Renal Pathology Part IV Flashcards
The Lower Urinary Tract acts as a conduit for transport of urinary ______ from the _____ to the _____. It consists of
1. ______ ureters
2. Urinary _________
3. _________
Most diseases of LUT are associated with _________ and _________, which can be concomitant
waste, kidney, exterior, Paired, bladder, Urethra, obstruction, infection
Label accordingly
Males are prone to ________ due to their urethra anatomy –> (?)
obstruction, sigmoid flexure, urethral process, os penis
Ureter is narrow and long.
Females are prone to _________ due to their ______ urethra and
its proximity to ______ environment and ______
flora
infection, short, external, rectal
Ectopic ureter
* Most important _______ anomaly
* Rather than terminating at the ______ of the bladder, it terminates at the ______ or ______
* Usually an _______ finding
* Predispose to ?
ureteral, trigone, urethra, vagina, incidental, hydronephrosis/hydroureter and UTI-pyelonephritis
Ectopic ureter
Prone to compression of ureter –> obstruction
Urolithiasis is defined as the presence of _____ (________ or _______) in the urinary passages.
calculi, uroliths, stones
Calculi are aggregates of precipitated urinary _________, urinary _______ and _______ debris
solutes, proteins, proteinaceous
e.g. cystitis
What is the difference between Calculi and urethral plugs?
- Calculi: minerals predominate, round/spherical hard structures
- Urethral plugs: masses of sandy sludge with a much higher organic component
- Several different types of calculi and usually when see bladder stone it is multi factorial
List the causes of Urolithiasis
- Defective metabolism of a substance
- Metabolic diseases
- High levels of a substance in the diet
- Infection
Explain how defective metabolism of a substance –> Urolithiasis.
Defective metabolism of a substance
- Uric acid in Dalmatian dogs: urate calculi; ca’t metabolize uric acid –> highlevel of uric acid in bladder –> urate calculi
- Cystine (defective proximal tubular resorption from GF), dogs and cats. High levels of cystine in bladder as a result of defect.
Explain how metabolic diseases –> Urolithiasis.
Metabolic diseases
- Hyperpathyroidism, hypercalcemia: Calcium oxalate
- Severe liver disease/portosystemic shunts: Ammonium biurate calculi
Explain how high levels of a substance in the diet –> Urolithiasis.
High levels of a substance in the diet
- Silicic acid in native pastures, ruminants (cattle and small ruminants)
- Mineral imbalance (calcium, phosphorus, magnesium)
e.g. case of urolithiasis in ruminants, first thing to do is change diet.
Explain how infection –> Urolithiasis
- Struvite +++ dogs/cats (Ureases from Staph/Proteus induce supersaturation).
Which factors are important to consider when evaluating a patient for Urolithias?
Certain factors are more or less important: urinary pH, reduced water intake, urine supersaturation, foreign body (suture, grass awn, catheter)
Are males or females more prone to developing urolithiasis?
Males > females, b/c urethra is more narrow; castrated animals more commonly affected.
Which species, other than dogs and cats, are prone to developing urolithiasis? Which species are less prone?
- +++ cattle, sheep, dogs and cats
- – horses and pigs
Name the dog breeds that are more prone to developing urolithiasis?
- Predisposed breeds in dogs: Dachshunds, Dalmations, Cocker
spaniels, Basset Hounds, Poodles, Schnauzers, and small terriers
Calculi may form in ___ ____ of the urinary system, from the ___ ____ to the ____.
any part, renal pelvis, urethra
Uroliths: their ____ and ____ vary and may be ______, even among calculi
of similar composition
color, shape, inconsistent
Hard to determine type of calculi by gross examination.
Name the most common sites of lodgment of urethral calculi in cattle.
Cattle: at the ischial arch and at the proximal end of the sigmoid flexure
Name the most common sites of lodgment of urethral calculi in rams.
Rams: at the urethral process (vermiform appendage)
Name the most common sites of lodgment of urethral calculi in dogs.
Dogs: at proximal to the base of the os penis
Name the most common sites of lodgment of urethral calculi in cats.
Cats: along the entire length of the urethra
At the site in which calculi lodge, there is ?
local pressure necrosis, ulceration of
the mucosa, and acute hemorrhagic urethritis/cystitis: Hematuria and dysuria
Uroliathiasis - goat
Nephrolith
Large calculi formation present. Can be one very large one or multiple.
Urolithiasis - dog
Large calculi formation present. Can be one very large one or multiple.
Urolithiasis - ram
Hydronephrosis
Sand like material + uroliths on right –> obstruction –> hydronephrosis with secondary atrophy of parenchyma; hemorrhage on left.
Dog, Hemorrhagic cystitis
Multiple bladder stones present; areas of hemorrhage. Treatment? surgical; remove stones.
Urolithiasis - cat
Hemorrhage below uroliths because cause direct damage to epithelium.
Urolithiasis - dog (dalmation)
Urate calculi
Necrosis of the urethral process of small ruminants; gangrenous necrosis
Urolithiasis
Rupture of the urethra with accumulation of urine in the subcutis
Very common in cattle
Urolithiasis
Goat
- Hydroureter
- Hydronephrosis
- Pyelonephritis
Explain what can be seen in this image and describe the physiological process.
Portosystemic shunts
Secondary to severe chronic liver disease.
When there is sever fibrosis in liver, compression of portal veins –> portal hypertension. Portal vein drains fluid from guts and brings to liver and liver metabolizes substances. When there is severel portal hypertension, blood can not reach the liver. New blood vessels will form from portal vein to link to vena cava. Blood bypasses the liver so ammonia can not be metabolized to form urea –> ammonia in blood , ammonia excreted in urinary system –> ammonium biurate crystals.
high levels of ammonia in blood: hepatic encephalopathy (ammonium toxic to brain –> neurological disease).
Ammonium biurate crystals due to acquired portosystemic shunts
(severe, chronic liver disease)
List the normal antibacterial properties of the bladder:
- Repeated voiding
- Protective urothelial mucus coating
- Mucosal IgA
- High urea and organic acids
List the risk factors for bladder infection:
- Stagnation of urine
- Incomplete voiding (spinal cord lesions)
- Urothelial trauma
List the causes of cystitis
- Bacterial (♀ - ↑cystitis)*
- Chemicals (cyclophosphamide)
- Urolithiasis
- Trauma
List the bacterial causes of cystitis
Usually enteric bacteria
E. coli > Staphylococcus spp. > Proteus spp. >
Klebsiella spp. > Enterococcous spp. > Streptococcous spp.
* Specific renal pathogens *
◦ Corynebacterium renale – cattle
◦ Actinobaculum suis – pigs
◦ Klebsiella spp. – horses
List the chemical causes of cystitis
Blister beetle - Epicauta spp (Cantharidin) in hay horses → ulcerative cystitis
* Cyclophosphamide in dogs and cats - hemorrhagic
(ulcerative) cystitis
Feline lower urinary tract
disease (FLUTD)
* Multifactorial condition
* Multiple causes:
- Feline idiopathic (interstitial) cystitis
- Infection
- Uroliths/urethral obstruction
FLUTD
FLUTD Risk factors?
- Middle-aged and neutered cats
- Over-weight and cats which take little exercise
- Cats with little or no access outside
- Cats that eat a dry diet
- Multiple animal households
- STRESS
Bladder is distended, looks hemorrhagic
Open bladder up, hemorrhage on walls of bladder and accumulation of “sand-like” material (most common in cats are the struvites secondary to cystitis).
What is the arrow pointing to?
Penis of a cat with urethral plug obstructing urinary flow
Chronic cystitis
* Classified based on the _______ and type of __________ response
- Follicular: ?
- Polypoid: ?
patterninflammatory
Disseminated submucosal lymphoid nodules
Polyps composed of connective tissue mixed with mononuclear cells
Follicular vs polypoid chronic cystitis
Emphysematous cystitis is characterized by multiple, _______, ______, ____-filled bulla in mucosa of _______ bladder
* Associated with what condition?
small, clear, air, urinary
Diabetes mellitus –> glucosuria (high levels of glucose in blood) +
glucose-fermenting bacteria –> emphysematous cystitis
What condition can be seen here?
Emphysematous cystitis
gmList the neoplasms of the urinary bladder and the species they predominantly affect.
- Transitional cell carcinomas in +++dogs and +cats
- Transitional cell carcinomas, hemangiomas,
hemangiosarcomas in cattle due to chronic Bracken fern
poisoning - Botryoid rhabdomyosarcoma in young dogs (rare)
Transitional cell carcinoma is the ____ common neoplasm of the _____ _____.
most, urinary tract
The most common site for transitional cell carcinoma is the?
bladder neck and trigone
Which species are most commonly affected by transitional cell carcinomas? Breed? Age?
- Old dogs (Scottish Terrier ++)
In 40% of transitional cell carcinoma cases, these tumors have ?
metastasized by the time of clinical
diagnosis
* Lymph nodes, lung and bone
How do you classify TCC?
Classification of TCC
1) Papillary and non-infiltrating - no invasion of the
stroma
2) Papillary and infiltrating (most common
3) Non-papillary and non-infiltrating (carcinoma in- situ)
4) Non-papillary and infiltrating – most common to
metastasize
TCC with Unilateral Hydronephrosis?
Mass in trigone or neck causes obstruction of urinary tract leading to hydroureter
Transitional cell carcinoma
Diffuse transitional cell carcinoma
Enzootic hematuria is caused by ________ ingestion of _____ fern (Pteridium aquilinum) in cattle
* Toxic principle: __________ (___________ —> neoplastic formation and ___________)
* Associated with ____-__ infection
* Results in?
chronic, Bracken, Ptaquiloside, carcinogenic, immunosuppressive, BPV-2
Papillomas, TTC, hemangiomas, hemangiosarcomas (can
occur concomitant) = hematuria (most common clinical sign)
Enzootic hematuria
Transitional cell carcinoma
Botryoid rhabdomyosarcoma effects ________ dogs (< ___ yrs. Old), _____ breed dogs especially ____. _______ overrepresented
* Arise at the ______ or bladder ____ from embryonic ______.
* Clinically cause _____ (In one case - hypertrophic osteopathy in a dog)
Young, 2, large, St.
Bernard, trigone, neck, myoblasts, obstruction
Botryoid Rhabdomyosarcoma
