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20 Cards in this Set
- Front
- Back
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Difference between Direct and Indirect Immune-Mediated Injury?
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Direct is to tubules, interestitium, blood vessels, or glomeruli
Indirect is a vascular injury leading to ischemia |
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Two General Mechanisms for Rejection?
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Antibody Mediated (humoral)
Cell-mediated (Cellular) |
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2 ways for Ab mediated?
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Pre-existing Ab's
Ab's produced after transplant |
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2 ways for Cell-mediated?
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Direct pathway
Indirect pathway |
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What do the Ab's usually bind to?
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Alloantigens on vascular endothelial cells
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What else happens w/ acute antibody-mediated rejection?
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Inflammatory mediators are recruited and damage the vascular walls in a hurry-->thrombosis
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What about antibodies and chronic rejection?
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controversial as to what role Ab's play
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Direct vs Indirect pathways of cell-mediated rejection?
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Direct: donor-derived APC's present Ag and cause response
Indirect: later, host-derived APC's present Ag and get response |
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Clinical forms of Rejection?
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Hyperacute
Accelerated Acute Acute Chronic |
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Clinical forms and humoral vs cellular?
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Hyperacute and Accelerated Acute are humoral
Acute is cellular Chronic an allograft nephropathy and a combo |
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How does Ab mediated rejection affect each separate part of the kidney?
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Interstitium: edema, hemorrhage
Tubules: Ischemic injury/necrosis Blood Vessels: SEVER vasculitis (fibrinoid necrosis) |
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How is Ab-mediated rejection Dx?
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In severe acute humoral rejection, there are plenty of signs of ischemia, infarction, necrosis, etc.
In milder cases, you've gotta use IF to detect C' |
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Which C' piece is indicative of Ab-mediated rejection?
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C4d
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How does Acute Cellular Rejection affect each separate area of the kidney?
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Interstitium: mononuclear cell infiltrate (not seen in humoral)
Tubules: Mononuclear cells beneath tubule BM = TUBULITIS*** (not seen in humoral) Vessels: Mononuclear cells in or beneath abnormal endothelium |
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How does Chronic Allograft Nephropathy affect each part of the kidney?
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Interstitium: Fibrosis (inc collagen)
Tubules: Atrophy (dec diameter) Vessels: Reduced diameter due to intimal thickening |
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How do you develop pre-existing Ab's?
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Blood group: natural
HLA: previous transplant, pregnancy, or transfusion |
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how can you minimize Ab-mediated rejection?
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IV Immunoglobulin
Plasmapheresis Rituximab Splenectomy |
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Rx for Acute Rejection?
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Inc Immunosuppression
Direct against T's Corticosteroids Anti-lymphocyte agents |
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Rx for Chronic Allograft nephropathy?
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Control HTN
Protein Restriction Change immunosuppression |
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What's up w/ Calcineurin-Inhibitor Toxicity?
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Produces intense vasoconstriction of preglomerular arterioles
Acute drop in GFR has been shown to cause CRF |
