Urinary Pathology Flashcards
What can cause the glomerulus to become visible to the naked eye?
Glomerulonephritis
Microscopic appearance of the glomerulus. (3)
- Fenestrated capillaries supported by mesangium
- Mesangial cells
- Podocytes
4 main fxns of mesangial cells
produce collagen & matrix
contract glomerular tuft
phagocytosis
secretion of inflammatory mediators
What are the visceral epithelial cells that participate in glomerular filtration?
podocytes
Glomerular filtration barrier selectively filters molecules based on:
size (< 70,000 Da)
charge (cations only)
Describe the glomerular filtration barrier.
filtration slits btwn podocyte pedicels & fenestrated endothelial cells w/ shared basal lamina
3 things that cause an increase in the amt of CT (scar tissue) in the interstitium of the kidney?
- age
- chronic inflammation
- ischemic damage
List the path blood flows through the kidneys
renal a.–> interlobar a. —> arcuate a–> interlobular a.–> afferent glomerular arterioles–> glomerular capillaries–> efferent glomerular arterioles–> peritubular capillary network
Which arteries are more susceptible to embolism leading to renal infarction? Why?
interlobular a.
terminal arteries that do NOT contain anastomoses & have a small lumen diameter
5 characteristics of renal infarction
- wedge-shaped
- well demarcated
- dark red or white
- acutely swollen (inflammation)
- chronically contracted (fibrosis)
5 basic renal fxns
- Urine –> eliminates metabolic waste
- Acid-base regulation–> reclaims bicarbonate
- Conserves H2O –> 99%
- Maintains normal extracellular [K]–> via aldosterone–> K excretion
- Controls endocrine fxn–> RAAS –> NaCl retention
What dictates plasma filtration?
Glomerular filtration barrier
How is BP regulated?
Renin-Angiotensin-Aldosterone System (know details)
The macula densa responds to low _____.
Na
Low Na stimulates juxtaglomerular cells to secrete______.
Renin
Fxn of Renin.
Converts Angiotensinogen —> Angiotensin I
liver
Fxn of ACE.
Angiotensin I–> Angiotensin II
lungs
Fxns of Angiotensin II
- stimulates aldosterone secretion (AG)
- stimulates ADH (PPG)
Cumulative effect= incr. BP
What kind of drugs are ACE-inhibitors?
anti-hypertensive
7 things reabsorbed in the Proximal tubules
Na, Cl, K, albumin, Gluc, H20, bicarb
How does the LoH produce a hypotonic filtrate?
via a countercurrent mechanism & Na/K-ATPase pump which absorbs more NaCl from the filtrate
2 places H20 is reabsorbed in the kidneys?
Distal tubules
Collecting ducts
What hormone influences Na & H2O reabsorption & K excretion in the Distal Tubules?
Aldosterone
How do the Collecting Ducts promote H2O reabsorption?
increasing urea gradient
How are H2O & Na reabsorption controlled in the Collecting Ducts?
Na/K-ATPase pumps, under the influence of ADH
What provides structural support for the glomerulus, tubules, BVs, lymphatics & nerves of the kidney?
the Interstitium
Interstitial fibroblasts produce what 3 things?
EPO (+ peritubular cells)
Prostaglandins
Inflammatory mediators
Definition of renal failure.
significant loss of renal fxn
kidneys have 75% fxnal reserve
Clinical indicators of renal failure
- Altered urine quantity - PU/PD; oliguria; anuria
2. Altered urine quality- Isosthenuria, proteinuria, azotemia, uremia
What does Isosthenuria inidcate? (TQ)
loss of renal fxn–> failure to concentrate urine
What does azotemia indicate? (TQ)
elevated serum Urea & Creatinine = >75% loss of nephrons
Uremia is a _______ characterized by numerous lesions & C.S.s caused by toxic levels of urea in blood.
syndrome
2 mechanisms by which uremia causes systemic lesions.
- uremic vasculopathy
2. uremic toxicity
What is uremic vasculopathy?
direct endothelial injury resulting in vasculitis, thrombosis & infarction
What is the term for caustic injury to epithelium of mucosal surfaces due to production of LG amts or ammonia by urea-splitting bacteria?
uremic toxicity
Systemic lesions of uremic syndrome
ulcerative glossitis (ventral tongue)
ulcerative stomatitis
ammonia breath
ulcerative gastritis w/ mineralization –> Cat & Dog
7 additional non-renal lesions caused by uremic syndrome.
- ulcerative colitis –> cattle & horse
- vascular thrombosis
- fibronous pericarditis
- pulmonary edema
- endocardial mineralization
- intercostal mineralization
- other soft tissue mineralizations
3 ways renal failure can lead to death.
- cardiotoxicity due to elevated serum K
- metabolic acidosis
- pulmonary edema
3 classifications of renal failure & azotemia.
pre-renal
intrarenal
post-renal
Why does acute pre-renal failure occur?
impaired renal perfusion causes reduced glomerular filtration &/o hypoxic injury
2 things that lead to acute pre-renal failure.
circulatory collaspe
renal ischemia –> vasculitis or embolic dz.
Why does acute intrarenal failure occur?
damage to the renal tissue
4 things that can cause acute intrarenal failure.
acute tubular necrosis
glomerulonephritis
tubulointerstitial nephritis
pyelonephritis
When form of acute intrarenal failure is most common?
acute tubular necrosis
2 clinical presentations that result from intrarenal failure.
oliguria
anuria
2 way tubular necrosis results in further renal injury.
- leakage of tubular ultrafiltrate–> necrosis & inflammation
- intratubular obstruction –> tubular casts
5 bacT infections that cause acute tubular necrosis.
- Lepto
- E. coli
- Strep
- Staph
- Proteus
3 virus that cause acute tubular necrosis in dogs.
- K9 hepatitis
- K9 distemper
- K9 herpes
A substance that accumulates to toxic conc. w/in the tubules.
nephrotoxin
4 general categories of nephrotoxins
pigments
heavy metals
oxalates
plants
3 pigments that act as nephrotoxins
Hb, myoglobin, bile/bilirubin
5 heavy metals that act as nephrotoxins
lead, mercury, arsenic, cadmium & thallium
2 oxalates that act as nephrotoxins
ethylene glycol (antifreeze) oxalate-rich plants
4 plants that can act as nephrotoxins.
pigweed, oaks, grapes/raisins & lilies
Why can Vit D toxicosis cause acute tubular necrosis (intrarenal failure)?
due to hypercalcemia
Which 4 drug types are nephrotoxic and can cause acute tubular necrosis?
antimicrobials
NSAIDs
immunemodulatory drugs
antineoplastic chemotherapeutics
4 things that can cause acute glomerulonephritits (intrarenal failure)
immune complexes
bacT
viruses
toxins
What causes acute pyelonephritits (intrarenal failure)?
ascending bacT infection from urethra, ureters & renal pelvis
What causes urinary obstruction w/ pressure atrophy & necrosis? (a.k.a obstructive nephropathy)
post-renal failure
3 causes of acute post-renal failure.
urolithiasis
tumors
iatrogenic
What 2 things can post-renal obstructions lead to?
hydroureter & hydronephrosis
possible organ rupture
Time period of chronic renal failure.
wks, mos., or yrs
When can CRF lead to end-stage kidney?
when it is prolonged & progressive
Term used to describe renal dz which is chronic, advanced, generalized, progressive & irreversible.
end-stage kidney
Gross appearance of an end-stage kidney
Fibrotic Atrophic Shrunken renal parenchyma Massive loss of fxnal nephrons Fibrosis
What is a common pathway to CRF, despite original cause of injury?
progressive fibrosis
Is it possible to determine the etiology once end-stage kidney is reached?
often impossible
Pathophysiology of CRF? (2)
- non-regenerative anemia
2. altered Ca:P metabolism
How does CRF alter Ca/P metabolism? what is this process known as?
HYPERphosphatemia–> HYPOcalcemia—> PTH secretion–> Ca mobilized from osteoclastic bone resorption–> osteopenia
Renal 2ry Hyperparathyroidism
Chronic hyperparathyroidism may lead to _____ ______.
fibrous osteodystrophy (bone replaces fibrous tissue)
Renal 2ry hyperparathyroidism is often due to what?
bilateral parathyroid gland hyperplasia
4 portals of entry to the kidney
- ascending from ureter
- hematogenous
- glomerular filtrate
- direct penetration
Ascending bacT infection results in _______.
suppurative pyelonephritis
What is the most important barrier (defense mechanism) of the kidney?
glomerular basement membrane
What prevents ascending bacT from gaining access to the kidney’s interstitium?
Tubular basement membrane (TBM)
What provides the scaffold for tubular regeneration?
tubular basement membrane
What typically destroys the TBM & causes permanent scarring w/ loss of tubules? (TQ)
Ischemia or Infarction
Humoral Abs protect the interstitium at the ____ ____ of the renal pelvis.
mucosal surface
What 3 cells w/in the interstitium provide cell-mediated immune surveillance against Lepto?
macrophages
lymphocytes
plasma cells
What is a defensive barrier against bloodborne pathogens?
intact endothelial lining (healthy vasculature)
Intact endothelium prevents activation of ____ ____ and reduces ____ formation
clotting cascade
thrombus
_____ to 1 part of the nephron results in _____ damage to other components of the nephron with eventual loss of _____.
Injury
progressive
fxn
Glomerular injury can result from the deposition of what 4 things?
- immune complexes (Type III)
- thromboemboli
- Bact emboli or direct infections
- amyloid & fibrin (proteins)
2 things that cause glomerular injury?
deposition of substances
hyperfiltration
2 things that result in hyperfiltration and glomerular injury?
prolonged systemic hypertension
increased dietary protein (prolonged proteinuria)
How does glomerular injury result in hypoxia with tubular atrophy & loss of fxn?
by interfering w/ peritubular blood supply
What 2 proteins leak into the urine due to damage to the glomerular filtration barrier?
Albumin
Antithrombin 3
2 characteristics of protein losing nephropathy?
nephrotic syndrome
wt. loss
What causes nephrotic syndrome? List some CS.
HYPOproteinuria –> reduced plasma oncotic pressure
C.S= ascites, pleural effusion, generalized edema
Loss of what protein can result in a hypercoagulable state & thromboembolic dz.
Antithrombin 3
List 4 ACUTE responses of the glomerulus to injury
- mesangial hypertrophy & hyperplasia
- increased vascular permeability
- infiltration of leukocytes
- necrosis
List 3 CHRONIC responses of the glomerulus to injury.
- atrophy
- Glomerulosclerosis (=fibrosis)
- 2ry atrophy of renal tubules due to ischemia
List some things that can cause tubular damage
bloodborne infections ascending infections toxins infarction/ischemia volume overload abnormal glomerular filtrate
What are some components of abnormal glomerular filtrate?
high protein
high crystalline salts
high organic acids –> oxalic/uric/pyruvic acid
4 responses to tubular damage?
- atrophy (2ry)
- degeneration
- regeneration
- necrosis
Which type of injury generally preserves the TBM & allows for regeneration of the tubules?
Toxic injury
Which type of injury destroys the TBM causing permanent scars & no regeneration of the tubules?
Ischemic injury
What is the single most important cause of acute renal failure in animals? (TQ)
Acute tubular necrosis
What are the 2 most common causes of acute tubular necrosis?
ischemia or nephrotoxicity
Acute tubular necrosis clinically results in ____ or _____.
oliguria or anuria
How does nephrotoxic injury cause acute tubular necrosis?
chemicals &/o toxic metabolites become concentrated in the tubules
3 mechanisms by which nephrotoxins cause damage to tubules?
- direct damage to epithelium
- reactive metabolites damage epithelium
- nephrotoxin-associated ischemia
Form of tubular necrosis that is NOT caused by inflammation? (TQ)
nephrosis
What typically causes nephrosis?
hypoxic injury combined w/ nephrototoxic injury
Type of nephrosis caused when hypoxic injury is exacerbated by hemoglobinuria during a hemolytic crisis?
Hemoglobinuric nephrosis
Type of nephrosis caused when hypoxic injury in exacerbated by myoglobinuria during acute muscle injury?
Myoglobinuric nephrosis
Gross lesions of acute tubular necrosis (often difficult to recognize)
- swollen, pale cortex that bulges on cut surface
2. may see accentuated striations or white streaks
Microscopic lesions of acute tubular necrosis? (6)
- tubular epithelial swelling
- vacuolation
- HYPEReosinophilia
- pyknosis
- karyorrhexis
- karyolysis
Which tubules are more sensitive to hypoxia due to higher metabolic demands?
proximal tubules
Which part of the kidney is resistant to ischemia & often remain morphologically normal?
glomeruli
Interstitium’s response to injury. (7)
- hyperemia
- edma
- lymphofollicular inflammation
- fibrosis
- interstitial nephritis
- tubulointerstitial nephritis
What is the most common response of the interstitium to chronic Lepto infection?
lymphofollicular inflammation
What leads to progressive loss of renal fxn? (TQ)
progressive fibrosis
3 causes of infectious interstitial nephritis.
- K9 ehrlichiosis
- Leptospirosis
- EIA
When will interstitial nephritis lead to renal failure & end-stage kidney?
only when it’s severe
4 things that can cause 2ry tubulointerstitial nephritis?
Lepto
Adenoviruses
Lentiviruses
Herpesviruses
_____ tubulointerstitial nephritis leads to end-stage kidney.
Chronic
What causes a well-demarcated, cone-shaped area of coagulative necrosis extending from medulla to cortex?
renal infarction
3 portals of entry to the lower UT.
- ascending infections
- direct penetration from lumen
- cyctocentensis
5 defensive mechanisms of the lower UT.
- flushing action –> reduces risk of ascending infections
- peristalsis –> eliminates bacT
- slightly acidic urine –> reduces some bacT growth
- protective urethral mucus layer –> decr. bacT adhesion
- innate & adaptive immune response
5 developmental anomalies of the kidney.
- renal aplasia, hypoplasia or dysplasia
- ectopic kidney
- fused kidney
- renal cysts
- polycystic kidneys
Juvenile progressive nephropathy is a specific form of inherited renal dysplasia common to what 3 breeds?
Lhasa apso
Shih Tzu
Golden retriever
“Horseshoe kidney” is an example of which developmental anomaly? What is the fxn of these kidneys?
fused kidney
usually maintain normal fxn
Ectopic kidney is most common in what 2 species?
dogs & pigs
Renal cysts are common in what 2 species?
cattle & pigs (just 1 to a few)
What is the clinical significance of renal cysts?
none–> usually an incidental finding
Term for many renal cysts affecting numerous nephrons?
Polycystic kidney
Polycystic Kidney Dz in an autosomal dominant trait in what 2 breeds? (TQ)
Persian cats
Bull Terriers
Dz caused by mutations in PKD-1 &/o PKD-2 resulting in abnormal tubulogenesis?
Polycystic Kidney Dz.
When can renal function by impaired in patients w/ Polycystic Kidney Dz?
severe cases –> when significant loss of parenchyma
List the 6 diseases of the glomerulus.
- immune-mediated glomerulonephritis
- glomerulosclerosis
- glomerular amyloidosis
- Acute suppurative glomerulitis (bacT embolic nephritis)
- viral glomerulitis
- chemical glomerulitis
Immune mediated glomerulonephritis occurs most commonly in ____ & _____.
cats & dogs
Immune mediated glomerulonephritis is associated with ___ ___ which enhances the formation of abundant ____ ____ in the blood plasma.
persistent infections
immune complexes
What results in complement fixation, leukocyte infiltration & formation of fibrin thrombi –> glomerular damage?
deposition of soluble immune complexes w/in glomeruli
What 5 things can cause immune-mediated glomerulonephritis in cats?
FeLV FIV FIP progressive polyarteritis neoplasia
What 2 things cause immune-mediated glomerulonephritis in horses?
Strept infections
EIA
What 2 things cause immune-mediated glomerulonephritis in cattle?
BVD
Trypanosome infections
What 2 viruses cause immune-mediated glomerulonephritis in swine?
Classical SF (Hog cholera) African SF
What gross lesion of immune-mediated glomerulonephritis might you see?
swollen, enlarged glomeruli as red pin-point foci in the cortex
List the 3 histologic forms of immune-mediated glomerulonephritis. Species each is common in?
- proliferative –> horses
- membranous –> cats
- mebrano-proliferative –> dogs
What is the condition of CHRONIC glomerulonephritis characterized by fibrosis of the glomerulus?
glomerulosclerosis
2 things associated with glomerulosclerosis?
high BP
unrestricted dietary protein
What is typically associated w/ Reactive Systemic Amyloidosis (AA amyloidosis) that occurs w/ CHRONIC inflammatory dz?
glomerular amyloidosis
Which 2 breeds are genetically predisposed to reactive amyoidosis? (TQ)
Abyssinian cats
Chinese Shar-Pei dogs
What is a common cause of protein losing nephropathy?
glomerular amyloidosis
What stain can be used to ID amyloid protein histologically?
Congo red stain
List the 4 examples of bacT & affect species that cause actute suppurative glomerulitis. (LG animals)
- A. equuli –> foals
- E. rhusiopathiae –> pigs
- C. pseudotuberculosis –> goats & sheep
- T. pyogenes –> cattle
List the 5 causes of viral glomerulitis? common or rare?
- Infectious K9 hepatitis (adeno-)
- EVA (arteri-)
- CSF (pesti-)
- Newcastle dz (paramyxo-)
- neonatel porcine cytomegalovirus
Rare
List 4 known examples that cause chemical glomerulitis
- puromycin aminonucleoside
- adriamycin
- histamine-receptor antagonists
- cyclosporin A
List 2 inherited abnormalities in renal tubular FXN.
- 1ry renal glucosuria –> trouble reabsorbing Gluc–> Norwegian elkhounds
- Basenji dog Fanconi Syndrome
Are there any lesions associated with 1ry Renal Glucosuria?
no, only a fxnal deficit
What other dz must by distinguished from 1ry Renal Glucosuria?
Diabetes mellitus
C.S. of acute tubular necrosis? (TQ)
oliguria or anuria w/ severe azotemia
Hemoglobinuria nephrosis & hemoglobinuria w/ hemolysis occurs in what 4 things? Species?
- Cu toxicity –> sheep
- Lepto or Babesia –> cattle
- Red maple toxicity –> horse
- Babesia or IMHA–> dogs
3 things that cause myoglobinuria (myoglobinuric nephrosis)?
- exertional myopathy (azotemia, tying up) –> horses
- capture myopathy (rhabdomyolysis)–> wild animals
- severe mm. trauma
List the 3 histologic changes seen in acute tubular necrosis.
tubular necrosis
tubular degeneration
IN inclusion bodies
When can nephrotoxic drugs cause acute tubular necrosis?
when administered at excessive doses or too frequently
Which drugs decrease the synthesis of renal prostaglandins which are responsible for maintaining normal renal blood flow?
NSAIDs
NSAIDs cause renal ____________.
vasoconstriction
NSAIDs cause acute tubular necrosis & ___ ___ ___.
renal papillary necrosis
Which mycotoxin from contaminated feed can result in acute tubular necrosis?
aflatoxin
What 2 things do mycotoxins cause?
tubular degeneration
tubular necrosis
List the 4 oxalate-rich plants
Halogeton
Sarcobatus
Rheum
Rumex
What happens when Ca oxalates precipitate in renal tubules froming oxalate crystals w/ subsequent epithelial injury & renal failure?
Oxalate nephrosis
Grapes & raisins can cause acute tubular necrosis in what species?
dogs
Lilies can cause acute tubular necrosis in what species?
cats
Oak toxicity can cause acute tubular necrosis in what 2 species?
cattle
horses
Ethylene glycol (antifreeze) results in ___ ____ & ___ ____.
nephrotoxic metabolites –> oxalate & glycolic acid
oxalate nephrosis
What 2 pet food contaminants cause distal tubular necrosis w/ characteristic irregular brown birefringent crystals?
Melamine
Cyanuric acid
Vit D toxicosis leads to ____calcemia.
hypercalcemia
Hypercalcemia causes ______ mineralization of tubular & glomerular basement membranes.
metastatic
Metastaic mineralization is followed by what 4 things?
degeneration
necrosis
fibrosis
loss of fxn
Pulpy Kidney is a typical dz seen in what animals?
small ruminants
What causes Pulpy Kidney?
enteric proliferation of C. perfringes type D
What exotoxin is produced in Pulpy Kidney dz?
Epsilon exotoxin
What 3 things do epsilon exotoxin cause in small ruminants?
Bilateral acute tubular degeneration & necrosis
Interstitial edema
Hemorrhage
What is caused by dilation of the renal pelvis due to obstruction of urine outflow?
Hydronephrosis
Pyelonephritis leads to infection of the ____ ____ w/ extension to the ____ ___.
renal pelvis
renal tubules
Pyelonephritis is often unilateral or bilateral?
bilateral (can do either or)
Gross lesion of pyelonephritis
expansion of renal pelvis by purulent exudate
Microscopic lesions of pyelonephritis
suppurative inflammation of pelvis & medulla w/ necrotic transitional epithelium
Papillary necrosis is due to ischemic injury caused by what drugs?
NSAIDs
Papillary necrosis is most frequently seen in _____. Can be seen in ___ & ___ due to accidental ingestion.
horses
cats & dogs
Hairy vetch toxicosis in cattle causes ______ _____ & accompanies systemic granulomatous dz.
granulomatous nephritis
What animals get Xanthogranulomas?
cats w/ inherited hyperlipoproteinmia
List the 3 types of epithelial tumors.
Renal adenoma
Renal carcinoma
Transitional cell papilloma & carcinoma
What is the most common primary renal neoplasm of the kidney? Common species?
renal carcinoma
older dogs
In what dog breed is renal carcinoma associated with nodular dermatofibrosis?
GSD
Transitional cell papilloma & carcinoma occur most commonly where?
urinary bladder
Which neoplastic dz has a very high metastatic potential?
transitional cell carcinoma
Another term for nephroblastoma.
embryonal neophroma
Wilm’s tumor
Nephroblastoma is common in which species?
pigs
chickens
some fish
What is a common metastatic tumor of the kidney?
renal lymphoma
2 invasive tumors of the adrenal glands that effect the kidney
- pheochromocytoma
2. adrenocortical carcinoma
5 developmental anomalies of the lower UT
- aplasia (rare)
- hypoplasia
- ectopic ureters
- patent urachus
- urinary bladder diverticulum
What is the most common malformation of the urinary bladder?
patent urachus
What causes patent urachus?
fetal urachus fails to close & completely involute –> channel btwn bladder’s apex & umbilicus
Where can one see urine coming from in patients with patent urachus?
urine dribbles from the umbilicus (navel region)
What 2 things are frequently observed with patent urachus?
neonatal omphalitis
abscess formation
Which animals are most commonly affected by patent urachus?
foals
Developmental abnormalities of the urinary bladder diverticulum can do what 3 things?
- be associated w/ obstructive dz (acquired form)
- predispose to systitis & calculi formation
- predispose to bladder rupture
Syndrome that occurs when familial, congenital, &/o pathophysiological factors increase the precipitation of stone-forming salts resulting in urinary calculi formation.
Urolithiasis
What is the essential precursor to initiation of crystal & urolith formation?
supersaturation of urine –> due to supersaturation of mineral salts & protein
What is only partially responsible for calculogenesis?
crystal formation
What type of crystal is most common in dogs & cats? What type of urine favors their formation?
struvite crystals
alkaline urine
Struvite crystals are also known as?
Infection calculi
Which breed of dog is predisposed to struvite uroliths and Ca oxalate dihydrate w/ urolith formation?
Mini Schnauzers
Bilirubinuria +/- bilirubin crystals is an abnormal finding in what 4 species?
cats
horses
cattle
camels
Ca carbonate crystals are not common in what 2 species’ urine?
cats & dogs
List the 4 UNCOMMON types of urinary crystals seen in animals.
- Ca oxalate MONOhydrate
- Ammonium biurate crystals
- Cystine crystals
- Drug-associated crystals
What shape of Ca oxalate monohydrate crystals are observed in the urine of dogs & cats w/ ethylene glycol toxicosis?
“picket fence” crystals
2 things that together indicate ethylene glycol toxicosis?
acute renal failure & picket fence crystalluria
What type of urinary crystal is commonly seen in dogs & cats w/ congenital or acquired portal vascular anomalies?
ammonium biurate crystals
Ammonium biurate crystals are NORMAL in what 2 breeds of dog? (TQ)
Dalmatians & bulldogs
Cystine crystalluria &/o urolithiasis is an indication of what genetic abnormality?
cystinuria
What animals are almost exclusively affected by cystinuria?
male dogs
Which drug most commonly causes drug-associated urinary crystals? Do these cause significant renal dz?
trimethoprim-sulfadiazine
No
What is the most common cause of obstructive uropathy?
Urolithiasis
Acute cystitis is common in all domestic animals. Which gender is more prone? Why?
females
due to shorter & wider urethra
Acute cystitis may have concurrent ____ & ____.
ureteritis & urethritis
What 4 bacT are the most common source of acute cystitis?
E. coli
Proteus sp.
Strept sp.
Staph sp.
C. renale commonly causes acute cystitis in what species?
cattle
A. suis commonly causes acute cystitis in what species?
pigs
E. faecalis commonly causes acute cystitis in what species?
cats
Klebsiella sp. commonly cause acute cystitis in what species?
horses
List some risk factors for acute bacterial cystitis. (8)
- stagnation of urine
- trauma
- vaginoscopy, vaginitis, coitus, AI
- urinary incontinence
- prolonged antibiotic use
- diabetes mellitus
- prolonged corticosteroid use or Cushing’s dz
- immunosuppression
Cantharidin toxicosis occurs in? from ingestion of what?
horses
blister beetles in alfalfa hay
2 causes of mycotic cystitis?
Aspergillus sp.
Candida albicans
What can cause cystitis, hematuria & urinary bladder neoplasia in cattle?
bracken fern toxicosis
Gross lesions of acute cystitis. (4)
edema
hemorrhage
ulceration
purulent exudate
Microscopic lesions of acute cystitis. (6)
epithelial denudation ulceration hemorrhage edema suppurative infiltration bacterial colonies
C.S. of acute cystitis
dysuria, stranguria or hematuria
sedimentation, blood, +/- bacT on UA
pyrexia
2 most common causes of chronic cystitis
chronic bacT infection
urolithiasis
3 types of chronic cystitis (based on morphologic pattern)
diffuse
lymphofollicular
polypoid
Gross lesions of chronic cystitis.
diffusely reddened, roughened & thickened mucosa
may see lymphoid follicles or polypoid hyperplasia
Microscopic lesions of chronic cystitis.
epithelial HYPERplasia
fibrosis
hemorrhage
mononuclear infiltration w/ few neutrophils
Where to most neoplasms occur in the lower UT?
urinary bladder
Transitional cell carcinoma is most common in ____.
dogs
What area of the bladder is transitional cell carcinoma most common?
trigone area
What is the most common mesenchymal tumor of the lower UT?
leiomyoma (less common that epithelial tumors)
Bacterial embolic nephritis is caused by what normal inhabitant of the alimentary tract?
A. equuli
How do foals get bacterial embolic nephritis?
via contamination of the umbilicus
What 2 NSAIDs can cause papillary necrosis?
phenylbutazone
flunixin meglumine
List the 5 disorders specific to horses.
bacterial embolic nephritis myoglobinuric nephritis (rhabdomyolysis) papillary necrosis patent urachus Klossiella equi infection
List the 10 disorders specific to ruminants
oak toxicity pulpy kidney dz. embolic nephritis (white spotted kidney) tubulointerstitial nephritis granulomatus nephritis pyelonephritis renal lymphosarcoma urolithiasis bracken fern toxicosis renal amyloidosis
White Spotted Kidney (embolic nephritis) occurs in ruminants due to ? Is it noticeable?
bacT embolize the kidney leading to microabscesses & abscess formation
no, commonly subclinical
What can cause tubulointerstitial nephritis in cattle?
Lepto. interrogans
Serovars- hardjo, pomona, & grippotyphosa
Tubulointerstitial nephritis causes direct damage to what 3 parts of the kidney?
endothelium
tubules
interstitium
Granulomatous nephritis in ruminants is due to ___ ____ toxicosis. (TQ)
hairy vetch
Is pyelonephritis common in cattle?
no
What is the most common isolate of Contagious Bovine Pyelonephritis?
C. renale
What viral dz in cattle can be associated with renal lymphosarcome?
Bovine Leukosis Virus (BLV)
List the common locations of urolith obstruction in bulls, rams & bucks.
bulls - sigmoid flexure
rams & bucks- urethral process
Why are uroliths typically silica calculi in ruminants?
due to the high silica content of pasture grasses
Bracken fern toxicosis is also known as ____ _____.
enzootic hematuria
What is the most common toxicosis of cattle? (TQ)
bracken fern toxicosis
Prolonge ingestion of bracken fern (P. aquilinum) causes what 3 things in cattle?
hemolysis
BM damage
immunosuppression
Repeated low level exposure to bracken fern causes what in cattle?
urinary bladder neoplasia –> transitional cell carcinoma
List the 7 disorders specific to swine.
glomerulonephritis toxic nephritis leptospirosis Viral interstital nephritis urolithiasis erysipelothrix kidney worm
What plant can cause acute tubular necrosis leading to acute renal failure in swine?
pigweed
Which 3 Leptospira serovars cause leptospirosis in swine?
pomona
tarassovi
australis
Which virus can cause granulomatous interstitial nephritis in swine?
Circovirus–> Postweaning Multisystemic Wasting Syndrome (PMWS)
What is the most common cause of embolic nephritis in pigs? (TQ)
Erysipelothrix (diamond skin dz)
Kidney worm of swine?
Stephanurus dentatus
List the 5 disorders specific to cats.
Granulomatous nephritis --> FIP (non-effusive form) Renal lymphosarcoma Feline Lower UT Dz (FLUTD) Hemorrhagic urocystitis Toxic tubulointerstitial nephritis
FLUTD is most commonly seen in what cats?
middle-aged, overweight cats w/ little exercise, indoor litter box & dry food diet
What is the term for a collection of diseases affecting the urethra & bladder of cats?
feline lower urinary tract disease (FLUTD)
3 things that cause FLUTD in cats?
Feline idiopathic cystitis
urolithiasis
chronic &/o recurring bacT UTIs
Older male acts typically form ____ calculi leading to urethral obstruction.
struvite
In what cats may inflammation predispose to formation of protein matrix plugs?
younger male cats
What is the consequence of urethral obstruction in male cats?
hemorrhagic urocystits
Pathology of hemorrhagic urocystitis.
urinary bladder becomes severely distended leading to pressure necrosis, hemorrhagic & ulceration
Chronic fibrosis limits bladder ____ & leads to poor ____ voiding & increased susceptibility to ____ infections.
fxn
urine
bacterial
3 things that cause toxic tubulointerstitial nephritis in cats
ethylene glycol toxicosis
melamine & cyanuric acid
lily toxicity
List the 15 disorders specific to dogs
Greyhound cutaneous glomerular vasculopathy Ethylene glycol toxicity Aminoglycoside toxicosis Leptospirosis Infectious K9 hepatits K9 herpesvirus Pyelonephritis Progressive juvenile nephropathy Urolithiasis Chronic urocystitis Transitional cell carcinoma Renal carcinoma Toxic tubulointerstitial nephritis Grape or raisin toxicity Giant kidney worm
What is a rare idiopathic vascular dz w/ genetic predisposition in Greyhounds?
Cutaneous Glomerular Vasculopathy
Lesions seen in Greyhounds w/ Cutaneous Glomerular Vasculopathy.
glomerular thrombotic microangiopathy (can look like DIC)
Why is ethylene glycol (antifreeze) so toxic to dogs?
Readily absorbed by the GIT & converted to toxic metabolites by hepatic alcohol dehydrogenase
What is the degree of nephrotoxicity of aminoglycosides in dogs. (-mycins)
Neo> Kana>Genta> Strepto> Tobra> Amikacin
Aminoglycoside toxicosis causes what 2 things in dogs?
acute tubular degeneration & necrosis
What other parts of the dog’s body can be affected by aminoglycoside toxicosis?
inner ear
neuromuscular jxn
2 most common Lepto isolates in dogs?
L. icterohaemorrhagiae
L. canicola
How do dogs pick up Leptospirosis?
infections obtained from wet, contaminated environments through compromised mucus membranes
Where does Lepto persists in dogs?
renal tubular epithelial cells
C.S. of Leptospirosis in dogs?
fever anorexia vomiting dehydration icterus mm. pain bleeding
Chronic causes of Lepto in dogs will present with what 2 signs.
wt loss
sometimes uveitis
Lepto causes what 2 things in dogs
acute tubular damage
acute to chronic tubulointerstitial nephritis
Is Lepto zoonotic?
Yes!!
How do young puppies (< 6 wks) get K9 herpesvirus?
due to intrauterine or neonatal infection from the dam w/ CHV-1
K9 herpesvirus causes what?
multifocal acute tubular necrosis w/ hemorrhage
CHV-1 neonatal mortality is associated in puppies w/ _____.
HYPOthermia
Most common organisms to cause pyelonephritis in dogs
E. coli S. aureus P. mirabilis Strept sp. K. pneumoniae P. aeruginosa Enterobacter sp.
CS of pyelonephritis in dogs.
fever
depression
arched back
PU
When is pyelonephritis likely to occur in dogs?
when there is altered lower UT defense
Inherited disorder in dogs leading to development of severe bilateral renal fibrosis, dysplasia & progressive loss of fxnal nephrons.
progressive juvenile nephropathy
Progressive juvenile nephropathy clinical resembles what?
CRF & end-stage kidney
Variable degrees of severity w/ progressive fibrosis leading to progressive loss of renal fxn in younger dogs.
progressive juvenile nephropathy
What breeds of dogs are over-represented w/ progressive juvenile nephropathy?
samoyeds
bull terriers
shih tzus
4 most common uroliths in dogs
struvite
urate
xanthine
cystine
What 2 dog breeds are predisposed to urate calculi due to inefficient hepatic uric acid metabolism?
Dalmatians
English bulldogs
Therapy for Dalmatians & English bulldogs w/ inefficient hepatic uric acid metabolism
low purine diets
Allopurinol –> lowers uric acid in blood
2 main dog breeds that are genetically predisposed to Ca oxalate urolithiasis.
Mini Schnauzers
Bichon Frises
What common symptoms to dogs develop with chronic urocystitis?
lymphofollicular & polypoid cystitis
hematuria
What is the most common primary kidney neoplasm in dogs?
renal dogs
Renal carcinoma occurs sporadically in ____ dogs.
older
Where can renal carcinoma metastasize to? (4)
lungs
lymph nodes
liver
adrenal glands
What cause distal tubular necrosis with characteristic irregular brown birefringent crystals in dogs? (TQ)
Melamine & Cyanuric acid toxicosis from contaminated pet food
Ingestion of grapes/raisins by dogs leads to these 3 things.
acute renal failure
uremic syndrome
diarrhea
What is the kidney worm that affects mostly fish eating mammals, especially dog & mink?
Dioctophyma renale
What may be the only initial C.S. of D. renale (giant kidney worm) infection?
hematuria
D. renale causes what 2 things in dogs.
hemorrhagic & purulent pylitis
hydronephrosis due to obstruction