Urinary 4, 5 and Practical Flashcards
What are the different forms of cystitis?
Acute- catarrhal, haemorrhagic, necrotic
Chronic- polypoid, follicular, metaplastic
What factors influence cystitis occurence?
Protective factors-
- Frequent voiding
- Urethral sphincters
- Chemical features- low pH, urea, osmolatiry
- Secretory IgA and mucin
Predisposing factors
- Urine stasis
- Incomplete voiding
- Trauma
- Glycosuria
- Dilute urine or high pH
- Short of wide urethra
What agents can cause cystitis?
Often intestinal flora
E.coli
Proteus
Strep/ staph
C. renale (cattle)
E. suis (pigs)
What toxic disease primarily affects cattle LUT?
Where is the toxin found that causes the disease?
What does it cause and where are lesions usually found?
Enzoonotic haematuria- occasionally sheep
Bracken-associared toxins (quercetin)
- Leads to hyperplasia/metaplasia with haemorrhagic cystitis and haematuria
- Chronic squamous or mucous metaplasia
- Leads to dysplasia to predisposition for malignant transformation
Lesions found at the trigone- neck of bladder- constant urine contact
Why does enzootic haematuria cause haematuria and what other symptoms does it cause?
Haematuria as tumours ulcerate and bleed into lumen
Causes:
Chronic weight loss
Epithelial or mesenchymal neoplasms
Where is neoplastic disease usually found in the LUT?
What species are predisposed?
Mostly within bladder
Dogs, cats, Cattle
What different mesenchymal neoplasms can form in the LUT?
Leiomyoma or leiomyosarcoma- smooth muscle
Fibroma or fibrosarcoma
Rhabdomyosarcoma- striated muscle (urethral sphincter)
Infiltratvie and metastatic
What primary epithelial neoplasms can form in the LUT?
Transitional cell papilloma
Squamous cell carcinoma- nodular, ulcerated, invasive
Trasnsitional cell carcinoma- nodule or plaque
What species and signalment do bladder transitional cell carcinomas affect?
Dogs- primarily older dogs, neutered dogs, airdale, beagle, scottie
Primarily at trigone
Frequent metastatic spread to:
Lung, lymph nodes, pelvic bones, transperitoneal if spread
How can secondary neoplasia form in the LUT?
Occasional site of metastases
Local obstruction of LUT
Local invasion- repro
What do the following terms mean?:
- Dysuria
- Haematuria
- Anuria
- Oliguria
- Polyuria
- Polydipsia
- Hypovolaemia
- Isothenuria
- Hyposthenuria
- Azotaemia
- Uraemia
- Dysuria- painful or difficult urination
- Haematuria- blood in urine
- Anuria- no urine output
- Oliguria- low urine output
- Polyuria- high urine output
- Polydipsia- high water consumption
- Hypovolaemia- low blood pressure
- Isothenuria- cannot concentrate/dilute
- Hyposthenuria- low specific gravity
- Azotaemia- higher then normal blood level of urea/nitrogen
- Uraemia- urea in blood- toxicosis of renal failure
What is renal failure?
What are the three critical requirments for renal function?
Progressive loss of renal function
Adequate renal blood flow- generates filtrate, supplies O2
Sufficient functional nephrons
Unimpaired drainage/expulsion of continuois urinary output
What are the three categories of renal failure and briefly describe them?
Pre-renal- inadequate blood flow
Renal- intrinsic- inflammation, neoplasia
Post-renal- LUT obstruction, inflammation
What can cause inadequate blood flow to the kidneys for pre-renal failure?
- Haemorrhage
- Shock
- Cardiac failure
- Trauma
Parenchyma initially undamaged and if blood flow restored reversible
Rapidly progressed to intrinsic with ishaemia
When is the urinary ststem in reserve, insufcient and failing?
Reserve- Upto 50% capacity
Insufficiency- 30-50% capacity remains
Failure- below 30% capacity
What is acute renal failure?
What are the signs?
What is the prognosis?
Sudden loss of 70-100% of capacity
Anuria or oliguria, isothenuric urine
Potentially reversible depending on speed of reversal
What is chronic renal failure?
What are the symptoms?
Gradual loss of renal capacity
Polyuria with secondary polydipsia and Hyposthenuria
What are the effects of chronic renal failure?
What causes death?
Build up of waste products
Failure of acid-base regulation
Failure of fluid volume regulation
Electrolyte disturbances
Endocrine disturbances
Death due to
Dehydration, acidosis, hyperkalaemia, pulmonary oedeama, hypocalcaemia
What is the difference between azotaemia and uraemia?
What are the clinical signs of uraemic toxicosis?
What types of lesions formed from Uraemia?
Azotaemia- biochemical finding of increased urea and creatinine
Uraemia- clinical syndrome of azotaemia
PU/PD, Pallor, Anorexia, Weakness, Muscle wasting, Mouth ulcers, Vomiting, Non-regen anaemia, Skeletal softening, renal pain
Causative lesion- primary disease process (pre/renal/post-renal)
Resultant lesinos- secondary to CRF
What are some secondary problems of uraemia?
- Cachexia- chronic weight loss
- Pulmonary oedema- toxaemia damaged endothelium
- GIT ulceration- uraemic vasculitis- necrosis and mucosa sloughing
- Fibrinous pericarditis- uraemia causes endothelial damage
- Thrombosis- loss of anti-thrombin III
- Pulmonary mineralisation- deposition of calcium
- Non-regen anaemia- reduced eryhtropoietin production
- Hyperparathyroidism- phosphate retention- rubber jaw
- Hypertension- renin released from reduced renal blood flow, RAAS
What additions may be found in the urinary system?
Inflammatory cells/leucocytes
Fibroblasts
Tumour cells
Exudate/oedema
Aetiological agents
The renal medulla is diffusely discoloured creamy white in radiating bands
The cortex has a yellow brown colour and appears soft in consistency
Describe changes to:
glomeruli (1)
Tubules (4)
Glomeruli- intact
Tubules-
Epithelium is vacuolated and necrotising
Lumen contains debris and basophilic to eosinophilic contents
Describe lumen contents?
What is your morphological diagnosis?
20% tubules contain colourless crystals in tubule lumen with necrotic epithelium
Ethylene glycol toxicity
Give a morphological diagnosis?
Kidney: diffusely, the renal pelvis is moderate to severely dilated
(hydronephrosis) by 5 multifocal tan to light brown polygranular
irregular deposits (uroliths) and clear space. The immediately
adjacent pelvic/medullary tissue is pale tan and has multifocal red
patches (haemorrhage). The pale tan discolouration extends
throughout the kidney. Consistency is expected to be more firm than
normal.
Describe histological changes?
Multifocal basophilic nodules in procimal medulla
Bands on radiating congestion and leucocyte infiltration
Describe the histological lesions?
Multifocal to coalescing areas of the cortex shows infiltration by leucocytes and dilation of some tubules with eosoinophilic fluid
Describe the histological lesions?
Give a morpholigical diagnosis?
Glomeruli detail has been multifocally replaced by eosinophilic material(fibrosis or necrosis). Theres is a moderate infiltration of lymphocytes and plasma cells.
Tubules are dilated by protinaceous (eosinophilic) fluid
MD- Severe chronic MF necrotising pyelonephritis with calculi
There are multifocal ~1mm diameter cream coloured firm raised
nodules throughout the cortical surface (and presumably extending
into the renal parenchyma)
Describe changes to the cortex
Multifocal to coalescing interstitial nodules- distending cortical surface
Describe changes:
Left
Middle
Right
Left- Normal
Middle- flattened/pressure atrophy of tubules
Right- disordered. Necrotic foci with infiltrating macrophages and lymphocytes
- What types of inflammatory cells are visible?
- Other changes?
- Aetiology?
- Macrophages, plasma cells, lymphocytes
- Central necrosis- liquefactive
- Ascarid migration with secondary granulomatous nephritis
Myobacteriosis (less likely)
Give a gross description
Kidney- Diffusely, across the entire cortical surface and also extending down into the medulla, there are multiple raised nodules approx 2- 3mm diameter, separated by grey white strands of material (fibrosis). The overall renal coloration is diffuse pale tan. Tissue consistency is expected to be firm
Describe the capsular surface
What are the tubular changes?
Widespread undulation
Diffusely dilated tubules
Describe more features visible on tubules?
And interstitium?
Dilation with eosinophilic (proteinaceous) fluid
Intersititium-
Multifocal fine basophilic stippling (leucocytes but not clear at this low power)
What further interstitial tissue change is there?
Time course/duration?
What is the name of this disease?
Give an MD?
Interstitial fibrosis
Chronic
Renal failure
Severe diffuse chronic lymphocytic tubulointerstitial nephritis
Describe the gross changes
Multifocal to coalescing areas with a tan/pink area in the renal cortex extending into the medulla and renal pelvis with a wedged shape. The medulla is haemorrhagic and reddened. Appears softer, necrotic. Approximately 5cm
Location- cortex
Distribution- multifocal to coalescing
Describe- coagulatvie necrosis ~5x8mm
Left- Focal eosinophilic degeneratoin/coagulative necrosis
Left/middle- WBC nuclear debris
Right- Some dilated but viable DCT, necrotic PCTs
Histomorphological diagnosis- Multifocal moderate subacute ishaemic infarcts
Pathogenesis- Necrotic embolie from heart lesions spread haematogenously to renal capillaries
Aetiology- Bacterial E. coli
Affecting the pelvic rim, extending into the medulla and to a lesser extent the cortex, there are red to brown multifocal linear radiating bands of affected tissue.
Undulating/indented surface
Radiating bands of material coincide with indents- some multifocal tubule dilation
Multifocally dilated tubules with eosinophilic (proteinaceous) material inside or haemorrhage
Multifocal leucocyes and fibrous tissue/collagen strands
- Inflammatory infiltrate mainly lymphocytes and plasma cells
- Fibrosis- wavy bands of collagen in interstitial tissue
- Tubular dilation with protein leakage
MD- Moderate to severe chronic multifocal to coalecing lymphocytic pyelonephritis
Pathogenesis-
Bladder: affecting the mucosal surface especially caudally, at the trigone, there is a multifocal to coalescing firm mottled pink to red black multinodular mass. There are multifocal, fine - less than 1 mm diameter red spots) petechial mucosal haemorrhage.
Diffusely thickened mucosa folds
Right- Epithelium is thick, cell dense, poorly contained by basement membrane, irregular
Centre- fibrous tissue with a few lymphocytes
Bottom left- Cluster of malignant epithelium cells as on right but presnt in capillary or lymphatic
Irregular, poorly organised epithelial cells on upper right and lower right extending into centre without any structure- tumour metastasis
MD- bladder transitional cell carcinoma
