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Pathology II > Lecture 21: Urinary Pathology 2 and 3 > Flashcards

Lecture 21: Urinary Pathology 2 and 3 Flashcards

1
Q

What is the portal of entry to vascular compartment of kidney

A

hematogenous

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2
Q

what is the defense mechanism of the vascular compartment of kidney

A

intact endothelial lining

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3
Q

what is hyperemia

A

active process of increased blood flow due to acute inflammation

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4
Q

what is congestion

A

passive process due to hypovolemic shock, cardiac insufficiency, or hypostasis

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5
Q

what causes hemorrhage of kidney

A

trauma or other underlying disease process (DIC, vasculitis, renal necrosis)

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6
Q

who does CHV-1 infect

A

young Puppies <4-6 weeks

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7
Q

what is pathogenesis of CHV-1 on kidney

A
  1. Intrauterine or neonatal infection
  2. Renal vascular insult
  3. Cortical hemorrhage and acute tubular necrosis with intraepithelial eosinophilic intranuclear inclusion bodies
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8
Q

answer kahoot

A

canine herpesvirus

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9
Q

From 5 week old puppy, what cause

A

CHV-1

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10
Q

histo from puppy kidney, suspect CHV-1 what is arrow pointing at

A

Intranuclear inclusion body

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11
Q

what is pathogenesis of renal infarcts

A
  1. Thromboembolism
  2. Regional ischemia
  3. Coagulative necrosis, hemorrhage, and inflammation
  4. Parenchymal loss and fibrosis over time
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12
Q

extent of damage from renal infarcts depends on what

A
  1. Septic vs sterile
  2. Size, number and location of occluded vessels
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13
Q

Is the following infarct acute, subacute or chronic

A

subacute

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14
Q

is the following infarct acute, subacute or chronic

A

chronic

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15
Q

is the following infract acute, subacute, or chronic

A

acute

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16
Q

acute tubular necrosis and cortical necrosis is a result of __/__

A

hypoperfusion/shock

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17
Q

how is outer cortex, inner cortex, and medulla affected in acute tubular necrosis

A

intrarenal blood flow disrupted—> decrease perfusion of outer cortex while perfusion of inner cortex and medulla maintained

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18
Q

ischemic acute tubular necrosis results in destruction of ___ and ___

A

tubular epithelium and basement membrane

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19
Q

cortical necrosis is caused by __

A

Prolonged renal ischemia

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20
Q

in cortical necrosis you get extensive necrosis of __ and __

A

tubules and glomeruli

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21
Q

what wrong and cause

A

patchy necrosis with necrotic proximal tubules
Cause: acute tubular necrosis

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22
Q

a lesion or disease that reduces medullary blood flow results in ischemic necrosis of __

A

papilla

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23
Q

what are two major causes of medullary ischemia

A
  1. NSAIDS and dehydration
  2. Dehydration—> medullary ischemia
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24
Q

what is the sequela to medullary/ papillary/ renal crest necrosis

A
  1. Necrotic tissue sloughs into renal pelvis forming a nidus for uroliths or directly caused obstruction
  2. Hydronephrosis
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25
Q

what wrong

A

Medullary/ papillary/ renal crest necrosis

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26
Q

what is the pathogenesis of NSAID induced nephropathy

A
  1. NSAID administration and dehydration/hypovolemia
  2. Dysfunction and damage of medullary cells
  3. Decrease production of prostaglandin vasodilators (PGE2)
  4. Hypoxia of renal papillae
  5. Well demarcated area of necrosis of renal papilla/inner medulla
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27
Q

what are some associated lesions in horses with NSAID induced nephropathy

A
  1. Right dorsal colitis
  2. Laminitis
  3. Gastritis
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28
Q

from horse- what wrong and what cause

A

Top image- renal papilla necrosis
Bottom image: right dorsal colitis

Cause: NSAIDS

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29
Q

what is hydronephrosis

A

unilateral or bilateral dilation of renal pelvis and calyces with tissue atrophy

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30
Q

what is cause of hydronephrosis

A

obstruction

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31
Q

what is pathogenesis of hydronephrosis

A
  1. Obstruction and continued glomerular filtration
  2. Tubule dilation and pressure atrophy of pelvis and tubules
  3. Compression of vasculature
  4. Papillary ischemia and necrosis
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32
Q

hydronephrosis has a high mortality if __

A

bilateral

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33
Q

what wrong and what is most likely cause

A

hydronephrosis
Cause: obstruction

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34
Q

what wrong and what cause

A

hydronephrosis
Cause: TCC

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35
Q

what is the portal of entry into glomerular compartment of kidney

A

hematogenous

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36
Q

what is defense mechanism in glomerular compartment

A

glomerular filtration barrier- capillary endothelium, basement membrane and podocytes

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37
Q

what does the glomerular mesangium contain

A

monocyte-macrophage system

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38
Q

Damage to the glomerulus leads to what

A

leakage of proteins (albumin—> protein urea—> protein losing nephropathy

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39
Q

UPC (urine protein: urine creatinine) ratio is 1-3, suggests __

A

tubular injury

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40
Q

UPC >3 suggests ____

A

glomerular permeability/damage

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41
Q

Marked proteinuria may progress to a __

A

nephrotic syndrome

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42
Q

___ in the urine= marked glomerular permeability, they are bigger than albumin

A

immunoglobulins

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43
Q

answer kahoot

A
  1. Creatinine
  2. Albumin
  3. Ig
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44
Q

what is nephrotic syndrome

A

marked protein loss in urine

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45
Q

what are the 4 components of nephrotic syndrome

A
  1. Proteinuria
  2. Hypoalbunemia
  3. Generalized edema
  4. Hypercholesterolemia/ hyperlipidemia
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46
Q

what is pathogenesis of nephrotic syndrome

A
  1. Marked glomerular damage
  2. Large loss of protein from blood (hypoalbunemia) into urine (proteinuria)
  3. Decreased oncotic pressure
  4. Generalized edema and increased lipids in blood
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47
Q

what is pathogenesis of glomerulonephritis

A
  1. Infection of low pathogenicity with chronic antigenic stimulation
  2. Immune reaction with immune complex formation that lodges in glomeruli
  3. Reaction of mesangial cells and recruitment of inflammatory cells
  4. Inflammatory and mesangial cells release enzymes and cytokines
  5. Damage and mesangial proliferation
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48
Q

what is most common cause of glomerulonephritis

A

idiopathic

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49
Q

what breed is predisposed to glomerulonephritis

A

BMD

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50
Q

what is gross appearance of glomerulonephritis

A

red to tan speckling in cortex, chronic irregular surface with areas of fibrosis

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51
Q

from BMD- what likely cause

A

Glomerulonephritis

52
Q

what is sequela of glomerulonephritis

A

progress to end stage renal failure

53
Q

what is amyloid

A

abnormally folded protein (B-pleated sheets)

54
Q

what is pathogenesis of renal amyloidosis

A
  1. Chronic inflammation/ antigenic stimulation
  2. Increase SAA by liver
  3. AA fibrils form
  4. Deposit in glomeruli (most dogs and ruminants) and medulla (shar-pedi dog, cats, ruminants)
  5. Severe protein loss
55
Q

what breeds/species predisposed to renal amyloidosis

A

shar-pei, abyssian cat

56
Q

what wrong

A

renal amyloidosis

57
Q

what wrong and what stain used in bottom image

A

Renal amyloidosis
Bottom stain: Congo red

58
Q

what is sequela to renal amyloidosis

A

protein losing nephropathy, papillary necrosis, nephrotic syndrome, chronic renal failure

59
Q

what is pathogenesis of acute suppurative glomerulitis: bacterial (embolism) nephritis

A
  1. Bacteremia/septicemia
  2. Bacteria lodge in glomerular capillaries and interstitial capillaries (bacterial emboli)
  3. Causes inflammation and sometimes infarction
  4. Forms micro abscesses and necrosis
60
Q

what wrong and what most common cause in horse, sheep and goats, pigs, and cattle

A

Acute suppurative glomerulitis/ bacterial (embolism) nephritis
Horse: Actinobacillus equuli

Sheep and goat: C. Pseudotuberculosis

Pigs: E. Rhusiopathie

Cattle: T. Pyogenes

61
Q

what are the portals of entry in tubular compartment

A
  1. Glomerular filtrate
  2. Ascending injury
  3. Hematogenous
62
Q

what is defense mechanism for tubular compartment

A

tubular basement membrane

63
Q

what is the most important cause of acute renal failure

A

acute tubular necrosis

64
Q

what are the causes of acute tubular necrosis

A
  1. Hypoperfusion/shock
  2. Nephrotoxins
65
Q

what is destroyed in acute tubular necrosis caused by hypoperfusion/shock

A

tubular epithelium and basement membrane

66
Q

what type of necrosis do you get with acute tubular necrosis caused by hypoperfusion/shock

A

patchy necrosis

67
Q

what part of tubular system most sensitive to cute tubular necrosis caused by hypoperfusion/shock

A

proximal tubules

68
Q

what is destroyed in acute tubular necrosis caused by nephrotoxins

A

epithelial necrosis with preservation of basement membrane

69
Q

what type of necrosis is caused by acute tubular necrosis caused by nephrotoxins

A

extensive necrosis

70
Q

what part of the tubular system is most sensitive to acute tubular necrosis caused by nephrotoxins

A

proximal tubules

71
Q

answer kahoot

A

nephrotoxicity because basement membrane intact

72
Q

what is gross appearance of kidney damaged by nephrotoxins

A
  1. Cortex- may see nothing, swollen, pallor, white steaks
  2. Medulla: pale or congested
73
Q

What is histo appearance of kidney from nephrotoxin damage. What is it dependent on

A

depends on duration of exposure and severity of toxin

Initially PCT—> PCT and DCt—> LOH—> CD

74
Q

t or f: glomeruli are affected by nephrotoxins

75
Q

answer kahoot

76
Q

nephrotoxic agent ethylene glycol is major compound in __

A

antifreeze

77
Q

what is pathogenesis of ethylene glycol causing renal damage

A
  1. Ingest ethylene glycol
  2. Rapidly absorbed by GIT
  3. Metabolized by liver
  4. Filtered by glomeruli
  5. Direct tubular toxicity and mechanical damage from formation of Ca2+ oxalate crystals—> acute tubular injury—> acute renal failure
78
Q

dog suddenly dies- do necropsy and kidney shows signs of acute renal failure. Take biopsy and see this- what cause

A

ethylene glycol- formation of calcium oxalate crystals

79
Q

what is pathogenesis of ingesting nephrotoxic agent melamine and cyanuric acid

A
  1. Ingestion of food containing compound
  2. Acute tubular necrosis of DCT
  3. Golden brown circular crystals in DCT
80
Q

dog went into acute renal failure after owner started on new diet. What wrong and what cause

A

golden brown circular cysts in DCT
Cause: melamine and cyanuric acid

81
Q

what species does oak toxicity effect

A

cattle and horses

82
Q

what is toxic principle in oak toxicity

A

tannin metabolites

83
Q

what is pathogenesis of oak toxicity

A
  1. Ingestion of leaves, buds, acorns
  2. Tannins altered into toxic metabolites
  3. Target endothelial cells
  4. Vascular leakage
  5. Hydrothorax, ascites, perirenal edema, GI ulcers, acute tubular injury
  6. Hematuria
  7. Death
84
Q

what is gross appearance of kidney with oak toxicity. Acute and chronic

A

Acute: pale, swollen, cortical petechiae
Chronic: white streaking/ fibrosis in cortex and medulla

85
Q

what likely caused these lesions in cow

A

oak toxicity
Top image- cortical petechiae
Bottom image: white streaking/ fibrosis

86
Q

what antibiotics are nephrotoxin and which ones in that class are most and least nephrotoxic

A

aminoglycosides
Most: neomycin
Least: Amikacin

87
Q

what is the pathogenesis of aminoglycosides causing renal damage

A
  1. Antibiotic filtered by glomeruli
  2. Accumulate in lysosomes of PCT
  3. Once large concentration in lysosomes will escape into cytoplasm
  4. Injury and death of PCT
88
Q

aminoglycosides also cause what other toxicity

A

ototoxicity

89
Q

what Is the toxic principle in grapes/raisins

90
Q

what flower is extremely bad for cats

91
Q

what do lilies cause in cats and what are some signs

A

severe acute tubular necrosis

Vomiting and lethargy in 1-5 days and death within a few

92
Q

what is pathogenesis of hemoglobinuria

A
  1. Acute intravascular hemolysis
  2. Increased hemoglobin in blood
  3. Hemoglobin filtered by kidneys
  4. Ischemic tubular necrosis and hemoglobinuria
93
Q

what diseases cause hemoglobinuria in sheep, horses and any species

A

sheep: chronic copper toxicity
Horses: red maple toxicity and neonatal isoerythrolysis
Any: incompatible blood transfusions

94
Q

What wrong and what cause

A

Hemoglobinuria
Cause: oxidative agent

95
Q

what wrong and what cause

A

hemoglobinuria
Oxidative damage

96
Q

what is pathogenesis of myoglibinuria

A
  1. Muscle damage, necrosis and hypoperfusion
  2. Renal ischemic tubular necrosis and myoglobin urea
97
Q

what diseases can cause myoglobinuira

A
  1. Exertional rhabdomyolysis
  2. Capture myopathy
  3. Trauma
98
Q

what wrong and what cause

A

myoglobinura- muscle damage

99
Q

what are the 3 differentials for red urine

A
  1. Hematuria
  2. Hemoglobinuria
  3. Myoglobinura
100
Q

what does Hematuria indicate

A

bleeding from urinary/ reproductive tract

101
Q

you can tell difference between Hematuria and myoglobinura and hemoglobinuria after centrifuge. Which one is Hematuria

102
Q

what is pyelonephritis

A

bacterial infection of renal pelvis with extension into tubules

103
Q

what is pyelitis

A

inflammation of renal pelvis

104
Q

pyelonephritis is more common in males or females

105
Q

what is cause of pyelonephritis/type of infection

A

ascending infection

106
Q

what is cause of pyelonephritis in all animals, cattle, pigs

A

all: E. Coli
Cattle: Corynebacterium renale and T. Pyogenes
Pigs: Actinobaculum suits

107
Q

what are some risk factors for pyelonephritis

A

alkaline urine, urine with low osmolarity, urine stasis, urinary bladder sphincter malfunction and reflux

108
Q

what are some clinical findings with pyelonephritis

A

fever, PU/PD, lumbar or renal pain, Hematuria

109
Q

what are some gross findings of acute and chronic pyelonephritis

A

acute: suppurative exudate in calyces or pelvis
Chronic: pelvic dilation and fibrosis

110
Q

what wrong

A

pyelonephritis- suppurative exudate in calyces

111
Q

what are portals of entry for interstitial compartment

A
  1. Ascending injury
  2. Hematogenous
112
Q

what is defense mechanism of interstitial compartment

A

intact endothelial lining

113
Q

suppurative inflammation seen in interstitial compartment mainly __

A

hematogenous bacteria

114
Q

what is tubulointerstitial nephritis

A

inflammation of interstitium and tubules

115
Q

t or f: most lepto infections are us clinical

116
Q

What is pathogenesis of leptospirosis

A
  1. Bacteria penetrate mucosal surfaces or water softened skin
  2. Spreads
  3. Multiples in organs
  4. By one week organism cleared except from sites like renal PCT, ocular vitreous and CSF
117
Q

what are some acute to subacute signs of lepto

A

systemic disease- nephritis, hepatitis, endotoxemia, hemoglobinuria, coagulopathy

118
Q

what are some signs of chronic lepto

A

abortion, stillbirth, infertility, recurrent uveitis, interstitial nephritis

119
Q

what is histo appearance of lepto

A

lymphoplasmacytic interstitial nephritis, fibrosis, tubular atrophy

120
Q

what is pathogenesis of FIP

A
  1. Infection and mutation of feline enteric coronavirus
  2. Type IV hypersensitivity
  3. Pyogranulomatous necrotizing vasculitis
  4. Interstitial pyogranulomas
121
Q

answer kahoot and how do you know

A

lymphoma on left and FIP on right

FIP tracks on vessels

122
Q

what is cause of chronic renal disease in cats

A

chronic renal infarcts and pyelonephritis

123
Q

what is the gross appearance of chronic renal disease in cats

A

small kidneys with irregular depressions in cortical surface, fibrosis

124
Q

what is histo of chronic renal disease in cats

A

chronic interstitial nephritis

125
Q

from old cat- what wrong

A

chronic renal disease

Pathology II (26 decks)

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