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

Renal Pathology Part III - Tubular Diseases Flashcards

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
Q

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)

A

antifreeze, sweet, dogs, cats, alcohol dehydrogenase, GLYCOALDEHYDE, glycolic, GLYOXYLATE, oxalate, ATP, membrane, Proximal, calcium oxalate

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26
Q

Name the condition

A

Ethylene glycol toxicity - histopathology
* Birefringent with polarized light, light yellow arranged in rosettes or sheaves

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27
Q

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

A

decrease
Vomiting, diarrhea, GI hemorrhage, burns
Heart failure, severe valvular disease
Sepsis – massive release of cytokines
Thrombi –> Renal Infarction

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28
Q

Renal infarction is defined as _______ areas of ________ necrosis
- Obstructive material: ______ (hypercoagulable state),
_____ emboli, _______ emboli
- Predisposing conditions: ______ endocarditis, Feline ________ (HCM), ________, _______.,

A

localized, coagulative, thrombi, septic, neoplastic, Valvular, cardiomyopathy, endotoxemia, neoplasia

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29
Q

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

A

artery, artery, necrotic, anastamose, right, Arcuate, wedge, cortex, medulla, Interlobular, cortex

30
Q

Describe the timeline depicted below.

A
31
Q

Name the condition and describe the condition below.

A

Renal medullary/papillary/crest necrosis
Blood flow is regulated by local prostaglandins

32
Q

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

A

ischemia.
Non-steroidal anti-inflammatory drugs (NSAIDs), prostaglandin, medulla
Dehydration, phenylbutazone, amyloidosis, pyelonephritis, fibrous, Pelvic, tumor

33
Q

Name the condition and describe the condition below.

A

Crest necrosis = Dog with amyloidosis
Areas of necrosis in medulla, crest.
Probably Shar Pei

34
Q

Name the condition and describe the condition below.

A

Multiple focal areas of necrosis.
Papillary necrosis = Phenylbutazone treatment

35
Q

Inflammatory Tubulointerstitial Diseases
Caused by infectious agents such as?

A

bacteria, fungi, parasites that arrive at intestial capillaries leadng to necrossi of tubules and inflammation of interstitium.

36
Q

Inflammatory Tubulointerstitial Diseases
may result as ______ to acute tubular necrosis or GN.

A

secondary

37
Q

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:

A

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
Q

Inflammatory Tubulointerstitial Diseases are clinically characterized by loss of ?

A

concentrating ability (isosthenuria) on tubules leading to dillute urine.

39
Q

Classification is based on _______ (types of inflammation)
1. Nonsuppurative interstitial nephritis (lymphocytes, plasma cells
and macrophages)
2. Suppurative interstitial nephritis
◦ Embolic suppurative nephritis
◦ Pyelonephritis

A

exudate

40
Q

Nonsuppurative interstitial nephritis
- usually _____, multifocal, sometimes _____.
- ________ or ________ (depending upon the intensity of the
insult and the efficiency of the host’s response)
Causes?

A

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
Q

Name the condition and describe the image.

A

Nonsuppurative interstitial nephritis
Lymphoplasmacytic
inflammation

42
Q

Name the condition and describe the image.

A

Nonsuppurative interstitial nephritis

Interstitial fibrosis with
tubular dilation and atrophy –
Trichrome stain

43
Q

Name the condition and describe the image.

A

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
Q

Name the condition and describe the image.

A

Random distribution think hematogenous spread

45
Q

Name the condition and describe the image.

A

Malignant catarrhal fever produces nonsupprative interstial nephritis caused by bovine herpesvirus 2

46
Q

Name the condition and describe the image.

A

Systemic granulomatous inflammation
Common in texas and ?

Causes nonsup interstitial nephritis

47
Q

Name the condition and describe the image.

A

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
Q

Name the condition and describe the image.

A

Nonsuppurative (granulomatous) interstitial nephritis

Granulomatous lesion around larvae
Inflammatory cells around.

49
Q

Name the condition and describe the image.

A

FIP
Raised areas = granulomatous inflammation; targets veins –> vasculitis
Differential diagnosis? Lymphoma

50
Q

Name the condition and describe the image.

A

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
Q

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

A
52
Q

Name the condition and describe the image.

A

Suppurative embolic nephritis
Microabscess are mostly
located in the glomeruli
and peritubular capillaries

53
Q

Name the condition and describe the image.

A

Numerous, 2-3 mmm
microabscess in the
renal cortex

54
Q

Name the condition depicted below. List the causes of and results.

A

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
Q

List the predisposing factors for Pyelonephritis.
How does the bacteria reach renal pelvis?

A

Predisposing factors
◦ Urinary obstruction, urolithiasis,
prostatic hyperplasia, transitional cell
carcinoma of urinary bladder

◦ Abnormal vesicoureteral reflux
◦ Reverse peristalsis

56
Q

Name the condition depicted below.

A

Suppurative pylenophritis
Primary source of infection: renal pelvis with streaks going into the cortex.

57
Q

Name the condition and describe the image.

A

Severe dilation of pelvis and compression atrophy at renal parenchyma.
sequelae - pyonephrosis

58
Q

Name the condition and describe the image.

A

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
Q

Name the condition and describe the image.

A

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
Q

Name the condition and describe the image.

A

Parasite that caused this: stephanurus dentatus

61
Q

Name the condition and describe the image.

A

Parasite that caused this: Dioctophyma renale

62
Q

Parasitic diseases of kidneys
Toxocara canis
Stephanurus dentatus in pigs
Dioctophyma renale in dogs
Halicephalobus gingivalis in horses

A
63
Q

Name the parasitic disease pictured below. What speceis is affected?

A

Halicephalobus gingivalis in horses.
Produce huge granulomatous inflammation that looks like a tumor; histologically, multiple nematodes surrounded by inflammatory cells.

64
Q

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)

A

0.6, 2.5

65
Q

Name the condition depicted below.

Renal _______________
- Most common _________ renal neoplasm in ______, _______, _________.
- Origin - epithelium of __________ tubules
- Local invasion - ?
- Highly metastatic – ?

A

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
Q

Name the condition depicted below.

Renal _____________-nodular ____________ syndrome in ___________ __________ dogs
* __________ and ____________ renal cystadenoma/cystadenocarcinoma
* Nodular ___________: affects _____ limbs. _____, but inherited in ___.
* Uterine _________
*Autosomal __________.

A

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
Q

Name the condition depicted below.

_______________
- Most common ___________ renal neoplasm in _____ and _________ (slaughter house; _________ finding)
- Less common in _____ and _______
- Origin = ?
- _____ animals

A

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
Q

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 ?
A

Ectopic nephroblastoma
distal, Thoracolumbar, T13/L1, young, 5, 5, 14, hindleg, Embryonal, dura matter and spinal cord

69
Q

Other RENAL neoplasms
- ____________,___________ (MESENCHYMAL)
- __________________ (may be primary or metastatic)
- __________ - renal involvement is common (in cats and cattle)
◦ May be ______ or _____
◦ Usually ______

A

Fibroma, fibrosarcoma, Hemangiosarcoma, Lymphoma, nodular, diffuse, bilateral

70
Q

Name the condition and describe the image.

A

Metastatic Hemangiosarcoma

71
Q

Name the condition and describe the image.

A

Multicentric lymphoma

Systemic Pathology I (27 decks)

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