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Pathology > Urinary > Flashcards

Urinary Flashcards

1
Q

Functions of the kidney

A
  • Eliminate metabolic waste, toxic substances, drugs
  • Fluid, acid-base, electrolyte balance
  • Conserve nutrients (reabsorption proteins/glucose)
  • Endocrine (Renin-angiotensin-aldosterone, erythropoietin, Vit D activation, prostaglandin production)
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2
Q

Components of the kidney

A

Capsule
Cortex
Medulla
Renal papilla/crest
Renal pelvis
Hilus (ureter, renal artery, renal vein)

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3
Q

Function of lower urinary tract

A

Transport and store urine

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4
Q

Components of lower urinary tract

A
  • Ureters
  • Urinary bladder
  • Urethra
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5
Q

Examples of developmental anomalies of kidney

A

Renal dysplasia/maldevelopment (juvenile onset of chronic kidney disease)

Polycystic kidney disease

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6
Q

Examples of developmental anomalies of the lower urinary tract

A

Patent urachus
Urachal infection/abscess

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7
Q

Renal dysplasia

A

Disorganized development of renal parenchyma

Small/misshapen kidney

Needs histo to diagnose

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8
Q

Polycystic kidney disease

A

Inherited condition with cysts in kidney
Progressive disease —> chronic renal failure

In some animals genetic mutation known (PKD1 gene) (e.g., Persian cats, Bull terrier dogs)

Also can have cysts in liver, gall bladder, pancreas

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9
Q

Renal cysts

A

Congenital or acquired

In some species, a common incidental finding
Can become inflamed/infected…

Significance varies

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10
Q

Urachal abnormalities

A

Patent urachus
Urachal abscess
Urachal diverticulum

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11
Q

Components of the nephron

A

Glomerulus + tubules

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12
Q

Function of glomerulus

A

Blood filtration

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13
Q

Function of tubules

A

Water, acid-base, electrolyte balance

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14
Q

Assessment of kidney function

A

Glomerular filtration rate
(Kidney injury —> dec GFR —> increased BUN/creatinine)

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15
Q

Function of juxtaglomerular apparatus

A

Sensor between afferent/efferent arterioles

Component of Renin-Angiotensin-Aldosterone system (produces renin in response to dec GFR)

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16
Q

Functions of Angiotensin II

A

Act on hypothalamus —> stimulate thirst
Act on pituitary —> release antidiuretic hormone —> reabsorb water
Act on adrenal glands —> aldosterone —> increase Na reabsorption (+water retention)

Overall function: increase blood volume/pressure

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17
Q

Tools for evaluating renal function

A

Clinical pathology (bloodwork/urinalysis)
Imaging (radiographs/ultrasound)
Histo pathology (biopsy, postmortem exam)

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18
Q

Important mechanisms of injury /dysfunction of kidney components

A

Glomerulus: dysfunction of glomerular filtration membrane
Interstitium/blood vessels: fibrosis
Tubules: epithelial cell necrosis

Overall: Inflammation/necrosis

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19
Q

Primary portals of entry to kidney

A

Ascending (bladder —> kidney)
Hematogenous

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20
Q

BUN

A

Blood urea nitrogen

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21
Q

Creatinine

A

Marker of GFR (aka renal function)

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22
Q

SMDA

A

Sensitive, early marker of dec GFT in dogs and cats

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23
Q

Azotemia

A

Excess urea/creatinine in blood

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24
Q

Uremia

A

Urine in blood (uremic toxins, etc)

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25
Q

Urine specific gravity

A

Measure of urine concentration

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26
Q

Isosthenuria

A

Kidney is unable to concentrate or dilute urine (“fixed” urine specific gravity)

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27
Q

Anuria

A

Kidneys cannot produce urine

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28
Q

Oliguria

A

Production of small volume of urine

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29
Q

Polyuria

A

Production of large volume of (dilute) urine

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30
Q

Polydipsia

A

Increased thirst

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31
Q

Renal failure

A

<25% of normal renal function

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32
Q

Causes of acute kidney injury

A

Neprhotoxins
Ischemia
Infectious agents
Obstruction

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33
Q

Clinical manifestation of acute kidney injury

A

Rapid onset of symptoms
Vomiting, lethargy, diarrhea
Dec urine production
Changes in bloodwork - azotemia +/- metabolic acidosis

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34
Q

Chronic kidney disease

A

Progressive decline of renal function
IRREVERSIBLE

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35
Q

Symptoms of chronic kidney disease

A

Vomiting, lethargy, diarrhea, poor body condition
Increased urination/thirst
Bloodwork changes (azotemia, anemia +/- metabolic acidosis)

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36
Q

Stages of chronic kidney disease

A

Stage 1: decreased renal reserve (subclinical)
Stage 2: renal insufficiency (25-50% of normal renal function, azotemia)
Stage 3: renal failure (<25% renal function, azotemia, uremia)
Stage 4: end-stage renal disease (<5% renal function)

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37
Q

Impact and Sequelae of:
Tubular or lower urinary tract injury

A
  • Accumulation of metabolic waste

Seq: azotemia, uremia/uremic syndrome

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38
Q

Impact and Sequelae of:
Tubular necrosis

A
  • Inability to maintain fluid, acid-base, electrolyte balance

Seq: dehydration, polyuria to anuria, metabolic acidosis; altered Na, K, Ca, Phosphate —> K is cardiotoxic!!

39
Q

Impact and Sequelae of:
Damage to glomerular basement membrane

A
  • loss of selectivity of blood filtration

Seq: proteinuria, glucosuria

40
Q

Impact and Sequelae of:
Interstitial necrosis, inflammation, fibrosis

A
  • Endocrine alterations

Seq: dec erythropoietin —> anemia; dec Vit D activation —> secondary hyperparathyroidism

41
Q

Impact of uremic toxins

A

Interfere with electrolyte, protein, acid-base metabolism
Damage to endothelial/epithelial cells
Malaise (anorexia, vomiting, diarrhea)

42
Q

Impact of uremia/uremic syndrome

A

Multi-systemic manifestation of circulating uremic toxins (due to renal failure)
Severe acid-base + electrolyte disturbances —> death

43
Q

Non-renal lesions of uremia

A

Ulcerative stomatitis
Uremic gastritis, colitis
Uremic endocarditis (LA)
Parietal pleural mineralization
Uremic pneumonitis (alveolar walls/blood vessels mineralize)
Uremic encephalopathy (reactive astrogliosis)

44
Q

Mechanism of renal secondary hyperparathyroidism

A

Decreased GFR —> decrease Phos excretion / inc phos in blood —> altered CaP ratio / crystallization —> low calcium

Parathyroid compensates via hyperplasia

45
Q

% of cardiac output to kidney

A

20-25%

46
Q

Renal hemorrhage

A

Manifestation of a systemic disease (e.g. African Swine Fever, Equine Herpesvirus-1, Canine Herpesvirus-1)

Small foci of hemorrhage/necrosis

47
Q

Renal infarcts

A

Caused by ischemia

Wedge-shaped area of necrosis / hemorrhage

Acute: swollen, red to tan (hemorrhage, necrosis)
Chronic: depressed, firm, tan (fibrosis)

48
Q

Renal papillary necrosis

A

Associated with NSAID administration
(NSAID—> inhibit COX enzymes —> dec local production of prostaglandins —> loss of vasodilators action —> local ischemia —> Coagulative necrosis of renal papilla/crest)

Other causes: Pyelitis/pyelonephritis, urolithiasis, amyloid

49
Q

Glomerulonephritis

A

Inflammation of glomeruli and tubulointerstitium

Often immune-mediated; immune complex deposition (composed of antibody-antigen +/- complement)

Diagnosis by identification of IC and microscopic changes

Predisposing: disease with prolonged antigenemia +IC formation

50
Q

Tubulointersitial nephritis

A

Inflammation of tubules + interstitium

Injury to interstitium that also impairs tubular function —> impairment of glomerular function

Sequelae: interstitial fibrosis + nephron loss (CKD)

51
Q

Pyelitis/pyelonephritis

A

Inflammation of the renal pelvis +/- tubulointerstitium

52
Q

Embolic nephritis

A

Hematogenous inflammation

Inflammation centered on glomeruli + bacterial emboli in capillaries

53
Q

Cystitis

A

Inflammation of the urinary bladder

54
Q

Exemplary causes of tubulointerstitial nephritis

A

Leptospirosis
Borrelia burgdoferi
Canine adenovirus
Ischemia

55
Q

Causes / predisposing factors for Pyelitis/pyelonephritis

A

Ascending infection
(Actinobacillus suis, E. coli, Corynebacterium renale)

Predisposing factors: vesicoureteral reflux, urine stasis, short urethra (females)

56
Q

Causes / predisposing factors for embolic nephritis

A

Hematogenous infection
(E. Coli, Actinobacillus equuli, E. Rhusiopathiae, disseminated fungal infections)

Predisposing conditions: sepsis, septicemia

57
Q

“White spotted kidney”

A

Gross appearance of embolic nephritis

58
Q

Causes / predisposing factors for cystitis

A

Possible causes: bacteria (common), toxins

Predisposing factors: damage to mucosa, incomplete emptying of bladder, diabetes

59
Q

Pizzle rot

A

Ulcerative urethritis/posthitis due to Corynebacterium renale

60
Q

Feline infectious peritonitis (FIP)

A

Pyogranulomatous and necrotizing vasculitis, can affect kidneys

61
Q

Glomerulitis

A

Inflammation of glomeruli
Often associated with septicemia

62
Q

Glomerulopathy/glomerulonephropathy

A

Glomerular injury without inflammation
Unknown cause

63
Q

Components of glomerular filtration membrane

A

Endothelium
Glomerular basement membrane
Visceral epithelium with podocytes

64
Q

Consequence of glomerular dysfunction

A

Proteinuria (due to non-selective filtration)

65
Q

Sequelae to glomerular dysfunction

A

Loss of albumin (edema)
Loss of antithrombin III (hypercoaguable state)
Eventual loss of nephron (renal failure)

66
Q

Response to glomerular injury

A

Dysfunction of glomerular filtration membrane —> endothelial, epithelial, mesangial cell proliferation —> hyper cellular tuft (seen on histo)

Glomerular basement membrane thickening

67
Q

Glomerulosclerosis

A

Fibrosis/scarring of the glomerulus

68
Q

Glomerular obsolescence

A

Glomerulus is shrunken, hypocellular + sclerotic

69
Q

Types of glomerulonephritis

A

Membranous GN
Proliferative GN
Membranoproliferativ GN

70
Q

Diagnosis of ICGN

A

Requires: clin path, histochem stains, TEM, IFA, immunohistochem

71
Q

Amyloidosis

A

Most species glomerular - proteinuria

Medullary interstitium in cats, Shar Pei dogs

Reactive Amyloidosis

72
Q

Acute tubular injury (ATI)

A

Causes: ischemic, toxic

73
Q

Consequence of tubular dysfunction

A

Unmodified urine

Sequelae: polyuria/oliguria/anuria/isothenuria, metabolic acidosis, retention of metabolic waste, electrolyte imbalance, proteinuria, glucosuria

74
Q

Tubular response to injury

A

Epithelial cell degeneration, necrosis, regeneration
Basement membrane rupture, thickening

Pigment, glycogen, and/or lipid accumulation

75
Q

Response to acute tubular injury

A

Necrosis/sloughing of tubular epithelial cells
Downstream luminal CASTS (block filtrate flow, damage epithelium)
Regeneration of epithelial cells

76
Q

Examples of nephrotoxins

A

Plants: lilies (cats), oak (ruminants, horses), grapes/raisins (dogs)

Drugs: increased susceptibility if prior renal disease, dehydration

Other: endogenous pigments, antifreeze

77
Q

Hemoglobinuria

A

Nephrotoxic hemoglobin pigment in urine; by hemolysis (e.g., copper toxicosis, red maple toxicity, babesiosis, IMHA)

Two causes of injury associated with this: ischemia, cytotoxicity

78
Q

Myoglobinuria

A

Rhabdomyolysis/extensive muscle necrosis —> myoglobin (nephrotoxic pigment) in urine

79
Q

Ethylene glycol toxicosis

A

Ingestion of antifreeze —> metabolized by liver to toxic species

Calcium oxalate crystals in kidney —> obstruct tubules, damage epithelial cells, AKI/ATI/ATN

Non-renal lesions: crystal deposition in brain, pulmonary edema

80
Q

Urolithiasis

A

Obstructive lower urinary tract disease (i.e. feline lower urinary tract disease)

Uroliths can form/lodge anywhere in urinary tract (not always obstructive)

81
Q

Cystorrhexis

A

Bladder rupture

Exemplary causes: birthing trauma in male foals, secondary to obstructive urolithiasis

Sequelae: uroperitoneum

82
Q

Sequelae to lower urinary tract dysfunction

A

Retained K (potential acute cardiac arrhythmias or arrest), retained acids, retained waste

83
Q

Uroliths / calculi / stones

A

Concretions of urinary solutes, urinary proteins, Proteinaceous debris

Minerals predominate

84
Q

Sabulous urolithiasis

A

Masses of sandy sludge
Organic matrix predominates

85
Q

Factors involved in urolith formation

A

Urine pH
Hydration status
Infection
Diet
Breed

86
Q

Obstructive urolithiasis

A

Urethral obstruction most common

Males are predisposed (long urethral length)

87
Q

Common sites for obstructive urolithiasis

A

Cats: urethra

Ruminants, swine: sigmoid flexure

Sheep/goats: vermiform appendage

Dogs: proximal os penis

88
Q

Sequeale to obstructive urolithiasis

A

Hyperkalemia
Mucosal hemorrhage, ulcer necrosis
Rupture
Fibrosis (chronic stricture)
Proximal distension (hydroureter, hydronephrosis)
Infection
Smooth muscle hypertrophy

89
Q

FLUTD

A

Feline lower urinary tract disease

Clinical syndrome in young to middle aged, overweight male cats (stranguria, hematuria, inappropriate urination)

Possible causes: urolithiasis, urethral plugs (common), strictures/developmental anomalies, bacterial cystitis, feline interstitial cystitis (neurogenic), idiopathic (common)

90
Q

Renal gout

A

In reptilian / avian species

Rate crystal deposition (rate tophi) : articular (humans), visceral (birds/reptiles)

Causes: dehydration, renal disease, overproduction of urine acid

91
Q

Neoplasias of the kidney

A

Epithelial: renal cell carcinoma, adenoma, urothelial cell (transitional cell) carcinoma

mesenchymal: lymphoma, hemangioma/sarcoma, nephroblastoma

Metastatic: lymphoma, hemangiosarcoma

92
Q

Neoplasms of the lower urinary tract

A

Epithelial: urothelial cell (transitional cell) carcinoma, squamous cell carcinoma, papilloma

Mesenchymal: lymphoma, hemangioma/sarcoma, leiomyoma/sarcoma, rhabdomyosarcoma

Metastatic: uncommon

93
Q

Ectopic nephroblastoma

A

Extramedullary intramural spinal canal mass in DOGS (T10-L2)

94
Q

Bovine hemangiosarcoma

A

Urinary bladder neoplasia associated with Bracken Fern + Bovine papilloma virus-2

Pathology (21 decks)

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