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Anatomic Pathology 2 > Kidney Reaction to Injury > Flashcards

Kidney Reaction to Injury Flashcards

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1
Q

What does the kidney do to adapt to the loss of nephrons?

A

shunt blood to remaining nephrons, hypertrophy of remaining nephrons creating a super nephron, and an increase of SNGFR to maintain TGFR

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2
Q

What are some long-term consequences of adaptation to nephron loss?

A

polyuria, urine specific gravity is fixed in isosthenuric range, and over-perfusion injury to glomeruli

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3
Q

What are some ways that the glomeruli react to injury?

A

hypoplasia, inflammation, thrombosis and necrosis, hypertrophy, glomerulosclerosis, and amyloidosis

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4
Q

What can cause glomerulonephritis?

A

an embolism due to systemic bacterial infection, an immune complex deposition, or an abnormality in the alternative complement pathway

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5
Q

What is glomerulosclerosis?

A

the general reaction to long-term glomerular injury where the severely effected glomeruli shrink and become hyalinized and they lose their podocyte foot processes

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6
Q

What is renal amyloidosis?

A

a manifestation of systemic acute phase protein deposition which is derived from increased SAA production; usually secondary to an inflammatory response

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7
Q

Glomerulonephritis is an immune complex disease, how does the immune system cause glomerulonephritis?

A

There is an antigen-antibody complex accumulation either creating a split or thickened glomerular basement membrane which will also result in a leukocyte infiltration

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8
Q

What clincial features are associated with glomerulonephritis?

A

nephrotic syndrome and thrombosis

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9
Q

What are the key clinical features of nephrotic syndrome that is the result of glomerulonephritis?

A

proteinuria, hypoproteinemia, subcutaneous edema, and hypercholesterolemia

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10
Q

Why does thrombosis occur with glomerulonephritis?

A

Antithrombin III is lost and without it the coagulation cascade is up-regulated and thrombosis will occur

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11
Q

What are some ways that the tubules respond to injury?

A

degeneration, cyst formation, necrosis of epithelium, re-epithelialization, inflammation, or mineralization

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12
Q

What types of degeneration can the tubules go through in respond to injury?

A

hydropic degeneration or lipidosis

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13
Q

If cyst formation in tubules is congenital, what does the kidney look like?

A

polycystic kidney

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14
Q

If cyst formation in tubules is acquired, what is the likely cause of it?

A

it is likely secondary to chronic injury and interstitial fibrosis

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15
Q

If necrosis in tubules is due to ischemia, what likely is the pattern seen?

A

multifocal

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16
Q

If necrosis in tubules is due to a nephrotoxin, what pattern is commonly seen?

A

diffuse necrosis in the proximal convoluted tubules

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17
Q

What does re-epithelialization of the tubules require?

A

an intact basement membrane

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18
Q

What is tubulointerstitial nephritis?

A

exudate and inflammation in the tubules and interstitium

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19
Q

What are some ways that the interstitium reacts to injury?

A

inflammation, necrosis, amyloidosis, and fibrosis

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20
Q

What types of inflammation involve the interstitium?

A

lymphoplasmacytic interstitial nephritis and tubulointerstitial nephritis

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21
Q

What parts of the kidney need to be involved in order to diagnose it with tubulointerstitial nephritis?

A

both the tubules and the interstitium

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22
Q

What is necrosis in the interstitium secondary to?

A

inflammation or ischemia

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23
Q

What type of necrosis (as in what area) can be associated with the interstitium?

A

renal crest necrosis

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24
Q

Where in the interstitium can amyloidosis occur?

A

in the medullary interstitium

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25
What is the role of fibrosis in the interstitium?
to replace lost nephrons
26
What are some ways that vessels in the kidney react to injury?
vasculitis, fibriboid necrosis, thormbosis, infarction, or mural lamination
27
What does mural lamination in the kidney lead to?
hypertension
28
What are some ways that the renal pelvis respond to injury?
inlammation, dilation, and calculi
29
What is pyelitis?
inflammation of the renal pelvis
30
What is pyelonephritis?
inflammation of the renal pelvis and renal parenchyma
31
What is pyelonephritis typically caused by?
an ascending bacterial infection
32
What is pyelonephritis a secondary lesion to?
an impairment of urine flow becauase there is decreased flushing action
33
Where is inflammation specifically seen in pyelonephritis cases?
in tubules and interstitium of the medulla to the cortex
34
What is seen in the urine sediment in cases of pyelonephritis?
leukocyte casts
35
What is dilation of the renal pelvis called?
hydronephrosis
36
What is nephrolithiasis?
the formation of stones within the kidney
37
What specifically qualifies an animal to be in acute renal failure?
there is an abrupt loss of greater than %70 of renal function due to a significant lesion that is affecting msot nephrons at once
38
What occurs to GFR in acute renal failure?
there is a decrease in SNGFR that leads to an overall decrease in TGFR
39
What clinical features are associated with acute renal failure?
renal azotemia and decrease in urine production (oliguria/anuria)
40
What can cause acute renal failure?
nephrotoxins, thrombosis, or hypoxia due to decreased renal perfusion
41
What renal lesion do nephrotoxins cause in acute renal failure?
acute coagulative nexrosis of proximal convoluted tubules
42
What renal lesion does thrombosis lead to in acute renal failure?
infarction and segmental coagulative necrosis
43
What renal lesion does hypoxia cause in acute renal failure?
multifocal coagulative necrosis in tubules
44
What are some possible outcomes of acute renal failure?
death due to hyperkalemia or recovery if necrotic
45
What specifically qualifies an animal to be in chronic renal failure?
there is a slow loss of greater than %70 of renal function due to a progressive loss of nephrons and nephron hypertrophy
46
What occurs to GFR in animals that have chronic renal failure?
there is a decrease in SNGFR in some nephrons, an increase in SNGFR in hypertrophied nephrons and eventually a decrease in TGFR
47
What clinical features are associated with chronic renal failure?
renal azotemia, polyuria and polydispia, and fixed isosthenuria
48
What renal lesions are associated with chronic renal fialure?
renal dysplasia, chronic tubulointerstitial nephritis, chronic glomerulonephritis, and glomerular amyloidosis
49
What specific lesions are associated with renal dysplasia?
fibrosis and hypertrophied nephrons
50
What specific lesions are associated with chronic tubulointerstitial nephritis?
exudate, fibrosis, and hypertrophied nephrons
51
What specific lesions are associated with chronic glomerulonephritis?
glomerulosclerosis and fibrosis
52
What are the possible outcomes of chronic renal failure?
uremia, secondary renal hyperparathyroidism, and non-regenerative anemia
53
What is uremia?
it is another word for chronic renal failure used to describe a group of systemic lesions due to the accumulation of toxic metabolites in chronic renal failure
54
What systemic lesions are associated with uremia?
ulcerative stomatitis/glossitis, ulcerative gastritis, fibrinoid vascular necrosis, and soft tissue mineralization
55
What is fibrinoid vascular necrosis?
damage to small vessels throughout the body
56
How does an animal with chronic renal failure develop secondary renal hyperparathyroidism?
there is a deranged Ca/P metabolism because the kidney is not working properly
57
What systemic lesion is associated with secondary renal hyperparathyroidism?
fibrous osteodystrophy
58
How does an animal with chronic renal failure get fibrous osteodystrophy?
an increase in serum P causes a decrease in serum Ca and D3 production which in turn causes an increase in parathyroid hormone production leading to an increase in Ca and P liberation via bone resorption and proliferation of fibrous tissue in bone
59
What classifies anemia to be non-regenerative?
when the kidney cannot make erythropoeitin so more RBCs cannot be made and there is a shortened RBC life
60
What lesion is shown here?
renal fibrosis secondary to renal dysplasia with glomerular hypoplasia (note the smaller kidney)
61
Identify this structure:
proximal convoluted tubules
62
Identify this structure:
vascular pole
63
Identify this structure:
renal corpuscle
64
Which one of these is normal?
A
65
What lesion is shown here?
hypertrophied nephron
66
What is happening here?
interstitial fibrosis
67
Identify this structure:
podicytes
68
What lesion is shown here?
hypertrophied podocytes and thickened basement membranes in glomerulonephritis
69
What is happening here?
segmental glomerulosclerosis
70
What lesion is shown here?
renal amyloidosis
71
What is this?
amyloid depositid in the glomeruli
72
What lesion is shown here?
acute multifocal purpulent nephritis due to actinobacillosis
73
What is this?
bacteria localized in the glomerulus
74
What lesion is shown here?
chronic glomerulonephritis in a horse
75
What lesion is shown here?
subcutaneous edema
76
What lesion is shown here?
ascites due to hypoproteinemia
77
What lesion is shown here?
membranous glomerulonephritis
78
What lesion is shown here?
membranous glomerulonephritis - note the spikey appearance of the glomeruli
79
Identify this structure:
basement membrane
80
Identify this structure:
antigen-antibody complex (Ag-Ab)
81
What lesion is shown here?
membranous glomerulonephritis
82
What lesion is shown here?
membranoproliferative glomerulonephritis as seen in Lyme's disease
83
What lesion is shown here?
membranoproliferative glomerulonephritis as seen in Lyme's disease
84
What lesion is shown here?
proliferative glomerulonephritis - note the hypercellularity of the glomerulus
85
What lesion is shown here?
slightly enlarged, pale kidney due to acute tubular necrosis
86
What lesion is shown here?
acute tubular necrosis due to a nephrotoxin
87
What lesion is shown here?
intratubular accumulation of pmns in purulent pyelonephritis
88
What lesion is shown here?
renal tubular mineralization in a dog with hypercalcemia
89
What lesion is shown here?
lymphoplasmacytic tubulointerstitial nephritis
90
What lesion is shown here?
renal crest necrosis
91
What is a common cause for this lesion?
the use of NSAIDS as treatment in a dehydrated horse
92
What lesion is shown here?
diffuse renal fibrosis
93
What lesion is shown here?
vasculitis with fibrinoid necrosis
94
What is this?
antigen-antibody complex in the wall of the vessel
95
What lesion is shown here?
serofibrinous and pyogranulomatous peritonitis due to FIP
96
What lesion is shown here?
multifocal pyogranulomatous vasculocentric nephritis
97
What lesion is shown here?
multifocal pyogranulomatous vasculocentric nephritis
98
What are these?
immune complex deposits
99
What lesion is shown here?
multiple acute renal infarcts
100
What lesion is shown here?
multiple acute renal infarcts with acute coagulation necrosis
101
What lesion is shown here?
proliferative arteriolopathy due to hypertension
102
What lesion is shown here?
acute necrotizing and fibrinopurulent pyelonephritis
103
What lesion is shown here?
subacute (purulent) pyelonephritis
104
What lesion is shown here?
chronic multifocal pyelonephritis
105
What lesion is shown here?
chronic multifocal pyelonephritis
106
What lesion is shown here?
diffuse hydronephrosis
107
What lesion is shown here?
nephroliths with hydronephrosis
108
What lesion is shown here?
hydronephrosis with renal crest necrosis
109
What lesion is shown here?
oral ulcers secondary to CRF
110
What lesion is shown here?
gastritis secondary to CRF
111
What lesion is shown here?
fibrous osteodystrophy secondary to CRF
112
What lesion is shown here?
diffuse renal fibrosis

Anatomic Pathology 2 (48 decks)

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