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004 - Urine Path > C. SYNDROME: Acute Renal Failure (ARF) > Flashcards

C. SYNDROME: Acute Renal Failure (ARF) Flashcards

1
Q

(1)

(Acute Renal Failure (ARF))

  1. aka what?

2-4. characterized by what three things?

A
  1. Acute Kidney Injury (AKI)
  2. oliguria (low urine output) or anuria (no urine) of rapid onset (days)
  3. azotemia (^BUN and creatinine)
  4. metabolic acidosis, hyperkalemia, hyperphosphatemia
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2
Q

(2)

(Acute Renal Failure (ARF))

1-3. Distinguishing Chronic From Acute can be difficult… what helps?

  1. in which are kidneys small?

normal to large?

A
  1. rapidity of onset (days vs months/years)
  2. present of non-regenerative anemia (in chronic)
  3. polyuria (CRF) vs. oliguria or anuria (ARF)
  4. CRF

ARF

(however… this isn’t completely accurate cause some chornic conditions don’t make smaller (amyloidosis,neoplams,polycystic)

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3
Q

(3)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

  1. what is nephrosis?
A
  1. acute tubular injury not caused by inflammation (usually by ischemia or nephrotoxins)
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4
Q

(4)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Ischemic)

  1. usually associated with what?
  2. characterized by multifocal or pathcy necrosis along what?
  3. What tubules are especially vulnerable?
A
  1. severe hypotension or renal hypoperfusion due to shock (also called “shock kidney”)
  2. the nephron
  3. proximal

(distal tubules also affected… basement membranes rupture)

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5
Q

(5)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

  1. caused by wide variety of nephrotoxins including what? (Oak Vase Have HAPPEN)
A
  1. organic solvents (carbon tetrachloride, chloroform)

vitamin D

hypercalcemia

Heavy metals (mercury, lead, etc)

antibiotics

plant/fungal/bacterial toxins (oak tannins, oxalate)

pesticides

ethylene glycol

NSAIDS (decrese synth of renal prostaglandins that maintain blood flow)

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6
Q

(6)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

(Morph)

  1. macro appearance?
  2. micro?
  3. In ethylene glycol poisoning see what?
  4. If animal survives may see tubular regeneration why?
A
  1. swollen and pale (may be perirenal edema)
  2. proximal tubules diffusely involved…. distal nephron relatively spared
  3. Ca oxalate crystals in proximal tubules
  4. nephrotoxins usually don’t damage basement membrane
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7
Q

(7)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

  1. cats get toxicity from what?
  2. toxic ingredient?
  3. renal damage in form of what?
  4. clinical signs?
A
  1. lilies

(Easter lily, some species of Day lily, Tiger lily, Rubrum lily, and Japanese Show lily)

  1. unknown
  2. acute tubular necrosis (can be severe)
  3. lethargy and vomiting
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8
Q

(8)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

  1. ingestion of what by dogs can lead to a syndrome of acute renal failure and uremia with vomiting, lethargy, anorexia, and diarrhea?
  2. mech is unclear - what are several possibilites?
A
  1. raisins and grapes
  2. tannins, mycotoxins, pesticides, heavy metals, sugar overload –> shock, enyzme differences, excess vitamin D
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9
Q

(9)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

  1. What were both involved in recent large-scale outbreaks of renal failure mortality in dogs and cats (pet food contamination)?
  2. These cases involved necrosis of what?
  3. what else?
A
  1. melamine and cyanuric acid
  2. distal tubules
  3. irregular brown birefringent crystals
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10
Q

(9)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Morph and Etiology)

(Toxic)

  1. Nephrotoxic pigments such as what can cause tubular necrosis?
  2. are pigments themselves nephrotoxic?
  3. Large conc of pigments can also increase tubular necrosis as a result of what?
  4. Other potential causes of acute tubular necrosis include: acute tubulointerstitial nephritis and urinary obstruction.
A
  1. hemoglobin, myoglobin, bile
  2. no (but hemoglobin/myoglobin can add to preexsiting ischemic necrosis of tubules)
  3. renal ischemia (renal vasoconstrction and intraluminal cast formation)
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11
Q

(11)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Path of ARF in ATN)

(1) Tubule Epithelial cell injury

1-3. these cells very vulnerable for what 3 reasons?

A
  1. very metabolically active (high energy and O2 requirements)

(prox tubules and Henle esp)

  1. high surface area/transport (of toxins)
  2. concentrate toxins intracellularly
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12
Q

(12)

(Acute Renal Failure (ARF))

(Acute Tubular Necrosis)

(Path of ARF in ATN)

(2) Principal mechanisms causing oliguria:

1-4. What 4?

A
  1. endothelial dysfunction (ischemic or toxic)

^ endothelin (vasoconstrictor) and decreased NO and PGI2 (dilators)

glomerular vasoconstriction and reduced GFR

  1. tubuloglomerular feedback

epi cell injury –> reduced Na transport out of tubule –> ^ delivery of Na to distal tubules –> ^ renin –> glomerular vasoconstriction

  1. damage/necrosis –> loss of tubular integrity –> backflow (into blood) of filtrate
  2. increased tubular pressure due to casts/crystals –> increases back pressure –> reduces GFR (contributes to leakage from tubules)
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13
Q

(13)

(Acute Renal Failure (ARF))

1-3. What are three more causes of ARF?

A
  1. acute gomerulonephritis
  2. acute massive renal infarction (acute renal cortical necrosis)
  3. complete bilateral urinary tract outlfow obstruction
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14
Q

(14)

(Acute Renal Failure (ARF))

(Renal Papillary (medullary crest) Necrosis)

  1. primary disease in animals treated with what?
  2. most often seen in horses treated with what?

or cats/dogs treated with?

  1. What cells are primary target of papillotoxins?

have a key role in what?

  1. the lesion involves coagulation necrosis of what?
A
  1. NSAIDs
  2. phenylbutazone or flunixin megumide

aspirin, ibuprofen, or acetaminophen

  1. medullary interstitial cells

synth of prostaglandins, antihypertensive factors, and glycosaminoglycan matrix of medullary interstitium

  1. medullary crest/inner medulla (yellow-gray, green, pnik) with hemorrhage
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15
Q

(14)

(Acute Renal Failure (ARF))

(Renal Infarcts)

  1. areas of coagulative necrosis due to what?
  2. What makes blood suplly to kidney susceptible?
  3. how do they look grossly?

when chronic?

shape?

A
  1. local ischemia of occlusion (usually thromboembolism)
  2. has end-arteries with few/no anastomoses or collateral circulation
  3. infarcts swollen and red –> in 2-3 days become pale with red rim

pale, shrunken –> depression in renal contour

involve cortex/wedge shaped - point of triangle at occlued blood vessel

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004 - Urine Path (7 decks)

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