemia.
- Hyperlipidemia.
- Edema.
- Proteinuria.
- Urine sediment: Hyaline and granular casts.
- Causes of nephrotic syndrome in children and adults:
- Membranous glomerulonephritis.
- Lipoid nephrosis (minimal change GN).
- Focal segmental glomerulosclerosis.
- Membranoproliferative glomerulonephritis.
- Proliferative GN (focal, IgA....).
- Systemic diseases (diabetes, SLE, amyloidosis...).
Nephritic Syndrome
- Clinical symptoms:
- Periorbital edema.
- Hypertension.
- Proteinuria.
- Oliguria.
- Hematuria.
- Urine sediment: Red blood cell casts.
- Causes of nephritic syndrome:
- Postinfectious GN.
- Rapidly Progressive GN.
- IgA Nephropathy.
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