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Anatomic Pathology 2 > Kidney Reaction to Injury > Flashcards

Kidney Reaction to Injury Flashcards

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
Q

What is the role of fibrosis in the interstitium?

A

to replace lost nephrons

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26
Q

What are some ways that vessels in the kidney react to injury?

A

vasculitis, fibriboid necrosis, thormbosis, infarction, or mural lamination

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27
Q

What does mural lamination in the kidney lead to?

A

hypertension

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28
Q

What are some ways that the renal pelvis respond to injury?

A

inlammation, dilation, and calculi

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29
Q

What is pyelitis?

A

inflammation of the renal pelvis

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30
Q

What is pyelonephritis?

A

inflammation of the renal pelvis and renal parenchyma

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31
Q

What is pyelonephritis typically caused by?

A

an ascending bacterial infection

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32
Q

What is pyelonephritis a secondary lesion to?

A

an impairment of urine flow becauase there is decreased flushing action

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33
Q

Where is inflammation specifically seen in pyelonephritis cases?

A

in tubules and interstitium of the medulla to the cortex

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34
Q

What is seen in the urine sediment in cases of pyelonephritis?

A

leukocyte casts

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35
Q

What is dilation of the renal pelvis called?

A

hydronephrosis

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36
Q

What is nephrolithiasis?

A

the formation of stones within the kidney

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37
Q

What specifically qualifies an animal to be in acute renal failure?

A

there is an abrupt loss of greater than %70 of renal function due to a significant lesion that is affecting msot nephrons at once

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38
Q

What occurs to GFR in acute renal failure?

A

there is a decrease in SNGFR that leads to an overall decrease in TGFR

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39
Q

What clinical features are associated with acute renal failure?

A

renal azotemia and decrease in urine production (oliguria/anuria)

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40
Q

What can cause acute renal failure?

A

nephrotoxins, thrombosis, or hypoxia due to decreased renal perfusion

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41
Q

What renal lesion do nephrotoxins cause in acute renal failure?

A

acute coagulative nexrosis of proximal convoluted tubules

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42
Q

What renal lesion does thrombosis lead to in acute renal failure?

A

infarction and segmental coagulative necrosis

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43
Q

What renal lesion does hypoxia cause in acute renal failure?

A

multifocal coagulative necrosis in tubules

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44
Q

What are some possible outcomes of acute renal failure?

A

death due to hyperkalemia or recovery if necrotic

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45
Q

What specifically qualifies an animal to be in chronic renal failure?

A

there is a slow loss of greater than %70 of renal function due to a progressive loss of nephrons and nephron hypertrophy

46
Q

What occurs to GFR in animals that have chronic renal failure?

A

there is a decrease in SNGFR in some nephrons, an increase in SNGFR in hypertrophied nephrons and eventually a decrease in TGFR

47
Q

What clinical features are associated with chronic renal failure?

A

renal azotemia, polyuria and polydispia, and fixed isosthenuria

48
Q

What renal lesions are associated with chronic renal fialure?

A

renal dysplasia, chronic tubulointerstitial nephritis, chronic glomerulonephritis, and glomerular amyloidosis

49
Q

What specific lesions are associated with renal dysplasia?

A

fibrosis and hypertrophied nephrons

50
Q

What specific lesions are associated with chronic tubulointerstitial nephritis?

A

exudate, fibrosis, and hypertrophied nephrons

51
Q

What specific lesions are associated with chronic glomerulonephritis?

A

glomerulosclerosis and fibrosis

52
Q

What are the possible outcomes of chronic renal failure?

A

uremia, secondary renal hyperparathyroidism, and non-regenerative anemia

53
Q

What is uremia?

A

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
Q

What systemic lesions are associated with uremia?

A

ulcerative stomatitis/glossitis, ulcerative gastritis, fibrinoid vascular necrosis, and soft tissue mineralization

55
Q

What is fibrinoid vascular necrosis?

A

damage to small vessels throughout the body

56
Q

How does an animal with chronic renal failure develop secondary renal hyperparathyroidism?

A

there is a deranged Ca/P metabolism because the kidney is not working properly

57
Q

What systemic lesion is associated with secondary renal hyperparathyroidism?

A

fibrous osteodystrophy

58
Q

How does an animal with chronic renal failure get fibrous osteodystrophy?

A

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
Q

What classifies anemia to be non-regenerative?

A

when the kidney cannot make erythropoeitin so more RBCs cannot be made and there is a shortened RBC life

60
Q

What lesion is shown here?

A

renal fibrosis secondary to renal dysplasia with glomerular hypoplasia (note the smaller kidney)

61
Q

Identify this structure:

A

proximal convoluted tubules

62
Q

Identify this structure:

A

vascular pole

63
Q

Identify this structure:

A

renal corpuscle

64
Q

Which one of these is normal?

65
Q

What lesion is shown here?

A

hypertrophied nephron

66
Q

What is happening here?

A

interstitial fibrosis

67
Q

Identify this structure:

68
Q

What lesion is shown here?

A

hypertrophied podocytes and thickened basement membranes in glomerulonephritis

69
Q

What is happening here?

A

segmental glomerulosclerosis

70
Q

What lesion is shown here?

A

renal amyloidosis

71
Q

What is this?

A

amyloid depositid in the glomeruli

72
Q

What lesion is shown here?

A

acute multifocal purpulent nephritis due to actinobacillosis

73
Q

What is this?

A

bacteria localized in the glomerulus

74
Q

What lesion is shown here?

A

chronic glomerulonephritis in a horse

75
Q

What lesion is shown here?

A

subcutaneous edema

76
Q

What lesion is shown here?

A

ascites due to hypoproteinemia

77
Q

What lesion is shown here?

A

membranous glomerulonephritis

78
Q

What lesion is shown here?

A

membranous glomerulonephritis - note the spikey appearance of the glomeruli

79
Q

Identify this structure:

A

basement membrane

80
Q

Identify this structure:

A

antigen-antibody complex (Ag-Ab)

81
Q

What lesion is shown here?

A

membranous glomerulonephritis

82
Q

What lesion is shown here?

A

membranoproliferative glomerulonephritis as seen in Lyme’s disease

83
Q

What lesion is shown here?

A

membranoproliferative glomerulonephritis as seen in Lyme’s disease

84
Q

What lesion is shown here?

A

proliferative glomerulonephritis - note the hypercellularity of the glomerulus

85
Q

What lesion is shown here?

A

slightly enlarged, pale kidney due to acute tubular necrosis

86
Q

What lesion is shown here?

A

acute tubular necrosis due to a nephrotoxin

87
Q

What lesion is shown here?

A

intratubular accumulation of pmns in purulent pyelonephritis

88
Q

What lesion is shown here?

A

renal tubular mineralization in a dog with hypercalcemia

89
Q

What lesion is shown here?

A

lymphoplasmacytic tubulointerstitial nephritis

90
Q

What lesion is shown here?

A

renal crest necrosis

91
Q

What is a common cause for this lesion?

A

the use of NSAIDS as treatment in a dehydrated horse

92
Q

What lesion is shown here?

A

diffuse renal fibrosis

93
Q

What lesion is shown here?

A

vasculitis with fibrinoid necrosis

94
Q

What is this?

A

antigen-antibody complex in the wall of the vessel

95
Q

What lesion is shown here?

A

serofibrinous and pyogranulomatous peritonitis due to FIP

96
Q

What lesion is shown here?

A

multifocal pyogranulomatous vasculocentric nephritis

97
Q

What lesion is shown here?

A

multifocal pyogranulomatous vasculocentric nephritis

98
Q

What are these?

A

immune complex deposits

99
Q

What lesion is shown here?

A

multiple acute renal infarcts

100
Q

What lesion is shown here?

A

multiple acute renal infarcts with acute coagulation necrosis

101
Q

What lesion is shown here?

A

proliferative arteriolopathy due to hypertension

102
Q

What lesion is shown here?

A

acute necrotizing and fibrinopurulent pyelonephritis

103
Q

What lesion is shown here?

A

subacute (purulent) pyelonephritis

104
Q

What lesion is shown here?

A

chronic multifocal pyelonephritis

105
Q

What lesion is shown here?

A

chronic multifocal pyelonephritis

106
Q

What lesion is shown here?

A

diffuse hydronephrosis

107
Q

What lesion is shown here?

A

nephroliths with hydronephrosis

108
Q

What lesion is shown here?

A

hydronephrosis with renal crest necrosis

109
Q

What lesion is shown here?

A

oral ulcers secondary to CRF

110
Q

What lesion is shown here?

A

gastritis secondary to CRF

111
Q

What lesion is shown here?

A

fibrous osteodystrophy secondary to CRF

112
Q

What lesion is shown here?

A

diffuse renal fibrosis

Anatomic Pathology 2 (48 decks)

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