Patterns Of Disease In Kidney Flashcards
Possible portals/routes of entry into urinary tract
Haematogenous- blood
Ascending from lower urinary tract
Epidermal (from skin)
Direct injury
Haematogenous entry
-features
Localise in large renal vessel, interstitial vessel, glomerular capillary
- can lead to Infarction
– Septic
– Immune-mediated disease
– Can affect glomerulus, tubule and/or interstitium
Ascending from lower urinary tract
– Females mainly
– Secondary to gastrointestinal, genital, or epidermal contamination
– Targets tubules and interstitium primarily
Direct injury
-features
Substances secreted into glomerular filtrate
-e.g Formation of crystals which damage cells
-affects tubules mainly
Describe the Defence mechanisms of kidney
‒ Vasculature: Basement membrane
‒ Glomerulus:
Glomerular basement membrane (GBM; filtration barrier); glomerular
mesangium (phagocytic)
‒ Tubules:
Basement membrane (provides physical
barrier and scaffolding)
‒ Interstitium:
Innate humoral and cell-mediated immune system responses
Patters of disease in kidney are recognised by…
Route of infection
Name the main routes of infection
– (Developmental)
– Vascular
– Glomerular
– Tubules/Tubulointerstitial – Pelvis/Ascending
– Endstagekidney (everywhere)
– Anylocation
Developmental infection
What is fused kidneys
What are polycystic kidneys
Vascular lesions
-what is this
-what is it caused by
-Blood vessels are blocked
-An infarction (inadequate blood supply)
3 types of progression of vascular lesions infarction
Acute—>
Subacute—>
Chronic—>
Vascular lesions- what is haemorrhage
Any systemic vascular injury (e.g.: septicaemia, vasculitis, DIC)
Glomerular lesions
-3 types
• Glomerulonephritis/glomerulonephropathy
• Glomerular amyloidosis
• Glomerulosclerosis
Endpoint of glomerular disease:
Protein losing nephrotrophy
What can glomerular disease lead to?
Hypoproteinaemia, decreased oncotic pressure, loss of ATIII (hypercoagulability)
Nephrotic syndrome: hypoproteinaemia, proteinuria, ascites, hypercholesterolaemia
Glomerulonephritis / Glomerulonephropathy
• most common cause for this; Immune-mediated disease
—Most common is immune complex (Ag-Ab) deposition
-May be due to animal having viral or bacterial infections – FeLV, FIP, pyometra, chronic parasitism (dirofilariasis)
-May be autoimmune;
Systemic lupus erythematosus (SLE)
Neoplasia
• Results in continual damage to GBM via podocyte effacement
Glomerulonephritis: Lesions
-grossly
-histological
usually normal
May see uniform, tan/red “dots” (limited to cortex)
-so not much
Immune deposits are red “dots” along capillary loops
-should see lesions more clearly
How would you do a diagnosis of lesions
renal biopsy HE, special stains, EM, immunofluorescence
Glomerular Amyloidosis
-grossly
Can see enlarged, pale or orange, waxy kidneys
Amyloid deposition which expands mesangium
What are amyloids
– Insoluble fibrillar protein deposited in
extracellular space
– Associated with source of chronic ongoing inflammation
-Most commonly found in glomerular
Occurs in Glomerular Amyloidosis
What glomerular disease is shown in this image
Put on anki*
Glomerulosclerosis
• End-stage glomerulus = obsolescent
– Obliteration of capillary loops with increased matrix and fibrous CT
– Nonspecific response to chronic glomerular injury
• Effects on tubules (via dec flow in efferent arterioles)
• Mild, multifocal, segmental GS is COMMON in aged animals
• can lead to End-stage kidney = severe, multifocal to diffuse
What is sclerosis
= hardening of tissue (usually due to fibrosis)
Protein-losing glomerular injury—>
Name the Tubulointerstitial Diseases
• Acute tubular necrosis
– Nephrotoxic vs. ischemic
Oxalate nephrosis
Acute Tubular Necrosis:
-caused by…
Toxins; e.g antifreeze consumption, ethylene glycol metabolites
Drugs
Plants; oxalate
Bacterial
Metals; lead mercury
Miscellaneous
Vitamin D
Haem/myoglobin
Oxalate nephrosis
-grossly
Cortex much paler
Haemorrhages
Tubulointerstitial lesions
-grossly
-result of…
Pitted, irregular surface due to interstitial fibrosis
– Palefoci= result of inflammation (lymphoplasmacytic to mixed) and fibrosis
Leptospirosis lesions
-grossly
-Histological
pale radiating streaks in cortex and haemorrhagic foci in cortex and medulla
Histology: interstitial inflammation and tubular degeneration
Tubulointerstitial: FIP
• Systemic disease with
vasculitis (phlebitis)
• Pyogranulomatous to
• lymphoplasmacytic nephritis
Track along vasculature in FIP
• Lesions can look like lymphoma
Tubulointerstitial lesions
-histologically
• Tubular dilation, attenuation of epithelium
• Casts
• Interstitial fibrosis
• Interstitial inflammation
Renal pelvis
-2 types
• Hydronephrosis
• Pyelonephritis
Hydronephrosis
-what is this
-lateral or bilateral
dilation of renal pelvis
– can cause Obstruction of outflow (calculi) of urine
Likely to be bilateral (affect both kidneys)
Clinical significance variable
Pyelonephritis
-result of…
-common diseases causing this
-As a result of ascending infection in domestic animals
-Impaired vesico-ureteral reflux (2ndary obstruction, cystitis)
-Common:
E. coli Proteus
Klebsiella
Staph, Strep (all species)
C. renale & T. pyogenes
(cattle)
Neoplasia
-main ones in kidney
• Epithelial:
-Renal carcinoma – most common primary
– Transitional cell carcinoma (from lower urinary tract)
– Nephroblastoma
• Mesenchymal
• Round cell: Lymphoma
End stage kidney in uraemia
-hallmark of chronicity is…
-grossly
-histologically
• Hallmark of chronicity is FIBROSIS
• Gross: pale, shrunken, pitted, firm
• Histology: increased connective tissue with ectatic/atrophied tubules and sclerotic glomeruli
Sequelae / Nonrenal lesions of renal failure
-2 types
• Sequelae of acute renal failure
– Death due to elevated serum potassium,
metabolic acidosis, and/or pulmonary oedema
– Recovery
• Sequelae of chronic renal failure:
– Mineralisation of tissues (usually chronic)
Uremic acids
-Lungs, gastric mucosa, intercostal pleura, renal
tubules, left atrium and great vessels
-Elevated Ca x P product
– Uraemia = clinical manifestation of azotaemia
– Uremic ulcers (glossitis, gastritis)
Uremic acids cause…
Injury to small vessels
