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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
what wrong
Medullary/ papillary/ renal crest necrosis
26
what is the pathogenesis of NSAID induced nephropathy
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
27
what are some associated lesions in horses with NSAID induced nephropathy
1. Right dorsal colitis 2. Laminitis 3. Gastritis
28
from horse- what wrong and what cause
Top image- renal papilla necrosis Bottom image: right dorsal colitis Cause: NSAIDS
29
what is hydronephrosis
unilateral or bilateral dilation of renal pelvis and calyces with tissue atrophy
30
what is cause of hydronephrosis
obstruction
31
what is pathogenesis of hydronephrosis
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
32
hydronephrosis has a high mortality if __
bilateral
33
what wrong and what is most likely cause
hydronephrosis Cause: obstruction
34
what wrong and what cause
hydronephrosis Cause: TCC
35
what is the portal of entry into glomerular compartment of kidney
hematogenous
36
what is defense mechanism in glomerular compartment
glomerular filtration barrier- capillary endothelium, basement membrane and podocytes
37
what does the glomerular mesangium contain
monocyte-macrophage system
38
Damage to the glomerulus leads to what
leakage of proteins (albumin—> protein urea—> protein losing nephropathy
39
UPC (urine protein: urine creatinine) ratio is 1-3, suggests __
tubular injury
40
UPC >3 suggests ____
glomerular permeability/damage
41
Marked proteinuria may progress to a __
nephrotic syndrome
42
___ in the urine= marked glomerular permeability, they are bigger than albumin
immunoglobulins
43
answer kahoot
1. Creatinine 2. Albumin 3. Ig
44
what is nephrotic syndrome
marked protein loss in urine
45
what are the 4 components of nephrotic syndrome
1. Proteinuria 2. Hypoalbunemia 3. Generalized edema 4. Hypercholesterolemia/ hyperlipidemia
46
what is pathogenesis of nephrotic syndrome
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
47
what is pathogenesis of glomerulonephritis
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
48
what is most common cause of glomerulonephritis
idiopathic
49
what breed is predisposed to glomerulonephritis
BMD
50
what is gross appearance of glomerulonephritis
red to tan speckling in cortex, chronic irregular surface with areas of fibrosis
51
from BMD- what likely cause
Glomerulonephritis
52
what is sequela of glomerulonephritis
progress to end stage renal failure
53
what is amyloid
abnormally folded protein (B-pleated sheets)
54
what is pathogenesis of renal amyloidosis
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
what breeds/species predisposed to renal amyloidosis
shar-pei, abyssian cat
56
what wrong
renal amyloidosis
57
what wrong and what stain used in bottom image
Renal amyloidosis Bottom stain: Congo red
58
what is sequela to renal amyloidosis
protein losing nephropathy, papillary necrosis, nephrotic syndrome, chronic renal failure
59
what is pathogenesis of acute suppurative glomerulitis: bacterial (embolism) nephritis
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
what wrong and what most common cause in horse, sheep and goats, pigs, and cattle
Acute suppurative glomerulitis/ bacterial (embolism) nephritis Horse: Actinobacillus equuli Sheep and goat: C. Pseudotuberculosis Pigs: E. Rhusiopathie Cattle: T. Pyogenes
61
what are the portals of entry in tubular compartment
1. Glomerular filtrate 2. Ascending injury 3. Hematogenous
62
what is defense mechanism for tubular compartment
tubular basement membrane
63
what is the most important cause of acute renal failure
acute tubular necrosis
64
what are the causes of acute tubular necrosis
1. Hypoperfusion/shock 2. Nephrotoxins
65
what is destroyed in acute tubular necrosis caused by hypoperfusion/shock
tubular epithelium and basement membrane
66
what type of necrosis do you get with acute tubular necrosis caused by hypoperfusion/shock
patchy necrosis
67
what part of tubular system most sensitive to cute tubular necrosis caused by hypoperfusion/shock
proximal tubules
68
what is destroyed in acute tubular necrosis caused by nephrotoxins
epithelial necrosis with preservation of basement membrane
69
what type of necrosis is caused by acute tubular necrosis caused by nephrotoxins
extensive necrosis
70
what part of the tubular system is most sensitive to acute tubular necrosis caused by nephrotoxins
proximal tubules
71
answer kahoot
nephrotoxicity because basement membrane intact
72
what is gross appearance of kidney damaged by nephrotoxins
1. Cortex- may see nothing, swollen, pallor, white steaks 2. Medulla: pale or congested
73
What is histo appearance of kidney from nephrotoxin damage. What is it dependent on
depends on duration of exposure and severity of toxin Initially PCT—> PCT and DCt—> LOH—> CD
74
t or f: glomeruli are affected by nephrotoxins
false
75
answer kahoot
PCT
76
nephrotoxic agent ethylene glycol is major compound in __
antifreeze
77
what is pathogenesis of ethylene glycol causing renal damage
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
dog suddenly dies- do necropsy and kidney shows signs of acute renal failure. Take biopsy and see this- what cause
ethylene glycol- formation of calcium oxalate crystals
79
what is pathogenesis of ingesting nephrotoxic agent melamine and cyanuric acid
1. Ingestion of food containing compound 2. Acute tubular necrosis of DCT 3. Golden brown circular crystals in DCT
80
dog went into acute renal failure after owner started on new diet. What wrong and what cause
golden brown circular cysts in DCT Cause: melamine and cyanuric acid
81
what species does oak toxicity effect
cattle and horses
82
what is toxic principle in oak toxicity
tannin metabolites
83
what is pathogenesis of oak toxicity
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 5. Hematuria 6. Death
84
what is gross appearance of kidney with oak toxicity. Acute and chronic
Acute: pale, swollen, cortical petechiae Chronic: white streaking/ fibrosis in cortex and medulla
85
what likely caused these lesions in cow
oak toxicity Top image- cortical petechiae Bottom image: white streaking/ fibrosis
86
what antibiotics are nephrotoxin and which ones in that class are most and least nephrotoxic
aminoglycosides Most: neomycin Least: Amikacin
87
what is the pathogenesis of aminoglycosides causing renal damage
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
aminoglycosides also cause what other toxicity
ototoxicity
89
what Is the toxic principle in grapes/raisins
tannins
90
what flower is extremely bad for cats
Lilies
91
what do lilies cause in cats and what are some signs
severe acute tubular necrosis Vomiting and lethargy in 1-5 days and death within a few
92
what is pathogenesis of hemoglobinuria
1. Acute intravascular hemolysis 2. Increased hemoglobin in blood 3. Hemoglobin filtered by kidneys 4. Ischemic tubular necrosis and hemoglobinuria
93
what diseases cause hemoglobinuria in sheep, horses and any species
sheep: chronic copper toxicity Horses: red maple toxicity and neonatal isoerythrolysis Any: incompatible blood transfusions
94
What wrong and what cause
Hemoglobinuria Cause: oxidative agent
95
what wrong and what cause
hemoglobinuria Oxidative damage
96
what is pathogenesis of myoglibinuria
1. Muscle damage, necrosis and hypoperfusion 2. Renal ischemic tubular necrosis and myoglobin urea
97
what diseases can cause myoglobinuira
1. Exertional rhabdomyolysis 2. Capture myopathy 3. Trauma
98
what wrong and what cause
myoglobinura- muscle damage
99
what are the 3 differentials for red urine
1. Hematuria 2. Hemoglobinuria 3. Myoglobinura
100
what does Hematuria indicate
bleeding from urinary/ reproductive tract
101
you can tell difference between Hematuria and myoglobinura and hemoglobinuria after centrifuge. Which one is Hematuria
left
102
what is pyelonephritis
bacterial infection of renal pelvis with extension into tubules
103
what is pyelitis
inflammation of renal pelvis
104
pyelonephritis is more common in males or females
females
105
what is cause of pyelonephritis/type of infection
ascending infection
106
what is cause of pyelonephritis in all animals, cattle, pigs
all: E. Coli Cattle: Corynebacterium renale and T. Pyogenes Pigs: Actinobaculum suits
107
what are some risk factors for pyelonephritis
alkaline urine, urine with low osmolarity, urine stasis, urinary bladder sphincter malfunction and reflux
108
what are some clinical findings with pyelonephritis
fever, PU/PD, lumbar or renal pain, Hematuria
109
what are some gross findings of acute and chronic pyelonephritis
acute: suppurative exudate in calyces or pelvis Chronic: pelvic dilation and fibrosis
110
what wrong
pyelonephritis- suppurative exudate in calyces
111
what are portals of entry for interstitial compartment
1. Ascending injury 2. Hematogenous
112
what is defense mechanism of interstitial compartment
intact endothelial lining
113
suppurative inflammation seen in interstitial compartment mainly __
hematogenous bacteria
114
what is tubulointerstitial nephritis
inflammation of interstitium and tubules
115
t or f: most lepto infections are us clinical
true
116
What is pathogenesis of leptospirosis
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
what are some acute to subacute signs of lepto
systemic disease- nephritis, hepatitis, endotoxemia, hemoglobinuria, coagulopathy
118
what are some signs of chronic lepto
abortion, stillbirth, infertility, recurrent uveitis, interstitial nephritis
119
what is histo appearance of lepto
lymphoplasmacytic interstitial nephritis, fibrosis, tubular atrophy
120
what is pathogenesis of FIP
1. Infection and mutation of feline enteric coronavirus 2. Type IV hypersensitivity 3. Pyogranulomatous necrotizing vasculitis 4. Interstitial pyogranulomas
121
answer kahoot and how do you know
lymphoma on left and FIP on right FIP tracks on vessels
122
what is cause of chronic renal disease in cats
chronic renal infarcts and pyelonephritis
123
what is the gross appearance of chronic renal disease in cats
small kidneys with irregular depressions in cortical surface, fibrosis
124
what is histo of chronic renal disease in cats
chronic interstitial nephritis
125
from old cat- what wrong
chronic renal disease

Pathology II (26 decks)

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