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Systemic Pathology I > Renal Pathology Part III - Tubular Diseases > Flashcards

Renal Pathology Part III - Tubular Diseases Flashcards

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1
Q

Tubular diseases
Occur as a result of _____ epithelium damage from
the following:
* _____-borne infections (septicemia)
* ____ and _______ (heavy metals, drugs, food, plants,
bact/fungal toxins, oxalates, vitamin D, pigments [hemoglobin,
myoglobin, bilirubin], etc..)
* _____/______
* ________ infections (infection of lower urinary tract)

A

tubular, Blood, Toxins, chemicals, Hypoxia, Ischemia, Ascending

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2
Q

What can be seen in this image?

A

Ascending infection
Pylenonephritis

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3
Q

Label the image accordingly

A

Proximal tubules = brush border
Interstitial capillaries ?
?? tubules = no brush border

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4
Q

______ tubular necrosis is the most important cause of acute renal failure. Can be caused by ______ or _____. Clinically results in _____ and _____.

A

Acute, nephrotoxin, nephrotoxin, oliguria, anuria

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5
Q

What is occurring in each image?

A

Fluid leaving tubules is retained in the kidney,

Celllular debirs from necrotic tubules, destroy tubules? fluid retinaed and not excreted in the urine.

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6
Q

Difference in outcome of tubular necrosis
Toxic vs Ischemic
- Nephrotoxins – cause _____ necrosis, but leave the basement membrane _____, so damaged epithelium is replaced by _______.
- Ischemia result in damage to the
_______ membrane, so tubular damage heal by ______.

A

tubular, intact, regeneration, basement, fibrosis

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7
Q

Name the pathway for Toxic insult versus Ischemia.

A
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8
Q

What can be seen here?

A

Acute tubular necrosis - Toxic
Eosiniphillic granular ?
Cellular debris
BM is intact.
If toxin is removed from the body quickly, animal will have a greater chance of survival.

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9
Q

What can be seen here?

A

Acute tubular necrosis - Ischemic
Necrosis of everything

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10
Q

Toxins preferentially damage kidneys because:
1) ___% of cardiac output goes to the kidney
2) The substance is filtered into the urine by the _______.
3) The toxin or its metabolites within the renal tubular lumina are ________.

A

25, glomerulus, concentrated

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11
Q

Common Nephrotoxins of Domestic Animals:
* Pigments: Hemoglobin, Myoglobin, Bile/bilirubin
* Heavy metals: Lead, Mercury
* Pharmaceutical agents (e.g., chemotherapeutic and antimicrobial agents): Cisplatin,
Aminoglycosides, Oxytetracycline, Amphotericin B, Sulfonamides, Monensin, NSAIDs
* Fungal toxins (Aspergillus and Penicillium: ochratoxin)
* Plant toxins: Pigweed (Amaranthus retroflexus), Oxalate-containing plants, Oak tannins
* Antifreeze (ethylene glycol)
* Vitamins and minerals: Vitamin D, Hypercalcemia
* Bacterial toxins (epsilon toxin)
* Pet food contaminants: Melamine, Cyanuric acid, Raisins and Grapes

A

Only study ones in bold
Pharm: Toxic when administered in excessive doses or very frequently.
Aspergillus: contaminate food and produce ochratoxin which are toxic to tubular epithelial cells
Oak tannins: in cattle
Antifreeze is the most common cause of acute renal failure in dogs and cats

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12
Q

Nephrotoxic Pigments

**Hemoglobinuric Nephrosis
**
Describe what the steps leading ot Hemoglobinuric Nephrosis.

Intravascular ________ > __________ > hemoglobin passes into the ________ _______ > ________ accumulation > direct damage to _____ epithelium + _____
(because of intravascular hemolysis) > ______ of the epithelium and ____ casts

A

Hemoglobinuric means hemoglobin in urine.
Nephrosis means in tubules

hemolysis, Hemoglobinemia, glomerular filtrate, intraluminal, tubular, hypoxia, necrosis, hemoglobin

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13
Q

Name the conditions that cause Hemoglobinuric Nephrosis.

  • Chronic _____ toxicity in sheep
  • (3) in cattle
  • _______ _____ toxicity in horses
  • (2) in dogs
A

copper, Leptospirosis, babesiosis, Clostridium haemolyticum, Red Maple, Babesiosis or autoimmune hemolytic anemia

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14
Q
  1. Name the condition.
  2. What can be seen in this image?
A
  1. Chronic copper toxicity in sheep
  2. Coagulative necrosis of tubular epithelium. Orange-red, granular
    (hemoglobin) casts in tubule lumens
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15
Q
  1. Name the condition.
  2. What can be seen in this image?
A
  1. Chronic copper toxicity in sheep
  2. Diffuse red-brown to blue- black discoloration
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16
Q
  1. Name the condition.
  2. What can be seen in this image?
A

Hemoglobinuric Nephrosis

a dog
Adipose tissue yellow b/c?

Immune-mediated hemolytic anemia in?

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17
Q
  1. Name the condition.
  2. What can be seen in this image?
A

Red Maple toxicosis in a horse

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18
Q

Myoglobinuric Nephrosis results from?

A

acute and extensive muscle necrosis

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19
Q

Describe the mechanism that causes Myoglobinuric Nephrosis

A
  • Same mechanism of hemoglobinuric nephrosis: Myoglobin is
    filtered by the glomerulus and it is toxic to tubular epithelium
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20
Q

List the conditions that cause Myoglobinuric Nephrosis

A
  • Exertional rhabdomyolysis in horses, greyhounds,
    and wild or exotic animals
  • Cassia spp. toxicity in cattle
  • Severe direct trauma to muscle (traffic accident)
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21
Q

Name the condition and describe the image below.

A

Myoglobinuric Nephrosis
Exertional rhabdomyolysis in a horse
- Diffuse myoglobin staining of the cortex and medulla
(red-brown) is secondary to myoglobinemia

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22
Q

Name the condition and describe the image below.

A

Intraluminal myoglobin casts

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23
Q

Name the condition and describe the image below.

A

Cholemic Nephrosis
- Acute fulminant hepatic failure > icterus > bile cast nephropathy
- Kidney is discolored green

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24
Q

What causes the resulting condition below?

A

Heavy metals
* Lead
- Affects LA such as ruminants
- Source Old paints, batteries, automobile components
- Direct damage to membranes of epithelial cells and mitochondria
- Tubular epithelial cells sometimes have intranuclear inclusion bodies
composed of a lead-protein complex
- Intranuclear inclusion bodies are acid-fast positive (acid-fast stains mycobacteria)

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25
Ethylene glycol toxicity is more common in ____ , but ____ are more susceptible. * Constituent of engine _____ solution (95%), _____, voluntarily consumed, especially by young animals * Oxidized by ______ _______ (liver) into toxic metabolites _______, _____ acid, ______ and ultimately into ____ * Filtered by glomeruli --> direct toxic effects (_____ depletion and ________ damage) * _____ tubular degeneration and necrosis, with characteristic ______ ______ crystals (large numbers is pathognomonic)
antifreeze, sweet, dogs, cats, alcohol dehydrogenase, GLYCOALDEHYDE, glycolic, GLYOXYLATE, oxalate, ATP, membrane, Proximal, calcium oxalate
26
Name the condition
Ethylene glycol toxicity - histopathology * Birefringent with polarized light, light yellow arranged in rosettes or sheaves
27
Ischemic renal tubular damage - Anything that will ______ the volume of blood going through the kidneys Volume depletion ◦ List examples. Not enough blood being pumped ◦ List examples Systemic vasodilation - Hypotension ◦ List examples Renal artery occlusion ◦ List examples
decrease Vomiting, diarrhea, GI hemorrhage, burns Heart failure, severe valvular disease Sepsis – massive release of cytokines Thrombi --> Renal Infarction
28
Renal infarction is defined as _______ areas of ________ necrosis - Obstructive material: ______ (hypercoagulable state), _____ emboli, _______ emboli - Predisposing conditions: ______ endocarditis, Feline ________ (HCM), ________, _______.,
localized, coagulative, thrombi, septic, neoplastic, Valvular, cardiomyopathy, endotoxemia, neoplasia
29
Renal infarction is usually lodged in... 1. Renal _____- Occlusion of the renal _____: entire kidney will be _______. Branches _______ and form ______ angle --> more prone to infarct. 2. ______ artery - _____ shaped necrosis of _____ and _______ 3. ______ artery - necrosis of _____ only
artery, artery, necrotic, anastamose, right, Arcuate, wedge, cortex, medulla, Interlobular, cortex
30
Describe the timeline depicted below.
31
Name the condition and describe the condition below.
Renal medullary/papillary/crest necrosis Blood flow is regulated by local prostaglandins
32
Renal medullary/papillary/crest necrosis causes _______. List the causes of this. 1) _______*Most common* ◦ Aspirin, phenylbutazone, flunixin meglumine, meloxicam Pathogenesis: NSAIDs → block _______ production (PGE2) → ischemia of renal _____ → necrosis ◦ Associated with ______ ◦ Analgesic nephropathy – Dehydrated horses treated with __________ 2) Medullary __________: Compression of medullary capillaries 3) Chronic __________: Scarring – ______ connective tissue compresses medullary capillaries 4) ______ calculi or _____: pressure necrosis
ischemia. Non-steroidal anti-inflammatory drugs (NSAIDs), prostaglandin, medulla Dehydration, phenylbutazone, amyloidosis, pyelonephritis, fibrous, Pelvic, tumor
33
Name the condition and describe the condition below.
Crest necrosis = Dog with amyloidosis Areas of necrosis in medulla, crest. Probably Shar Pei
34
Name the condition and describe the condition below.
Multiple focal areas of necrosis. Papillary necrosis = Phenylbutazone treatment
35
Inflammatory Tubulointerstitial Diseases Caused by infectious agents such as?
bacteria, fungi, parasites that arrive at intestial capillaries leadng to necrossi of tubules and inflammation of interstitium.
36
Inflammatory Tubulointerstitial Diseases may result as ______ to acute tubular necrosis or GN.
secondary
37
Inflammatory Tubulointerstitial Diseases may also result from bacterial or viral septicemia (bypass the _______) > infect the kidney ______ and damage them > incites an _______ response in the interstitium. --> There are 2 forms:
glomeruli, tubules, inflammatory 1. Acute (neutrophils, edema and tubular necrosis): Leptospira spp., canine adenovirus and herpesvirus. 2. Chronic (mononuclear inflamm. cells, interstitial fibrosis, tubular atrophy/dilation): Leptospira spp., E. coli septicemia in cattle, Malignant Catarrhal Fever.
38
Inflammatory Tubulointerstitial Diseases are clinically characterized by loss of ?
concentrating ability (isosthenuria) on tubules leading to dillute urine.
39
Classification is based on _______ (types of inflammation) 1. Nonsuppurative interstitial nephritis (lymphocytes, plasma cells and macrophages) 2. Suppurative interstitial nephritis ◦ Embolic suppurative nephritis ◦ Pyelonephritis
exudate
40
Nonsuppurative interstitial nephritis - usually _____, multifocal, sometimes _____. - ________ or ________ (depending upon the intensity of the insult and the efficiency of the host’s response) Causes?
chronic, diffuse, Multifocal, Generalized 1. Leptospirosis, white-spotted kidneys in calves (E.coli or Salmonella), larval migration of Toxocara canis, malignant catarrhal fever, FIP, Lyme disease 2. Vicia spp. - hairy vetch – causes systemic granulomatous inflammation (skin, heart, spleen, kidney, liver, intestines)
41
Name the condition and describe the image.
Nonsuppurative interstitial nephritis Lymphoplasmacytic inflammation
42
Name the condition and describe the image.
Nonsuppurative interstitial nephritis Interstitial fibrosis with tubular dilation and atrophy – Trichrome stain
43
Name the condition and describe the image.
White = lymphocytes, plasma cells, MQ Most of the time = Incidental finding in young calves (related to bacteremia by E. coli or Salmonella) Nonsuppurative interstitial nephritis White spotted kidneys in calves
44
Name the condition and describe the image.
Random distribution think hematogenous spread
45
Name the condition and describe the image.
Malignant catarrhal fever produces nonsupprative interstial nephritis caused by bovine herpesvirus 2
46
Name the condition and describe the image.
Systemic granulomatous inflammation Common in texas and ? Causes nonsup interstitial nephritis
47
Name the condition and describe the image.
Nonsuppurative (granulomatous) interstitial nephritis * Multiple subcapsular, cortical, tan, raised granulomas caused by migrating ascarid larvae (T. canis) Causes no clinical signs Areas are inflammatory cells surroundng larva of nematode.
48
Name the condition and describe the image.
Nonsuppurative (granulomatous) interstitial nephritis Granulomatous lesion around larvae Inflammatory cells around.
49
Name the condition and describe the image.
FIP Raised areas = granulomatous inflammation; targets veins --> vasculitis Differential diagnosis? Lymphoma
50
Name the condition and describe the image.
Nonsuppurative (Acute) interstitial nephritis Neonatal puppy (first week of age) Canine herpesvirus - 1 Multifocal cortical hemorrhages are due to viral-induced tubular necrosis and secondary interstitial hemorrhage. Histologically: necrosis of epithelial cells with hemorrhage of ?.
51
# Name the causes & sources of Suppurative embolic nephritis. Gross? Micro 1. Actinobacillus equuli (foals) 2. Erysipelothrix rhusiopathiae in pigs 3. Trueperella pyogenes in cattle 4. Corynebacterium pseudotuberculosis in sheep and goats Common sources = septic omphalophlebitis (inflammation of umbilical vein in the first days of life) or endocarditis. Gross: Multiple, small, randomly-scattered microabscesses Microscopic: microabscesses ± bacteria
52
Name the condition and describe the image.
Suppurative embolic nephritis Microabscess are mostly located in the glomeruli and peritubular capillaries
53
Name the condition and describe the image.
Numerous, 2-3 mmm microabscess in the renal cortex
54
# Name the condition depicted below. List the causes of and results.
Pyelonephritis - Inflammation of the renal pelvis (pyelitis) and renal parenchyma * Ascending urinary tract infection Cause: common inhabitants of the vulva, vagina and prepuce ◦ Most common - E. coli, Pseudomonas spp., Proteus spp., Streptococcus spp. ◦ Corynebacterium renale in ruminants ◦ Actinobaculum suis in pigs
55
List the predisposing factors for Pyelonephritis. How does the bacteria reach renal pelvis?
Predisposing factors ◦ Urinary obstruction, urolithiasis, prostatic hyperplasia, transitional cell carcinoma of urinary bladder ◦ Abnormal vesicoureteral reflux ◦ Reverse peristalsis
56
Name the condition depicted below.
Suppurative pylenophritis Primary source of infection: renal pelvis with streaks going into the cortex.
57
Name the condition and describe the image.
Severe dilation of pelvis and compression atrophy at renal parenchyma. sequelae - pyonephrosis
58
Name the condition and describe the image.
Horse Lots of mucous glands in pelvis, producing mucoid material when you cut the kidney during necropsy, so this is normal in horse NOT pylenephritis
59
Name the condition and describe the image.
Hydronephrosis * Progressive cystic dilatation of renal pelvis from obstruction of urine outflow * Result in pressure atrophy of renal medulla and cortex * Unilateral or bilateral; depends on where obstruction is in Urinary tract.... Mild or Severe * Causes: obstruction of LUT: calculi, external pressure, neoplasia in the urinary bladder
60
Name the condition and describe the image.
Parasite that caused this: stephanurus dentatus
61
Name the condition and describe the image.
Parasite that caused this: Dioctophyma renale
62
Parasitic diseases of kidneys Toxocara canis Stephanurus dentatus in pigs Dioctophyma renale in dogs Halicephalobus gingivalis in horses
63
Name the parasitic disease pictured below. What speceis is affected?
Halicephalobus gingivalis in horses. Produce huge granulomatous inflammation that looks like a tumor; histologically, multiple nematodes surrounded by inflammatory cells.
64
Neoplastic diseases of the kidney General considerations ◦ Prevalence ___- ___% of total neoplasms (dog and cat) ◦ Primary neoplasms (very rare to see primary; usually affected by neoplasia). ◦ Epithelial, embryonal, or mesenchymal ◦ Primary neoplasms usually unilateral (<5% bilateral)
0.6, 2.5
65
Name the condition depicted below. Renal _______________ - Most common _________ renal neoplasm in ______, _______, _________. - Origin - epithelium of __________ tubules - Local invasion - ? - Highly metastatic – ?
Renal carcinoma - Most common primary renal neoplasm in dogs, cattle and horses - Origin - epithelium of proximal tubules - Local invasion - epaxial muscles, adrenal glands, vena cava - Highly metastatic – lungs, lymph nodes, liver
66
Name the condition depicted below. Renal _____________-nodular ____________ syndrome in ___________ __________ dogs * __________ and ____________ renal cystadenoma/cystadenocarcinoma * Nodular ___________: affects _____ limbs. _____, but inherited in ___. * Uterine _________ *Autosomal __________.
Renal cystadenocarcinoma-nodular dermatofibrosis syndrome in German Shepherd dogs * Bilateral and multifocal renal cystadenoma/cystadenocarcinoma * Nodular dermatofibrosis: affects hind limbs. Rare, but inherited in GS. * Uterine leiomyoma * German Shepherd dogs (Autosomal dominant)
67
Name the condition depicted below. _______________ - Most common ___________ renal neoplasm in _____ and _________ (slaughter house; _________ finding) - Less common in _____ and _______ - Origin = ? - _____ animals
Nephroblastoma - Most common primary renal neoplasm in pigs and chickens (slaughter house; incidental finding) - Less common in dogs and cattle - Origin = metanephric blastema - Young animals
68
Name the condition that can be seen in this image. * Always appears in _____ segments - _________ junction (____/____) in _____ dogs (__ months - ___ years, the median age being ____ months). Leads to ____ paresis in young dogs. * _______ renal rests trapped between the ?
Ectopic nephroblastoma distal, Thoracolumbar, T13/L1, young, 5, 5, 14, hindleg, Embryonal, dura matter and spinal cord
69
Other RENAL neoplasms - ____________,___________ (MESENCHYMAL) - __________________ (may be primary or metastatic) - __________ - renal involvement is common (in cats and cattle) ◦ May be ______ or _____ ◦ Usually ______
Fibroma, fibrosarcoma, Hemangiosarcoma, Lymphoma, nodular, diffuse, bilateral
70
Name the condition and describe the image.
Metastatic Hemangiosarcoma
71
Name the condition and describe the image.
Multicentric lymphoma

Systemic Pathology I (27 decks)

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