Renal Pathology - Part 1 Flashcards
Normal Kidney
Which species possess the following kidney types:
1. Unipyramidal (unilobar): ?
2. Multipyramidal (multilobar): ?
- Cats, dogs, horses, sheep, and goats
- Pigs and cattle
Label the image accordingly
Glomeruli = black pinpoints
cortex to medulla ratio in domestic species: 1:2/1:3
Blood leaves kidney via renal vein
Multiple lobes; each lobe is like 1 kidney.
cortex to medulla ratio in domestic species: 1:2/1:3
Bovine and pigs do not have renal crest; have multiple renal papillla
urine travels like so: minor calex –> major calex –> ureter
This kidney belongs to which species?
Ox
Bovine is the only species with external lobation
This kidney belongs to which species?
Horse
This kidney belongs to which species?
Pig
similar to structure of bovine
This kidney belongs to which species?
Dog
This kidney belongs to which species?
Cat
Are these kidneys normal or abnormal? Is this the color of a normal kidney? Explain your rationale for each image.
Color of a normal kidney?
Left - cat; renal tubular cells have large amounts of lipids which is why feline kidneys are lighter. Multiple veins/prominent is normal for cats as well.
Right - Bovine
Color should be dark brown/red; this is a diffusely pale kidney. Severely anemic kidney from cow.
What causes anemia in cattle? haemonchus contortus
Renal architecture
The kidney is composed of four structural units. Name these units.
- Renal corpuscle (glomerulus and Bowman’s capsule)
- Tubules
- Interstitium
- Vasculature
- The functional unit of the kidney is the _______, which includes the renal ______ and renal _______.
nephron, corpuscle, tubules
- The ______ contains the renal vasculature, which supplies blood first to the _______ and then to the renal ______.
interstitium, glomerulus, tubules
Renal artery branches and forms ________ artery –> ______ —> interlobular artery forming _______ artery –> small branches of intralobular artery form _____ arteriole that enter glomerulus –> blood leaves glomerulus through the _______ arteriole and then provides blood supply to _____ system (first proximal, ?, distal tubules, and then drains blood through veinous system) –> leaves kidney through ____ vein.
Blood enters through renal artery
Kidney is called an end artery organ, which is why the kidney is prone to infarct b/c (1) the blood vessels do not anastomose and (2) branching is in a right angle, so it is prone to emboli/embolis lodging.
interlobular, arcuate, intralobular, afferent, efferent, tubular, renal
Only 1 artery with multiple branches. The branches do NOT anastomose; right angle branches prone to emboli; first provide blood to glomerulus and then tubules.
*nephron is just 1 structure, the glomerulus, tubules is just 1 structure; so lesion in 1 –> other structures are affected
Bowman’s capsule surrounds ________; capsule surrounded by ______ epithelial cells.
Space between Bowmans capsules and glomeruli is the ______ _______.
Endothelial cell of capillaries is easier to ID in the _____ of glomerular duct.
Visceral epi or podocytes are called ________ cells; can not tell on microscope. Podocyte function: main function is ______ of the blood.
_______ and ______ cells line the basement membrane; important component of _________ filtration.
Mesangial cells form Mesangial matrix supports ______ structure. Mesangial cells can also _______ blood-borne pathogens.
Urine formation; filters _____ and keep the ______ molecules and proteins in blood, excrete waste products into the _______ ______.
proximal and distal tubules; proximal = _______ (increase absorptive surface), distal does not have microvilli
________ has multiple capillaries that provide blood to kidneys
glomerulus, parietal, urinary space, edge, mesangial, filtration, Capillaries, endothelial, glomerular, glomerular, phagocytize, plasma, important, urinary space, microvilli, Interstitium
- Can you see the glomeruli in normal kidneys?
- What do the white striations represent?
- In normal kidneys you can NOT see the glomeruli, so this kidney is damaged.
- white striations are the collecting ducts
Glomerular Filtration Barrier
* Structure formed by ______ cells, ______ membrane, and ______ epithelial cells (_______)
* Its main function is to filter _____ to maintain ___ and _____ homeostasis in the blood
endothelial, basement, visceral, podocytes, plasma, ionic, osmotic
Plasma flows: Capillary to urinary space where the glomerular filtration barrier is. Fenestrations present in ? Basement membrane and foot process of visceral epthelal podocytes; filter based on size of substance and elecrical charge.
Renal architecture
* Renal corpuscle
* Tubules
* Interstitium
* Vasculature
–> all are _______
If one component is irreversibly damaged, function of the other components will be _______! There is a tendency for chronic renal disease to affect ____ components of the kidney, resulting in ? –> identification of the initiating cause may be ______.
Interconnected, impaired, multiple, chronic renal failure (CRF) and shrunken, scarred end-stage kidneys, impossible
Renal function
“The kidney is the central organ involved in the maintenance of a
constant _____ environment in the body”
1. Excrete _____ waste
2. Maintenance of normal concentrations of ?
3. Regulation of ___-___ balance (bicarb is filtered and then the proximal epithelial cells reabsorb to maintain homeostasis)
4. Production of ______ - ?
5. Vitamin D to ___ form - 1,25 dihydroxycholecalciferol (1,25(oh)2d3)
*Requires – adequate renal ____ (>____ mm Hg), sufficient renal _____ and normal ______ of urine.
extracellular, metabolic, salt, water and electrolytes, acid-base, hormones, Erythropoietin (stimulate bone marrow to produce erythrocytes), Renin (renin-aklsterone) and Prostaglandins (renal medulla produces this- important for blood profusion; keeps vessels dilated to avoid vasoconstriction to avoid renal damage), active, perfusion, 60, tissue, elimination
Renal function
Renal disease is detected if any of these requirements are not met,
and the outcome is always appropriately the same:
There is imbalance of salt and water –> edema, and of acids
and bases –> metabolic acidosis, and there is retention of wastes.
The most commonly used index of failure is the amount of ___ and/or ______ that is retained!
urea, creatinine
Renal function
“The kidney is the central organ involved in the maintenance of a
constant extracellular environment in the body”
1. Excrete metabolic waste = ______
2. Maintenance of normal concentrations of salt and water = ____
3. Regulation of acid-base balance = ____
4. Production of hormones - Erythropoietin, Renin and
Prostaglandins = ?
5. **Hallmark of chronic renal failure Vitamin D to active form - 1,25 dihydroxycholecalciferol
(1,25(oh)2d3) = ?
Impairment of:
1.) Excrete metabolic waste = UREMIA
2.) Maintenance of normal concentrations of salt and water = EDEMA
3.) Regulation of acid-base balance = ACIDOSIS
4.)Production of hormones - Erythropoietin, Renin and Prostaglandins = ANEMIA, HYPERTENSION, ISCHEMIC NECROSIS
5.)5.Vitamin D to active form - 1,25 dihydroxycholecalciferol (1,25(oh)2d3) = HYPOCALCEMIA →→ HYPERCALCEMIA
renin angiotensin aldosterone system if activated leads to –> vasocontriction –> ?
ACUTE X CHRONIC RENAL FAILURE
* When renal function capacity is impaired approximately ___% or ____
75, more
Acute or Chronic renal failure?
Acute
Kidneys will be swollen
Subtle to ID
When you cut the kdieny, cut surface buldges because of how swollen it is. Swollen because urine goes ot the interstitium due ot iffuse tubular necrosis.
Retention of urine in the kidney; swollen and moist; paranchema buldges.
Acute or Chronic renal failure?
Chronic
Kidneys will be shrunken
Areas of mineralization
Loss of parenchyma; end stage kidney failure.
Acute renal failure - Prerenal
Caused by transient renal ______ due to?
_____% of cardiac output goes to kidney
hypoperfusion, - Hypotension, decreased cardiac output, decreased arterial blood volume (hypovolemia)
25
Acute renal failure - Postrenal
Due to ______ of the urinary tract
obstruction
Acute renal failure
Renal disease
1. Acute glomerulonephritis: (______ by bacteria or virus) (more _____ b/c blood supply is to the glomerulus and then tubules; sometimes agents bypass glomeruli).
2. Acute ______ _______ (septicemia by bacteria or virus)
3. Acute tubular necrosis (_______ or ______) (this is the most common cause of ____ renal failure in domestic species)
septicemia, common, interstitial nephritis, nephrotoxins, ischemia, acute
ARF by tubular necrosis
Most common signs of ARF?
Oliguria (decrease urine formation) and anuria (complete absence of urine production)
left : B/c of diffuse tubular necrosis, swelling of ? and basement menbrane; alll of urine goes to interstitium.
right: retention of urine due to bstruction.
due to anemia or diffuse tubular necrosis
renal cysts here too; common in bovine; congenital, incidental finding.
What can be seen in this image?
ARF by tubular necrosis
Tubules here are necrotic (large pink things)
Hypereosinophillic cytoplasm; lumen of tubules is complete obstructed by cellular debris. Nuclei are shrunken and condensed (pyknosis)
fragmentation of nuclei = pyrexia
Acute renal failure – Death occurs by?
*↑ serum K = cardiotoxicity (hyperkalemia)
* Metabolic acidosis (reclamation of bicarb stops)
* Pulmonary edema (b/c of retention of fluid and lungs are very prone to develop edema). swollen, wet
Chronic renal failure
* Progressive renal disease with loss of _____ and severe _____
* The cause may be a progression from ____, but most of the time is ______
* CRF → lack the ability to ______ urine → _____ and _____
* Hallmark of CRF = Alteration in _____-________ metabolism (Hyperphosphatemia, hypocalcemia/hypercalcemia)
* Nonregenerative anemia due to lack of production of ______
* ↑PTH secretion (2⁰ hyperparathyroidism) → _____ release from bone
* Fibrous _______ and soft tissue _____
nephrons, scarring, ARF, unknown, concentrate, polyuria, polydipsia, calcium, phosphorus, erythropoietin, Ca, osteodystrophy, calcification
What is this an image of?
CKD
* Mononuclear interstitial inflammation, interstitial fibrosis, tubular atrophy and loss,
glomerulosclerosis, thickened Bowman’s capsules, tubular and glomerular ectasia
firosis = compresses interstium –> dilation of?
see these lesions = end stage; cause is hard to determine
What can be seen in this image?
swollen
paranchemya buldging at surface
What can be seen in this image?
depression of surface
Azotemia: Biochemial abnormality characterized by elevation of
blood ____ and/or ______, but without obligatory of ____
manifestation of renal disease.
Which categories of acute renal failure does this fall under?
urea, creatinine, clinical
Prerenal, renal, post-renal.
List the causes of extrarenal lesions of uremia
- Increased vascular permeability - toxins in bloodstream are toxic to endothelial cells, which line blood vessels, leading to necrosis of sais cells, vasculitis, and may see thrombus as well as infarct (sometimes hemorrhage)
- Hallmark: alteration of calcium/phosphorous metabolism –> hypercalcemia –> mineralization everywhere.
- Oral cavity and stomach can be affected in small animals, colon of LA is the production of ammonia. High levels of urea in blood, and bacteria present in body will transform urea to ammonia –> ulcerations present in locations mentioned above.
Uremia literally means urine in the _____. It is a ____ syndrome of
renal failure, caused by ________ disturbances, and is often
accompanied by ____ lesions and ?
blood, clinical, biochemical, extrarenal, severe clinical signs
UREMIC GASTROPATHY (very common in ____ and ____)
* _____ and _____ secondary to vasculitis
* Mucosal ____ (less common) –> Alteration in Ca/P metabolism
Dogs, Cats, Ulcers, hemorrhage, calcification
uremic gastropathy
Necrosis and hemorrhage of of the mucosa of the stomach.
Increased levels of uremia in the blood
Ammonia causes direct damage to ?
- Ulcers and hemorrhage secondary to vasculitis
H. pyloria
Less common than ulcers = mucosal calcification
in Chronci renal failure –> hypercalcemia leading ot soft tissue mineralization.
necrotizing vasculities
UREMIC COLITIS (Horses and Cattle)
* Ulcers and hemorrhage secondary to vasculitis
Present in colon
Soft tissue mineralization: Parietal pleura and
intercostal muscles
* Altered calcium-phosphorus metabolism
dystrophic or metasttic?
Soft tissue mineralization: Larynx
* Altered calcium-phosphorus metabolism
White slightly raised material —? calcification in larynx
Plaques present
Soft tissue mineralization: Nephrocalcinosis (mineralization in kidney)
* Altered calcium-phosphorus metabolism
When mineralization occurs in kidney –> neprho –> furher increases renal damage and renal failure due to diffse mineraloiation of kidney
chalky and firm surface
Pulmonary edema
o Increased vascular permeability
lungs will have ? inconsistency
edema ; eosino amorphic material; inflammatory cells due ot increase vacxular permabilityl minerliaztion of alveolar cells
Ulcerative glossitis and stomatitis
* Vasculitis
* Ammonia production by bacteria from the urea present in the
saliva
Characteristic lesion in small animal is bilateral symmetric ulcers on the surface of the tongue due to vasculitis and ammonia.
Breath smells like urine, which is one of the first clinical signs.
ULCERATIVE GLOSSITIS AND STOMATITIS
* Vasculitis
* Ammonia production by bacteria from the urea present in the
saliva
Icteric as well.
Necrotizing glossitis (infarct)
* Fibrinoid necrosis of the arterioles
Loss of blood supply in the extremity of the tongue leading to an infarct.
Left endocardium and pericardium. Not valvular, but endocarditis of the atrium.
Inflammation, cellular debris, calcification, ? pericardium.
Parathyroid Hyperplasia
* Altered calcium-phosphorus metabolism
Takes weeks to months to develop. Cause of the hypercalcemia and systemic mineralization.
Renal secondary hyperparathyroidism. What is the other form? Nutritional secondary hyperparathyroidism in large animals when they have a diet rich in phosphorous
Primary hyperparathyroidism is due to a tumor in the parathyroid gland?
Osteoclasts will multiply and reabsorb the calcium in the bone and put into bloodstream –? fibrous replacement of the bone and see this large markedly swollen maxilla; other bones outside of the face such as the ribs can be affected.
FIBROUS OSTEODYSTROPHY
Pathogenesis?
* Altered calcium-phosphorus metabolism
FIBROUS OSTEODYSTROPHY
Pathogenesis?
* Altered calcium-phosphorus metabolism
Alpaca. Can cut bones with knife. Obviously abnormal.
Know these!!
Renal agenesis
* No recognizable renal tissue
* Bilateral or unilateral (+/- asymptomatic)
* Familial in Beagles, Shetland Sheepdogs and Dobermans
?
Complete lack of development of renal tissue.
Usually unilateral
Incidental finding on necropsy.
Renal Hypoplasia means ________ development. Results in _____ kidneys without ______.
What are the criteria for diagnosis?
Incomplete, small, scarring
◦ Reduction in size of one kidney by more than 50%
◦ No pre-existing renal disease
Renal Hypoplasia
Smooth, no lesions, The other kidney has compensatory hyperplasia. Both are usually incidental findings on necropsy.
Renal Dysplasia ( ________ of kidney), is rare.
* Renal Dysplasia: _______ development of renal parenchyma
caused by _______ differentiation.
* Juvenile nephropathy: broad term for non-________, _______ or development conditions, ___ of obscure pathogenesis in young animals. Animals present with clinical signs early in life (between ___-___ months).
* Familial/breed nephropathy: the inheritance of the nephropathy
has been determined. Several breeds of dogs have this.
→→ Mild/Mod/Severe
→→ Age of onset of renal failure varies from a few weeks to several
years
→→ In most cases 4-18 months
malformation, Disorganized, anomalous, inflammatory, degenerative, CRD, 4-18
Renal Dysplasia
Gross pathology
◦ Shrunken, misshapen, fibrotic, pale due to degenerative lesions, often cystic.
Left image: cortex is necrotic, small. Cortical medullary junction is obscure. Pale, grey discoloration. Cysts in the cortex and medulla.
Top right: misshapen kidney
Bottom right: discoloration
Renal Dysplasia - Histopathology
Asynchronous maturation
Primitive ducts and mesenchyme.
Renal Dysplasia - Histopathology
Asynchronous maturation
Fetal glomerulus
Renal Dysplasia - Histopathology
Asynchronous maturation
Paucity of Tubules
Non-inflamed connective tissue
Tri-chrome stain, stains fibrous connective tissue.
Miscellaneous Developmental Abnormalities
Ectopic kidney usually unilateral, incidental finding. Predisposed to obstruction of ureter –> ? Might see ureter obstruction in ectopic kidneys.
Usually incidental
Congenital: few in numbers, same in size; incidental finding. Smooth surface, no lesions anywhere. 75% of renal parenchyma must be damaged in order to have renal failure.
Acq: fibrosis compresses tubules –> compresses urinary flow –> distend the ? of the obstruction. Cysts may be randomyl distributed
- What condition can be seen in this image?
- Genetically, how is this condition categorized?
- Which species and breed are most commonly affected?
- Describe the pathogenesis of this condition.
- Age of onset?
- Organs affected?
Feline (Persian) Polycystic Kidney
- Autosomal Dominant
- Persian and Persian-cross cats
- Mutation in PKD1 and PKD2 (encodes polycystin-1 and -2), which is part of the
primary cilia of the tubular epithelial cells
- This cilium senses fluid movement through the lumen
- Cysts also present in pancreas and liver
Cysts may arise anywhere along
the nephron, be located in cortex
or medulla, and vary from barely
visible to several centimeters in
diameter.
Start to present signs at 3 years old
Cysts also found in pancreas and liver. Can be found anywhere on the nephron, cortex, or medulla.
