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BVetMed4 - Urinary > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

Describe the gross appearance of kidneys in chronic renal failure.

A

Pale and shrunken with irregular depressions of the capsular surface

  • contraction of scar tissue causes irregularity
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2
Q

What features on histology may be observed in chronic renal failure?

A

Glomerulosclerosis

Periglomerular fibrosis

Degeneration and loss of tubules

Interstitial fibrosis

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3
Q

Define glomerulosclerosis

A

The glomerular tuft can become damaged and replaced by fibrous connective tissue

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4
Q

What is periglomerular fibrosis?

When in disease progression is this seen?

A

Fibrosis just around the glomerulus

Earlier than glomerulosclerosis

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5
Q

What occurs when tubules have degenerated?

A

Scar tissue fills the space where tubules are lost

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6
Q

What occurs as a result of interstitial fibrosis?

A

Presses on tubules causing atrophy

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7
Q

Describe some potential biochemical/clinical features of uraemia

A

Azotaemia + clinical signs :

  • metabolic acidosis,
  • other electrolyte imbalances
  • oedema (plasma protein loss)
  • mild non-regenerative anaemia
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8
Q

Outline secondary renal hyperparathyroidism

A

-When GFR low, phosphate no longer removed by kidneys enough
-Phosphate binds free calcium + precipitates in the serum - METASTATIC MINERALISATION
-Decrease 1 a-hydroxylase activity and subsequent D3 activation
- reduced calcium absorption and ionised serum calcium
PTH secretion -> chief cell hyperplasia

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9
Q

What occurs as a result of secondary renal hyperparathyroidism?

How does this occur

A

Fibrous osteodystrophy
Osteoclastic resorption of bone and replacement by fibrous connective tissue

Nephrocalcinosis - deposition of Ca in the kidney

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10
Q

What causes nephrocalcinosis?

A

Secondary renal hyperparathyroidism
Primary hyperparathyroidism
Vitamin D intoxication
Hypercalcaemia of malignancy

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11
Q

What neoplasias are associated with hypercalcaemia of malignancy?

A

Lymphomas

Anal sac adenocarcinomas

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12
Q

How does hypercalcaemia of malignancy occur?

A

Paraneoplastic effect where PTH-rap is mimicking the effect of PTH in the body

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13
Q

What non-renal mechanisms of pathology are associated with uraemia?

A

VASCULITIS
- endothelial degeneration and necrosis - thrombosis and infarction

Caustic injury to ORAL cavity and STOMACH - ammonia after urea breakdown by bacteria

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14
Q

Describe oral lesions associated with uraemia

A

Ventral surface on edge of tongue
Often bilateral

Ulcerative glossitis and stomatitis

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15
Q

What gastrointestinal lesions can be attributed to uraemia?

A

Ulcerative glossitis and stomatitis

Ulcerative and haemorrhagic gastritis/colitis

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16
Q

What CNS lesion is associated with uraemia?

A

Uraemic encephalopathy (degredation of White matter)

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17
Q

What lesions in the thoracic cavity are associated with uraemia ?

A

Fibrinous pericarditis
Uraemic pneumonitis and pulmonary calcification
Intercostal mineralisation

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18
Q

What is the underlying pathogenesis behind fibrinous pericarditis, arteritis and uraemic pneumonitis and pulmonary calcification?

A

Vasculitis

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19
Q

How is acute renal failure defined and what are the consequences?

A

> 75% loss of function

Oliguria or anuria
Azotaemia 
Hyperkalaemia 
Hypocalcaemia 
Metabolic Acidosis 
Hypertension
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20
Q

How can pathological agents access the kidney?

A

Haematogenous

Glomerular infiltrate

Ascending from the ureter

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21
Q

What haematogenous agents can cause renal pathology?

A

Septic embolic nephritis

Ischaemic necrosis post infarction

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22
Q

What glomerular infiltrate can cause pathology?

A

Substance secreted into the filtrate causing trauma to tubular lining OXYLATE CRYSTALS - ethylene glycol

Filtered preformed toxins or substances processed by tubular lining epithelium

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23
Q

What conditions may predispose a patient to developing an ascending infection from the ureter?

A

GIT contamination - diarrhoea
Genital tract contamination - pyometra
Dermal contamination - perivulval dermatitis

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24
Q

Name some developmental disorders of the kidney

A

Renal aplasia/hypoplasia/dysplasia

Ectopic kidneys

Fused kidneys

Progressive juvenile nephropathy

Polycystic kidney disease

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25
When is renal aplasia/hypoplasia/dysplasia a problem?
When it is bilateral
26
What can be an issue with ectopic kidneys?
Secondary Hydronephrosis due to kinking of ureters
27
What is the presentation seen with progressive juvenile nephropathy? What species?
DOG Present usually less than 2 years with end stage kidney disease typical of what you would see in an older animal
28
What is polycystic kidney disease? What is it seen in?
Persian Cats and Bull Terriers Problem with the tubular epithelium which allows large cystic cavities to form within the kidney Pressure atrophy and necrosis of normal surrounding tissue
29
When does immune mediated glomerulonephritis occur?
Persistent infections or prolonged antigenaemias which enhances formation of soluble immune complexes (+complement fixation and damage by leukocytes)
30
Describe the pathogenesis of immune mediated glomerulonephritis
Soluble immune complexes circulating can be deposited in the capillaries of the glomerular tufts or the basement membrane -> interferes with filtration When deposited, bind with complement releasing chemo tactic substances Attract leukocytes which release reactive oxygen species causing more damage
31
What is glomerular amyloidosis? When does it occur?
Deposition of extracellular protein Chronic inflammatory disorders, Systemic infectious disease, Neoplasia
32
What causes acute suppurative glomerulitis?
BACTERAEMIA Bacteria lodge in glomerular and interstitial capillaries and form microabscesses in the cortex.
33
What bacteria are associated with acute suppurative glomerulitis in: Foals Cows Pigs Sheep+goats
Foals - actinobacillus equuli Cows - Trueperella pyogenes Pigs - Erisipelothrix rheusiopathiae Sheep+Goats - Corynebacterium pseudotuberculosis
34
What is Nephrotic syndrome?
PLN -> NS Decrease in plasma osmotic pressure and loss of antithrombin III Oedema and effusions, hypercoagulability and hupercoagulability
35
What does nephrotic syndrome occur as a result of?
Glomerular damage - PLN
36
What is the most important cause of acute renal failure?
Acute tubular necrosis
37
When does acute tubular necrosis occur?
After nephrotoxic or ischaemic injury to the proximal tubular epithelium
38
Why is oliguria/anuria associated with acute tubular necrosis?
Leakage of tubular filtrate into interstitium Intratubular obstruction from sloughed epithelium
39
Why do toxins in blood preferentially damage the kidney?
Kidney recieves 25% of CO
40
How does nephrotoxin associated ischaemia occur?
Reactive metabolites are produced as they’re being processed by the cells Stimulate vasoconstriction -> ischaemia
41
After which insult is the tubular basement membrane more likely to be retained? How does this relate to prognosis?
TOXIC Improved - allows for regeneration
42
What agents can cause acute tubular necrosis?
NSAIDS Fungal and plant toxins Ethylene glycol Bacterial toxins
43
How do NSAIDs cause acute tubular necrosis?
Decreased PG synthesis (which usually causes vasodilation) Afferent arteriolar constriction Decreased renal perfusion Acute tubular and papillary necrosis
44
What makes ATN from NSAIDs more likely?
Excessive doses, Underlying dehydration, CHF CRD
45
What fungal and plant toxins cause ATN?
Mycotoxins - Aspergillus Lily plants cats Grapes and raisins dogs Oak poisoning in cows
46
How does Ethylene glycol cause ATN?
Dogs cats pigs -> readily absorbed from GIT Oxidised by the liver to toxic glycolic acid and oxalate Filtered by glomeruli - direct toxin to tubules Calcium oxylate crystals precipitate into tubular lumen -> obstruction and damage epithelium
47
What nephrotoxin is produced by C. Perfringens type D? What does it cause?
Epsilon PULPY KIDNEY
48
How does a small ruminant get pulpy kidney?
Overeating esp. well conditioned lambs Proliferation of clostridium type D Epsilon toxin Pulpy kidney
49
Describe the pathology of Pulpy Kidney
Acute tubular degeneration and/or necrosis Interstitial oedema and haemorrhage
50
What changes in the urine are associated with pulpy kidney?
Glycosuria
51
What causes disease of the interstitium?
Ascending infection - pyelonephritis Haematogenous - E.Coli and Leptospira, Canine adenovirus Secondary to injury of tubules/glomeruli (infectious, toxic, IMD)
52
Describe the appearance of a kidney with E.coli
White spotted kidney disease
53
Describe the kidney pathology associated with FIP
Granulomatous necrotising vasculitis
54
Outline the difference between hyperaemia and congestion
Hyperaemia - increased arterial blood flow e.g. acute inflammation Congestion - venous blood pooling (cardiac insufficiency, hypovolaemic shock, agonal)
55
What kidney changes are seen in septicaemia?
Pinpoint petechial haemorrhages
56
A puppy presents with sudden death and cortical ecchymotic haemorrhage on PM. DDx?
Canine HERPESVIRUS Causes direct endothelial damage
57
What area of the kidney will be affected if the interlobular artery is blocked?
CORTEX
58
What area of the kidney will be affected if the arcuate artery is blocked?
CORTEX+ MEDULLA
59
What are the sources of renal emboli?
Cardiac mural or valvular Endarteritis in pancreatic dz - angiostrongylus, strongylus vulgaris Neoplastic cell emboli Bacterial or septic emboli
60
Describe the appearance of an acute embolism in the kidney
Discrete dark wedge
61
Describe the appearance of a sub-acute embolism in the kidney
Lighter in colour as cells have undergone necrosis
62
Describe the appearance of chronic embolism in the kidney
Fibrous tissue laid down which contracts - depression
63
When would a patient with hydronephrosis tend to present clinically?
If bilateral
64
What predisposes a patient to hydronephrosis?
Congenital malformation Urethral or urethral blockage (calculi, neoplasia, inflammation) Neurogenic functional disorders Iatrogenic (accidentally tying off ureter)
65
What is pyelonephritis ? What is the most common cause?
Bacterial infection of the pelvis with extension into tubules and interstitium Ascending infection
66
What bacteria can cause pyelonephritis?
``` Corynebacteria E. coli Staph and Strep Pseudomonas Trueperella ```
67
What type of infarction is associated with pyelonephritis?
POLAR
68
What can cause primary papillary necrosis?
NSAIDs Ischaemic necrosis of inner medulla
69
What can cause secondary papillary necrosis?
Decreased blood flow to vasa recta | - glomerular dz, interstitial dz, compression of papilla e.g. stones
70
What is the most common primary renal neoplasm? | Metastatic?
Renal carcinoma Highly metastatic
71
What paraneoplastic effect is associated with renal carcinoma?
Polycythaemia - EPO
72
What developmental anomalies affect the LUT?
Ureteral aplasia and hypoplasia Ectopic ureters Patent Urachus (FOALS)
73
How can ureteral aplasia/hypoplasia affect the kidneys?
Obstruction -> hydronephrosis
74
How do patients with ectopic ureters tend to present? Why? What problems can they cause?
Urinary incontinence Empty into urethra, vagina, or bladder neck Prone to obstruction or infection
75
What is a patent urachus?
Foetal urachus fails to close -> direct channel between the bladder and umbilicus
76
What can cause a patent urachus?
Underlying omphalitis or congenital urethral obstruction creating backward pressure. Increased bladder pressure forces urine out into the urachus therefore dribbles urine from umbilicus
77
What Uroliths form at alkaline pH?
Struvites and carbonates
78
What uroliths form at acidic pH?
Oxalates
79
What stones are Dalmatians predisposed to? Why?
Urate stones Uric acid unusually metabolised
80
How can vitamin A deficiency result in Urolithiasis?
Causes metaplasia of urinary tract epithelium from transitional to keratinised stratified -> DESQUAMATION This provides a nidus for calculus formation
81
What factors predispose calculus formation?
Urinary pH Reduced water intake - mineral supersaturation Bacterial infection LUT Abnormal metabolism e.g. dalmations High dietary levels of substances e.g. Mg VitA deficiency
82
What bacteria causes cystitis in many species?
Uropathogenic E. coli
83
What causes cystitis in cattle?
Corynebacterium renale
84
What causes cystitis in pigs?
Eubacterium suis
85
Describe the pathogenesis of cystitis
Hydrolysis of urea by urease producing bacteria Excessive ammonia Mucosal damage and increased urine pH
86
What causes emphysematous cystitis?
E.g DIABETICS Glycosuria enhances bacteria E.coli/C.perfringens metabolise and release CO2 CO2 released into bladder Lumen Absorption of gas into lymphatics ->emphysema
87
What causes toxic cystitis
Bracken fern -> enzootic haematuria Cyclophosphamide
88
What causes Enzootic haematuria?
Chronic ingestion of Bracken fern Haemorrhage, chronic cystitis, bladder neoplasia
89
Bladder neoplasia is uncommon but what are the main types?
Epithelial - transitional cell carcinoma Mesenchymal - rhabdomyosarcoma

BVetMed4 - Urinary (15 decks)

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