10 Questions
Which immunological mechanism is primarily involved in renal diseases?
Antibody-mediated effects
What is the main structure affected by immunological diseases of the kidney?
Glomerulus
Which syndrome is associated with proteinuria, hypoalbuminemia, and hyperlipidemia?
Nephrotic syndrome
Which type of antibody reaction involves in situ reactions with the glomerular basement membrane?
Anti-GBM Ab
Which clinical symptom is common to both nephrotic and nephritic syndromes?
Periorbital edema
What type of activation leads to platelet aggregation following antibody deposition?
Fc receptor binding
Which condition is most commonly associated with nephrotic syndrome in children?
Lipoid nephrosis (minimal change GN)
Which pathogenetic mechanism is not typically associated with glomerular damage?
Antibody-independent T cell activation
Which of these is not a common clinical symptom of nephritic syndrome?
Hyperlipidemia
Which underlying disorder contributes to 40% of nephrotic syndrome cases in adults?
Systemic diseases (diabetes, SLE, amyloidosis)
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.
This quiz covers the immunological mechanisms underlying various renal diseases, their effects on the glomerulus, and the mechanisms of circulating antibody-mediated renal diseases.
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