Elimination & Detox 2: Urinary Pathology Flashcards
SDMA definition?
UREMIA definition?
CREATININE is a MARKER of…
SDMA = SENSITIVE & EARLY MARKER of DECREASED GFR in CATS & DOGS
UREMIA = URINE in BLOOD (UREMIC TOXINS)
CREATININE is a MARKER of GFR
what SPECIES is this kidney?
what are 2 TERMS to DESCRIBE THIS ANATOMY?
EACH of their ___ are considered INDIVIDUAL ___ ____, which then all COALESCE & DUMP into ONE ____
COW
2 terms?
1. EXTERNAL LOBATION
2. MULTI-PARAMETAL
EACH of their LOBULES are considered INDIVIDUAL RENAL PYRAMIDS, which then all COALESCE & DUMP into ONE URETER
what SPECIES is this kidney?
what is the RED DOT labeling?
DOG
RED DOT = RENAL CREST
POLYCYSTIC KIDNEY DISEASE…
etiology? (2)
what BREEDS are most PREDISPOSED? (2)
almost EVERY animal with this disease will END UP WITH ____ ____ ____ via…
etiology?
1. CONGENITAL
2. from PKD1 MUTATION
2 BREEDS…
1. PERSIANS
2. BULL TERRIERS
almost EVERY animal with this disease will END UP WITH CHRONIC RENAL FAILURE via CYSTIC STRUCTURES DESTROYING RENAL PARENCHYMA
ID DZ
2 predisposed BREEDS?
POLYCYSTIC KIDNEY DZ
2 BREEDS?
1. PERSIANS
2. BULL TERRIERS
ID LESION
RENAL CYST
TRUE/FALSE
JUST BECAUSE an animal HAS CYSTS DOES NOT MEAN THAT THEY HAVE POLYCYSTIC KIDNEY DZ.
TRUE
RENAL CYSTS…
etiology? (2)
often a(n) ____ FINDING associated with…
etiology? –> CAN BE EITHER…
1. ACQUIRED
2. CONGENITAL
often an INCIDENTAL finding associated with CKD
4 PORTALS OF ENTRY for KIDNEY INJURY…
- ASCENDING (from bladder/urethra to kidney)
- HEMATOGENOUS (from sepsis)
- DESCENDING (from kidney to UT)
- DIRECT (toxins)
ONCE A NEPHRON is DYSFUNCTIONAL, what happens?
what is a COMMON EXAMPLE of this?
NEPHRONS CANNOT REGENERATE, so REMAINING NEPHRONS must COMPENSATE
example = GLOMERULAR HYPERTROPHY
what do we usually SEE in response to INJURY to the…
GLOMERULUS?
INTERSTITIUM?
TUBULES?
GLOMERULUS = DYSFUNCTION of FILTRATION MEMBRANE
INTERSTITIUM = FIBROSIS
TUBULES = EPITHELIAL CELL NECROSIS or TUBULORRHEXIS
TUBULORRHEXIS definition?
RUPTURE of BASEMENT MEMBRANE in TUBULAR CELLS
difference between RENAL DISEASE & RENAL FAILURE?
INCREASED BUN & CREATININE (azotemia) occur SECONDARILY to…
RENAL DISEASE = ANY deviation from NORMAL STRUCTURE or FUNCTION with WIDE RANGE OF CLINICAL SIGNS & SEVERITY
RENAL FAILURE = LOSS of >75% RENAL FUNCTION or ~25% REMAINING RENAL FUNCTION that can have ACUTE OR CHRONIC PRESENTATION
AZOTEMIA is SECONDARY to KIDNEY INJURY & DECREASED RENAL FUNCTION
DIFFERENCES in DEFINING…
ACUTE KIDNEY INJURY?
CHRONIC KIDNEY DISEASE?
ACUTE KIDNEY INJURY = IRIS GRADING I-V
CHRONIC KIDNEY DISEASE = IRIS STAGING 1-4
what DIAGNOSTICS should we perform for EVALUATION of RENAL FUNCTION?
4 total, 2 subs for each!
- BLOODWORK
–> CHEM for ELECTROLYTES & KIDNEYS
–> CBC - URINALYSIS
–> USG
–> SEDIMENT - IMAGING
–> RADS (thoracic)
–> US (abdominal) - HISOPATH
–> RENAL BIOPSY
–> POSTMORTEM EXAM
ACUTE KIDNEY INJURY…
occurs on a ___, meaning…
has ___ ___ of CLINICAL SIGNS, including 3 SPECIFIC findings…
what are 2 COMMON CAUSES of AKI?
prognosis?
occurs on CONTINUUM, meaning INJURY can be SUBCLINICAL to SEVERE RENAL FAILURE
has RAPID ONSET of CLINICAL SIGNS, including 3 SPECIFIC findings..
1. DECREASED URINE OUTPUT
2. AZOTEMIA
3. METABOLIC DERANGEMENTS (metabolic acidosis)
2 COMMON CAUSES?
1. NEPHROTOXINS
2. ISCHEMIA
prognosis? = GENERALLY GOOD so long as DAMAGE IS NOT SEVERE ENOUGH to LEAD TO CKD
ID GENERAL DZ
AKI (dog kidney)
ID GENERAL DZ
CKD
CHRONIC KIDNEY DZ…
causes ___ CHANGE
5 CLINICAL SIGNS?
3 B/W changes?
2 POSTMORTEM changes to kidneys?
causes IRREVERSIBLE CHANGE
5 CLINICAL SIGNS?
1. V+
2. D+
3. LETHARGY
4. POOR BCS
5. PU/PD
3 B/W changes?
1. AZOTEMIA
2. NON-REGENERATIVE ANEMIA
3. +/- METABOLIC ACIDOSIS
2 POSTMORTEM changes to kidneys?
1. SMALL/SHRUNKEN
2. IRREGULAR CORTICAL SURFACE from TISSUE LOSS & FIBROSIS
UREMIA/UREMIC SYNDROME…
can be found with ___ or ____ RENAL ____
= definition
what kind of DAMAGE can the body sustain as a result? (2)
can be found with ACUTE or CHRONIC RENAL INJURY
= MULTIORGAN MANIFESTATION of CIRCULATING UREMIC TOXINS that BUILD UP (when they should be excreted in urine) due to ACUTE or CHRONIC RENAL FAILURE
DAMAGE to body?
1. toxins can DAMAGE ENDOTHELIAL & EPITHELIAL CELLS
2. cause MALAISE by CROSSING BBB
what 3 CLINICAL SIGNS define MALAISE?
V+, ANOREXIA, D+
NON-RENAL LESIONS of UREMIA…
= overall?
what FOUR LOCATIONS can this COMMONLY occur in?
pathogenesis?
= overall, INFLAMMATION and MINERALIZATION in DIFFERENT ORGANS
organs?
1. MOUTH
2. STOMACH
3. ALVEOLAR SEPTAL WALLS in LUNGS
4. MYOCARDIUM
PATHOGENESIS is UNKNOWN
ID DZ
this is SEQUELAE of…
ULCERATIVE STOMATITIS
SEQUELAE of UREMIC SYNDROME/UREMIA
ID DZ
this is a SEQUELAE of…
PLEURAL MINERALIZATION
this is a SEQUELAE of UREMIA/UREMIC SYNDROME
ID DZ
this is a SEQUELAE of…
GASTRIC MINERALIZATION
this is a SEQUELAE of UREMIA/UREMIC SYNDROME
2 TYPES of VASCULAR INJURY that can occur in KIDNEY?
list 2 subs for FIRST, 3 for SECOND
- HEMORRHAGE
–> manifestation of SYSTEMIC DZ like VASCULITIS or BACTEREMIA
–> LOCAL TRAUMA (hematoma) - ISCHEMIA
–> ACUTE or CHRONIC RENAL INFARCTS
–> RENAL PAPILLARY NECROSIS
–> ACUTE TUBULAR INJURY
RENAL HEMORRHAGE…
often a MANIFESTATION of ____ ____
on POSTMORTEM, can see…
examples of a DISEASE that can CAUSE THIS in…
–> SWINE?
–> FOALS?
–> PUPPIES?
–> ANY SPECIES?
often a MANIFESTATION of SYSTEMIC DZ
on POSTMORTEM, can see SMALL FOCI of HEMORRHAGE & NECROSIS
examples of a DISEASE that can CAUSE THIS in…
–> SWINE = AFRICAN SWINE FEVER
–> FOALS = EQUINE HERPESVIRUS-1
–> PUPPIES = CANINE HERPESVIRUS-1
–> ANY SPECIES = SEPSIS
ID LESION
RENAL HEMORRHAGE (see PETECHIAE)
RENAL INFARCTS
= definition? why does it look like this?
if ACUTE? (3)
if CHRONIC? (3)
what is the OVERALL CAUSE? give 3 subs for this cause
= WEDGE-SHAPED area of NECROSIS & HEMORRHAGE; wedge-shaped bc that’s how BLOOD FLOWS IN KIDNEY
if ACUTE…
1. SWOLLEN
2. RED (hemorrhage)
3. or TAN (necrosis)
if CHRONIC
1. DEPRESSED
2. FIRM
3. TAN (fibrosis to REPLACE necrotic tissue)
OVERALL CAUSE = ISCHEMIA
1. THROMBI or THROMBOEMBOLI
2. ENDOTOXEMIA
3. VASCULITIS
ID LESION based on THIS PATHOLOGIC DESCRIPTION & PICTURE:
RED RIM of HEMORRHAGE surrounding a WEDGE-SHAPED AREA of TAN NECROSIS.
ACUTE RENAL INFARCT
ID LESION based on THIS PATHOLOGIC DESCRIPTION & PICTURE:
RED RIM of HEMORRHAGE surrounding a WEDGE-SHAPED AREA of TAN NECROSIS.
ACUTE RENAL INFARCT
ID LESION & what 3 PATHOLOGIC DESCRIPTORS you’d list?
CHRONIC RENAL INFARCT
descriptors?
1. DEPRESSED
2. FIRM
3. TAN (FIBROSIS has REPLACED NECROTIC TISSUE)
RENAL PAPILLARY NECROSIS…
commonly associated with… in WHAT species?
pathophysiology? (4)
NSAIDs can also cause LESIONS in WHAT OTHER 2 ORGANS in the HORSE?
commonly associated with NSAID ADMINISTRATION in HORSES
pathophysiology?
1. PROSTAGLANDINS normally PRODUCED by RENAL INTERSTITIAL CELLS to cause KIDNEY VASODILATION
- NSAIDs PREVENT prostaglandins from WORKING
- loss of VASODILATION from PROSTAGLANDINS causes ISCHEMIA
- ISCHEMIA causes COAGULATIVE NECROSIS of RENAL PAPILLA/CREST
NSAIDs can also cause DAMAGE in the horse at these 2 organs…
1. STOMACH (GASTRIC ULCERS)
2. RIGHT DORSAL COLON
4 ETIOLOGIES of RENAL PAPILLARY NECROSIS? start with the MOST COMMON
- NSAID ADMINISTRATION
- PYELITIS/PYELONEPHRITIS
- UROLITHIASIS
- AMYLOID
PYELITIS definition?
PYELONEPHRITIS definition?
EMBOLIC NEPHRITIS definition?
PYELITIS = INFLAMMATION of RENAL PELVIS
PYELONEPHRITIS = INFLAMMATION of RENAL PELVIS & TUBULOINTERSTITIUM
EMBOLIC NEPHRITIS = HEMATOGENOUS INFLAMMATION of KIDNEY
TUBULOINTERSTITIAL NEPHRITIS..
this TERM is NOT a…
= definition?
3 causes?
END RESULT? (1 overall, 2 findings)
NOT A SPECIFIC DZ
= ACUTE or CHRONIC INFLAMMATION from INJURY to the INTERSTITIUM that also IMPAIRS TUBULAR FUNCTION, and EVENTUALLY GLOMERULAR
3 causes?
1. ISCHEMIA
2. LEPTOSPIROSIS in ALL SPECIES
3. BORRELIA BURGERFORI (LYME)
END RESULT = CKD
1. INTERSTITIAL FIBROSIS
2. NEPHRON LOSS
DESCRIBE this kidney (2)
LIKELY DZ? why?
duration?
DESCRIBE?
1. RED/CONGESTED kidney
2. with TAN REGIONS INTERSPERSED throughout CORTEX
likely TUBULOINTERSTITIAL NEPHRITIS
–> NORMALLY you SHOULDN’T be able to see INTERSTITIUM, but in this DZ then SEE FIBROSIS BETWEEN TUBULES
ACUTE
ID HISTOPATHOLOGIC DZ & how it USUALLY PRESENTS?
HISTOPATHOLOGIC DZ = CHRONIC TUBULOINTERSTITIAL NEPHRITIS
usually PRESENTS as CKD
PYELITIS/PYELONEPHRITIS…
USUALLY caused from ____ ____ that ARRIVES TO KIDNEY from ____ via… (2)
FEMALES vs. MALES?
POSSIBLE ETIOLOGIC AGENTS are usually… so, IMPORTANT TO DO WHAT DIAGNOSTIC?
USUALLY caused from ASCENDING INFECTION that ARRIVES TO KIDNEY from OUTSIDE via…
1. URINARY BLADDER
2. URETERS
FEMALES more PREDISPOSED than MALES due to SHORTER, WIDER URETHRA
POSSIBLE ETIOLOGIC AGENTS usually BACTERIAL, important to do CULTURE & SENSITIVITY TESTING if we SUSPECT UTI
PYELONEPHRITIS vs. RENAL INFARCTS?
PYELONEPHRITIS = should affect RENAL PYRAMIDS, RENAL CREST & radiate from RENAL MEDULLA into the CORTEX
RENAL INFARCTS = tend to JUST AFFECT PARTS OF RENAL CORTEX
LEFT vs. RIGHT?
what’s the DISEASE?
LEFT = ACUTE
RIGHT = CHRONIC
DZ = PYELONEPHRITIS
EMBOLIC NEPHRITIS..
caused by ____ ____ to KIDNEY during ____
GROSSLY, called “what?”
usually causes ___ & ____ around ____ ___ & ____
HEMATOGENOUS INFECTION to KIDNEY during BACTEREMIA
GROSSLY, “WHITE SPOTTED KIDNEY”
usually causes INFLAMMATION & NECROSIS around BLOOD VESSELS & GLOMERULI
ID DZ
what do the FOCI correlate to?
EMBOLIC NEPHRITIS, “white spotted kidney”
FOCI = regions of INFLAMMATION & sometimes NECROSIS
CYSTITIS…
3 PREDISPOSING factors?
4 etiologies? which is MOST COMMON? include what SPECIES they’re seen in
3 PREDISPOSING factors?
1. DAMAGE to BLADDER MUCOSA (from uroliths or trauma)
- INCOMPLETE EMPTYING of BLADDER
- DIABETES MELLITUS which can cause EMPHYSEMATOUS CYSTITIS
etiologies?
1. BACTERIAL INFECTION of URINARY BLADDER = MOST COMMON
- BRACKEN FERN causing ENZOOTIC HEMATURIA –> HEMORRHAGIC CYSTITIS
- CANTHARIDIN (blister beetles) to HORSES
- CYCLOPHOSPHAMIDE (dogs/cats) for CHEMO
EMPHYSEMATOUS CYSTITIS…
often a SEQUELAE of WHAT DZ?
see WHAT on DIAGNOSTICS?
SEQUELAE of DIABETES MELLITUS in DOGS/CATS
see GAS IN BLADDER WALL
what 2 SPECIES are PREDISPOSED for URETERITIS/URETHRITIS? what DZ do they usually get?
what is often the ETIOLOGIC AGENT/common name of DZ?
2 SPECIES? = SHEEP & GOATS with ULCERATIVE URETHREITIS/POSTHITIS
ETIOLOGIC AGENT = C. RENALE (pizzle rot)
FELINE INFECTIOUS PERITONITIS can cause ____ & _____ _____ that can then cause damage to the _____
FELINE INFECTIOUS PERITONITIS can cause PYOGRANULOMATOUS & NECROTIZING VASCULITIS that can then cause damage to the KIDNEYS
WHAT DZ?
describe the OVERALL CONDITION (4 words total) for the KIDNEY?
FELINE INFECTIOUS PERITONITIS
KIDNEY undergoes PYOGRANULOMATOUS & NECROTIZING VASCULITIS
what 2 UNIQUE things can cause CYSTITIS?
include what SPECIES
- PARASITES in HORSES, RABBITS, DOGS & CATS
- HAIRY VETCH (VICIA VILLOSA) TOXICOSIS in COWS
2 main GLOMERULAR DISORDERS?
- IMMUNE COMPLEX-MEDIATED GLOMERULONEPHRITIS
- NON-ICGN GLOMERULOPATHY/GLOMERULONEPHROPATHY
ID DZ & DURATION
ACUTE GLOMERULONEPHRITIS
ID DZ
CHRONIC GLOMERULONEPHRITIS
4 SEQUELAE of GLOMERULAR DYSFUNCTION causing NON-SELECTIVE FILTRATION?
- LOSS OF PROTEIN in BLOOD causing PROTEINURIA
- LOSS OF ALBUMIN causing EDEMA
- LOSS OF ANTITHROMBIN III causing HYPERCOAGULABILITY
- eventual LOSS of ENTIRE NEPHRON causing RENAL FAILURE
IMMUNE-MEDIATED GLOMERULONEPHRITIS
commonality in WHAT species?
treatability?
pathophysiology? (2)
etiologies? MOST COMMON cause in ANIMALS? (2)
this is a TYPE ____ _____ REACTION
COMMON in DOGS
VERY TREATABLE
pathophysiology?
1. due to IMMUNE-COMPLEX DEPOSITION in GLOMERULAR BASEMENT MEMBRANES
2. causes INFLAMMATION & FIBROSIS over time
etiologies?
1. PRIMARY/IDIOPATHIC
2. SECONDARY = from DISEASE with PROLONGED ANTIGENEMIA & IMMUNE COMPLEX FORMATION (MOST COMMON IN ANIMALS)
this is a TYPE III HYPERSENSITIVITY REACTION
DIAGNOSIS of GLOMERULAR DZ…
based on…
BASED ON EXTENSIVE TESTING! must SEND OFF TO A LAB
NONIMMUNE-COMPLEX GLOMERULONEPHROPATHIES…
which is the MOST COMMON?
can be a SEQUELAE of ___ ____
tends to MANIFEST in WHAT part of the kidney? what does it CAUSE?
3 postmortem findings GROSSLY?
MOST COMMON = AMYLOIDOSIS
AMYLOIDOSIS can be a SEQUELAE of CHRONIC INFLAMMATION
tends to MANIFEST in GLOMERULUS of kidney; AMYLOID will SQUISH GLOMERULAR CAPILLARIES so that THEY CANNOT FUNCTION
postmortem?
1. FIRM
2. WAXY
3. TAN
ACUTE TUBULAR INJURY can be due to ____ or ____
TOXINS, ISCHEMIA
FANCONI SYNDROME..
what BREED predisposed?
what TYPE of dz is this?
BASENJI
SPECIFIC TUBULAR DYSFUNCTION
TUBULAR DYSFUNCTION…
what does it cause?
causes INABILITY TO CONCENTRATE URINE, so it’s UNMODIFIED
ID DZ
NEPHROBLASTOMA
ID DZ
LYMPHOMA
6 SEQUELAE to TUBULAR DYSFUNCTION…
- changes to URINE OUTPUT & USG
- METABOLIC ACIDOSIS
- UREMIA
- ELECTROLYTE IMBALANCES & HYPERKALEMIA
- PROTEINURIA
- GLUCOSURIA
ATI/AKI is a VERY COMMON CAUSE OF ATI/AKI, but they can BOTH look ____
ACUTE TUBULAR INJURY is a VERY COMMON CAUSE OF ACUTE KIDNEY INJURY, but they can BOTH look SIMILAR
ACUTE TUBULAR INJURY/ACUTE TUBULAR NECROSIS…
= definition? including what this CAUSES
reversibility?
2 causes?
= NECROSIS & SLOUGHING of TUBULAR EPITHELIAL CELLS that causes DOWNSTREAM LUMINAL CASTS
REGENERATION IS POSSIBLE
2 causes?
1. ISCHEMIA
2. NEPHROTOXINS
LOWER URINARY TRACT DYSFUNCTION…
= definition?
MAJOR CONSEQUENCE?
4 SEQUELAE?
= CANNOT EXCRETE URINE
MAJOR CONSEQUENCE = RETAINED URINE
4 SEQUELAE?
1. HYPERKALEIA
2. METABOLIC ACIDOSIS
3. AZOTEMIA
4. UREMIA
ID LESION
how do you know?
HYDRONEPHROSIS
EXPOSURE of the RENAL CALYCES
4 causes of HYDRONEPHROSIS?
- LOWER UT OBSTRUCTION
- NEPHROLITHIASIS
- CHRONIC PYELONEPHRITIS
- RENAL PAPILLARY NECROSIS
