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17 - Immunological Aspects of Renal Disease
- Edited by John B. Zabriskie, Rockefeller University, New York
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- Book:
- Essential Clinical Immunology
- Published online:
- 18 December 2009
- Print publication:
- 12 January 2009, pp 313-330
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Summary
INTRODUCTION
Human kidneys play an integral role in the development of primary or secondary immunologic diseases. As a major filtering organ, the kidneys, which represent about 0.5 percent of the human body mass, receive 20 percent of the total cardiac output. The enormous blood flow (1 L/min) to the renal microcirculation exceeds that observed in other major vascular organs (heart, liver, and brain). Urine is produced after a complex process of glomerular filtration, tubular transport, and reabsorption at a rate of 1 ml/min. Cellular elements involved in immunity thereby have a high probability of interacting with glomerular and tubular cells that may or may not cause renal disease.
Sufficient knowledge of the anatomy and histology of the kidney is vital in understanding the pathogenesis of renal diseases. The renal corpuscle, or glomerulus (Figure 17.1), is composed of capillary tuft lined by a thin layer of endothelial cells; central region of mesangial cells and its surrounding matrix; and visceral and parietal epithelial cells with their respective basement membranes. The glomerulus is primarily responsible for production of ultrafilrate from the circulating plasma. The filtration barrier between the bloodstream and urinary space is made up by the fenestrated endothelium, the glomerular basement membrane (GBM), and the slit pores seen between the foot proc esses of the visceral epithelium (Figure 17.2).
The endothelial cells form as initial barriers to cellular elements of the blood (red blood cells, leucocytes, and platelets) in reaching the subendothelial space. The endothelial cells produce nitric oxide (a vasodilator) and endothelin-1 (a potent vasoconstrictor), chemical substances implicated in inflammatory processes.
12 - Immunological Aspects of Cardiac Disease
- Edited by John B. Zabriskie, Rockefeller University, New York
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- Book:
- Essential Clinical Immunology
- Published online:
- 18 December 2009
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- 12 January 2009, pp 199-230
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Summary
INTRODUCTION
Although the vast majority of cardiac diseases relate to the presence of atherosclerosis in the vessels supplying blood and oxygen to the heart, there are certain conditions in which immunological events play an important role. This chapter will concentrate on the immunological aspects of these diseases. We will also discuss the animal models associated with each of these disorders with particular emphasis on whether these models help us to understand further the immunological aspects of these conditions.
RHEUMATIC FEVER
Acute rheumatic fever (ARF) is a delayed, nonsuppurative sequela of a pharyngeal infection with the group A streptococcus. A latent period of two to three weeks follows the initial streptococcal pharyngitis. The latent period remains the same for each individual patient in the event of a recurrence. This suggests that the patient has already been exposed to more than one streptococcal infection in the past. The onset of disease is usually characterized by an acute febrile illness, which may manifest itself in one of three classical ways: (1) The patient may present with migratory arthritis predominantly involving the large joints of the body. (2) There may also be concomitant clinical and laboratory signs of carditis and valvulitis, or carditis and valvulitis may be the only signs of an acute episode. (3) There may be involvement of the central nervous system, manifesting itself as Sydenham's chorea. The clinical episodes are self-limiting but damage to the valves may be chronic and progressive, resulting in cardiac decompensation and death.
2 - Immunological Techniques
- Edited by John B. Zabriskie, Rockefeller University, New York
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- Book:
- Essential Clinical Immunology
- Published online:
- 18 December 2009
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- 12 January 2009, pp 21-32
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Summary
INTRODUCTION
This chapter is not designed to cover all the techniques and assays used in clinical immunology. Rather, it is an introduction to various techniques commonly used in diagnosing human disease or, rather, assays to evaluate the competence or incompetence of the immune system. Finally, it will serve as an introduction to the many new techniques emerging in the past several years that have widened our knowledge of the complex relationship of microbe–host interactions in human disease.
Laboratory tests vary widely in clinical immunology. Some are essential for diagnosis while others are useful in subclassifying disorders. Finally, some are of research interest only but may add to our immunological armamentarium in the future. In this regard, it is important to understand that these tests do vary in their sensitivity and specificity.
The sensitivity of a test is defined as the number of diseased individuals that are positive for the test compared with those who are negative. The specificity of a test is the proportion of individuals without a given disease that are negative. Thus, a positive test is really restricted to the disease in question.
The various assays to be discussed later in this chapter can be conveniently divided into two main divisions. Some assays are quantitative in that they produce precise results. Many of these assays are automated and can be related to international standards. Qualitative assays are less specific and will give answers such as normal–abnormal, or positive–negative results. The problem is that interpretation of results may be subjective and require special expertise in carrying out the test.
1 - Basic Components of the Immune System
- Edited by John B. Zabriskie, Rockefeller University, New York
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- Book:
- Essential Clinical Immunology
- Published online:
- 18 December 2009
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- 12 January 2009, pp 1-20
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INTRODUCTION
This chapter is not a comprehensive review of immunology but rather a condensed version of those aspects of immunology that have particular relevance to clinical immunology. Refer to the Bibliography for a more extensive discussion of the role of each component.
It is generally believed that the immune system evolved as the host's defense against infectious agents, and it is well known that patients with deficiencies in the immune system generally succumb to these infectious diseases. However, as we shall see, it may well play a larger role in the elimination of other foreign substances, including tumor antigens or cells and antibodies that attack self.
An immune response may be conveniently divided into two parts: (1) a specific response to a given antigen and (2) a more nonspecific augmentation to that response. An important feature of the specific response is that there is a quicker response to the antigen during a second exposure to that antigen. It is the memory of the initial response that provides the booster effect.
For convenience, the specific immune response may be divided into two parts: (1) the humoral response and (2) the cellular response to a given antigen. As we shall see, however, both responses are mediated through the lymphocyte. Humoral responses are antibodies produced in response to a given antigen, and these antibodies are proteins, have similar structures, and can be divided into various classes of immunoglobulins. Cellular responses are established by cells and can only be transferred by cells. (See the Bibliography for the extraordinary beginnings of the concept of a cellular arm of the immune system.)