Renal Pathology Part III - Tubular Diseases Flashcards
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)
tubular, Blood, Toxins, chemicals, Hypoxia, Ischemia, Ascending
What can be seen in this image?
Ascending infection
Pylenonephritis
Label the image accordingly
Proximal tubules = brush border
Interstitial capillaries ?
?? tubules = no brush border
______ tubular necrosis is the most important cause of acute renal failure. Can be caused by ______ or _____. Clinically results in _____ and _____.
Acute, nephrotoxin, nephrotoxin, oliguria, anuria
What is occurring in each image?
Fluid leaving tubules is retained in the kidney,
Celllular debirs from necrotic tubules, destroy tubules? fluid retinaed and not excreted in the urine.
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 ______.
tubular, intact, regeneration, basement, fibrosis
Name the pathway for Toxic insult versus Ischemia.
What can be seen here?
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.
What can be seen here?
Acute tubular necrosis - Ischemic
Necrosis of everything
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 ________.
25, glomerulus, concentrated
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
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
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
Hemoglobinuric means hemoglobin in urine.
Nephrosis means in tubules
hemolysis, Hemoglobinemia, glomerular filtrate, intraluminal, tubular, hypoxia, necrosis, hemoglobin
Name the conditions that cause Hemoglobinuric Nephrosis.
- Chronic _____ toxicity in sheep
- (3) in cattle
- _______ _____ toxicity in horses
- (2) in dogs
copper, Leptospirosis, babesiosis, Clostridium haemolyticum, Red Maple, Babesiosis or autoimmune hemolytic anemia
- Name the condition.
- What can be seen in this image?
- Chronic copper toxicity in sheep
- Coagulative necrosis of tubular epithelium. Orange-red, granular
(hemoglobin) casts in tubule lumens
- Name the condition.
- What can be seen in this image?
- Chronic copper toxicity in sheep
- Diffuse red-brown to blue- black discoloration
- Name the condition.
- What can be seen in this image?
Hemoglobinuric Nephrosis
a dog
Adipose tissue yellow b/c?
Immune-mediated hemolytic anemia in?
- Name the condition.
- What can be seen in this image?
Red Maple toxicosis in a horse
Myoglobinuric Nephrosis results from?
acute and extensive muscle necrosis
Describe the mechanism that causes Myoglobinuric Nephrosis
- Same mechanism of hemoglobinuric nephrosis: Myoglobin is
filtered by the glomerulus and it is toxic to tubular epithelium
List the conditions that cause Myoglobinuric Nephrosis
- Exertional rhabdomyolysis in horses, greyhounds,
and wild or exotic animals - Cassia spp. toxicity in cattle
- Severe direct trauma to muscle (traffic accident)
Name the condition and describe the image below.
Myoglobinuric Nephrosis
Exertional rhabdomyolysis in a horse
- Diffuse myoglobin staining of the cortex and medulla
(red-brown) is secondary to myoglobinemia
Name the condition and describe the image below.
Intraluminal myoglobin casts
Name the condition and describe the image below.
Cholemic Nephrosis
- Acute fulminant hepatic failure > icterus > bile cast nephropathy
- Kidney is discolored green
What causes the resulting condition below?
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)
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
Name the condition
Ethylene glycol toxicity - histopathology
* Birefringent with polarized light, light yellow arranged in rosettes or sheaves
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
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
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
Describe the timeline depicted below.
Name the condition and describe the condition below.
Renal medullary/papillary/crest necrosis
Blood flow is regulated by local prostaglandins
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
Name the condition and describe the condition below.
Crest necrosis = Dog with amyloidosis
Areas of necrosis in medulla, crest.
Probably Shar Pei
Name the condition and describe the condition below.
Multiple focal areas of necrosis.
Papillary necrosis = Phenylbutazone treatment
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.
Inflammatory Tubulointerstitial Diseases
may result as ______ to acute tubular necrosis or GN.
secondary
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.
Inflammatory Tubulointerstitial Diseases are clinically characterized by loss of ?
concentrating ability (isosthenuria) on tubules leading to dillute urine.
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
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)
Name the condition and describe the image.
Nonsuppurative interstitial nephritis
Lymphoplasmacytic
inflammation
Name the condition and describe the image.
Nonsuppurative interstitial nephritis
Interstitial fibrosis with
tubular dilation and atrophy –
Trichrome stain
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
Name the condition and describe the image.
Random distribution think hematogenous spread
Name the condition and describe the image.
Malignant catarrhal fever produces nonsupprative interstial nephritis caused by bovine herpesvirus 2
Name the condition and describe the image.
Systemic granulomatous inflammation
Common in texas and ?
Causes nonsup interstitial nephritis
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.
Name the condition and describe the image.
Nonsuppurative (granulomatous) interstitial nephritis
Granulomatous lesion around larvae
Inflammatory cells around.
Name the condition and describe the image.
FIP
Raised areas = granulomatous inflammation; targets veins –> vasculitis
Differential diagnosis? Lymphoma
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 ?.
Name the causes & sources of Suppurative embolic nephritis. Gross? Micro
- Actinobacillus equuli (foals)
- Erysipelothrix rhusiopathiae in pigs
- Trueperella pyogenes in cattle
- 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
Name the condition and describe the image.
Suppurative embolic nephritis
Microabscess are mostly
located in the glomeruli
and peritubular capillaries
Name the condition and describe the image.
Numerous, 2-3 mmm
microabscess in the
renal cortex
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
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
Name the condition depicted below.
Suppurative pylenophritis
Primary source of infection: renal pelvis with streaks going into the cortex.
Name the condition and describe the image.
Severe dilation of pelvis and compression atrophy at renal parenchyma.
sequelae - pyonephrosis
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
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
Name the condition and describe the image.
Parasite that caused this: stephanurus dentatus
Name the condition and describe the image.
Parasite that caused this: Dioctophyma renale
Parasitic diseases of kidneys
Toxocara canis
Stephanurus dentatus in pigs
Dioctophyma renale in dogs
Halicephalobus gingivalis in horses
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.
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
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
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)
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
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
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
Name the condition and describe the image.
Metastatic Hemangiosarcoma
Name the condition and describe the image.
Multicentric lymphoma
