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Organ Systems Pathology > Urinary Pathology > Flashcards

Urinary Pathology Flashcards

1
Q

What are the top five things the kidney does?

A
  1. Formation of urine to eliminate waste
  2. Acid-base regulation (bicarb)
  3. Sodium water balance (along with P and Ca)
  4. Maintaining potassium
  5. Endocrine functions (EPO production, Renin-angiotensin, Vitamin D conversion to active form)
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2
Q

T/F: Dog kidneys do not have a renal pelvis

A

F (cows do not)

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3
Q

What is the function of the proximal convoluted tubule?

A

Resorption of Na, Cl, K, albumin, glucose (should be all of it), and water; phosphorus can be absorbed but often is not

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4
Q

What is the basic function of the Loop of Henle?

A

Concentration of urine (resorption of water)

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5
Q

What is the function of the distal convoluted tubule?

A

Resorption of osmolytes and water

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6
Q

What is the function of the collecting duct?

A

Movement of water, urea, Na, Cl, H, and bicarb

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7
Q

Glomerular injury leading to decreased GFR affects the rest of the nephron by way of ___

A

Ischemia; inflammation

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8
Q

T/F: End stage kidney can only result from glomerular injury

A

F (glomerular or tubular)

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9
Q

Define acute renal failure

A

Rapid decrease in renal function over a short period of time (kidney is pale and swollen)

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10
Q

Define chronic renal failure

A

Decline in renal function over time with replacement of nephrons with fibrosis (end stage kidney)

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11
Q

Define azotemia

A

Increase of nitrogenous waste products in the blood (urea and creatinine); increased BUN and creatinine

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12
Q

What helps determine if azotemia is due to kidney dysfunction?

A

USG

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13
Q

Define uremia

A

Retention of nitrogenous waste products leading to multisystemic lesions (neuro and GI in dog)

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14
Q

What is a prerenal cause of acute renal failure?

A

Ischemia (shock)

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15
Q

What are three renal causes of acute renal failure?

A

Tubular necrosis from infectious agents (Leptospira)
Tubular necrosis from nephrotoxic drugs (aminoglycosides)
Tubular necrosis from chemicals (ethylene glycol)

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16
Q

What is a postrenal cause of acute renal failure?

A

Obstructive nephropathy (urolithiasis)

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17
Q

T/F: Retention of potassium in renal failure can lead to heart failure

A

T

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18
Q

T/F: Renal failure leads to metabolic alkalosis

A

F (metabolic acidosis)

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19
Q

T/F: Renal failure can lead to pulmonary edema

A

T (fluid therapy, kidney cannot regulate water balance)

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20
Q

Reduced erythropoietin production in renal failure leads to ___ anemia

A

Nonregenerative

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21
Q

As GFR is reduced, secretion by the kidneys is reduced, leading to ___

A

Hyperphosphatemia

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22
Q

Hyperphosphatemia leads to ___

A

Renal secondary hyperparathyroidism

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23
Q

T/F: Small, pitted kidneys that are scarred and have lost most of their nephrons are called end-stage kidneys

A

T

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24
Q

T/F: Nephrons are regenerative

A

F

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25
Q

T/F: Nephrons will hypertrophy to make up for the loss of other nephrons

A

T

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26
Q

What proportion of nephrons must be lost before alteration in urine concentration is seen?

A

2/3

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27
Q

What proportion of nephrons must be lost before azotemia is seen?

A

3/4

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28
Q

T/F: Creatinine elevation is easily detected in renal failure

A

F (range is so broad and increase is gradual)

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29
Q

T/F: Etiology of end stage kidney is grossly discernable

A

F (end stage kidney looks the same regardless of etiology)

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30
Q

Histologic properties of end stage kidneys (3)

A

Fibrosis with lymphocytes and plasma cells
Glomerulosclerosis
Hyaline casts

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31
Q

Causes of end stage kidney (5)

A 
Glomerular disease
Tubular disease
Vascular disease
Interstitial nephritis
Pyelonephritis
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32
Q

T/F: Large amounts of protein in the urine indicates glomerular disease

A

T

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33
Q

Glucosuria can be an indicator for ___ and can lead to ___

A

Diabetes mellitus

Emphysematous cystitis

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34
Q

Define uremia

A

Rapid and progressive increase in serum urea, creatinine, and phosphate AND a polysystemic toxic syndrome due to acute renal injury

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35
Q

T/F: Pyelonephritis is an important cause of uremia in horses

A

F (dogs and cats)

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36
Q

In dogs and cats, mineralization of the midzonal area of the gastric mucosa and necrosis of vessels are signs of ___

A

Uremic gastropathy

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37
Q

In what area in cows and horses will one find lesions similar to uremic gastropathy?

A

Colon

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38
Q

What is a common presenting clinical sign of uremia?

A

Vomition (may be able to smell ammonia on breath)

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39
Q

Four locations of mineralization in cases of uremia

A

Thoracic pleura (frosting)
Epicardium
Atrial endocardium
Alveolar walls in the lungs

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40
Q

What occurs in instances of metastatic mineralization?

A

Excess calcium and phosphorus circulating in the blood combine and deposit in tissues throughout the body

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41
Q

What occurs in instances of dystrophic mineralization?

A

Tissues are damaged by uremic toxins, undergo necrosis, and mineralize

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42
Q

Phosphorus inhibits the enzyme that activates vitamin D, which in turn helps animals absorb calcium; this condition is called ___

A

Secondary hypoparathyroidism

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43
Q

Decreased serum calcium (hypocalcemia) leads to the production of PTH, leading to bone resorption and ___

A

Fibrous osteodystrophy (with enlarged parathyroid glands)

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44
Q

Describe fibrous osteodystrophy histologically

A

Resorption of bone by osteoclasts with replacement by fibrous tissue

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45
Q

Why are renal infarcts common? (2)

A

Anastamoses

Primary function of the kidney is blood filtration

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46
Q

Components of the glomerulus (3)

A

Endothelial lined capillaries
Epithelial cells
Mesangial cells and mesangial matrix

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47
Q

Important components of the filtration barrier (3); they filter based on size of the particle and charge

A

Fenestrations in the endothelium
Basement membrane
Podocytes (epithelium)

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48
Q

Functions of mesangial cells (4)

A

Contract to alter capillary perfusion
Phagocytosis
Make collagen
Produce cytokines

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49
Q

The hallmark of glomerular disease is ___

A

Proteinuria

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50
Q

A normal protein:creatinine ratio is ___

A
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51
Q

A protein:creatinine ratio of 1-3 indicates ___

A

Tubular disease

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52
Q

A protein:creatinine ratio of >5 indicates ___

A

Glomerular disease

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53
Q

Sequelae of glomerular disease (5)

A 
Protein losing nephropathy
Nephrotic syndrome
Renal failure
Procoagulant state
Pulmonary thrombosis and edema (if severe)
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54
Q

Components of nephrotic syndrome (4)

A

Proteinuria
Hypoproteinemia
Edema
Hypercholesterolemia

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55
Q

T/F: Glomerular disease is discernible based on gross lesions

A

F

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56
Q

Ways glomerular disease can be seen grossly (3)

A 
Pinpoint red dots in the cortex
Pinpoint white/tan cortical dots
Pitted appearance (tubulointerstitial nephritis can look this way, too)
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57
Q

Types of glomerular disease (5)

A 
Exudative glomerulitis
Membranous glomerulonephritis
Proliferative glomerulonephritis
Membranoproliferative glomerulitis
Amyloidosis
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58
Q

Actinobacillus equuli in horses typically results in exudative ___

A

Glomerulitis

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59
Q

T/F: Glomerulitis is inflammation affecting ONLY the glomeruli

A

T

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60
Q

___ refers to an immune mediated group of diseases that affect the glomerulus

A

Glomerulonephritis

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61
Q

In membranous glomerulonephritis, thickening of the ___ occurs

A

Basement membrane

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62
Q

In ___ glomerulonephritis, there is an increase in the number of mesangial cells and matrix

A

Proliferative

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63
Q

___ is when the glomerulus is shrunken and hyalinized, leaving only fibrosis and increased mesangial matrix

A

Glomerulosclerosis

64
Q

Membranous glomerulonephritis, membranoproliferative glomerulonephritis, and proliferative glomerulonephritis are all caused by ___ mediated glomerular disease

A

Immune complex

65
Q

How do immune complexes get into the glomerulus? (2)

A

Preformed complexes become trapped

Antibodies complex with an antigen already present in the glomerulus

66
Q

What is the mechanism of Preformed antibody deposition?

A

Complexes call in N0, N0 release enzymes and free radicals, BM and podocyte foot processes are damaged, protein escapes

67
Q

Type of reaction observed in glomerulonephritis depends on ___

A

Where immune deposits are located

68
Q

Diseases in dogs that can lead to immune complex glomerulonephritis (11)

A 
Infectious canine hepatitis
Pyometra
Pyoderma
Prostatitis
Lyme disease
Heartworm disease
Systemic lupus erythematousus
Polyarteritis
Autoimmune hemolytic anemia
Hereditary C3 deficiency
Neoplasia
69
Q

Diseases in cats that can lead to immune complex glomerulonephritis (5)

A 
Feline leukemia virus
Feline infectious peritonitis virus
Feline immunodeficiency virus
Neoplasia
Progressive membranous glomerulonephritis (idiopathic)
70
Q

Diseases in horses that can lead to immune complex glomerulonephritis (2)

A

Equine infectious anemia

Streptococcus spp. infections

71
Q

What is an important tool in visualizing immune complexes?

A

TEM; one can see effacement of the podocyte foot processes

72
Q

What is amyloid?

A

A protein that can be deposited extracellularly in tissues throughout the body that can lead to dysfunction of an organ dt accumulation

73
Q

How do amyloid laden organs appear grossly? Histologically?

A

Enlarged, pale, and waxy

Eosinophilic, homogenous, hyaline substance filled

74
Q

What is the ideal stain for detectin amyloid?

A

Congo red

75
Q

Where in the kidney can amyloid be deposited?

A

Glomerulus

Medullary and papillary interstitium

76
Q

The hallmark of glomerular disease is ___

A

Proteinuria

77
Q

T/F: Proteinuria is appreciated in interstitial deposition of amyloid

A

F; amyloid in the interstitium is a breed related disease and does not lead to glomerular disease

78
Q

Name of the protein in the ascending loop and first portion of distal tubule that helps prevent water loss to the interstitium

A

Tamm Horsfall

79
Q

When protein is lost through the glomeruli, Tamm Horsfall protein ___

A

Precipitates to form hyaline casts

80
Q

Most important cause of acute renal failure

A

Acute tubular necrosis

81
Q

In acute renal failure, one will appreciate ___ or ___ (pertaining to urine)

A

Oliguria

Anuria

82
Q

Causes of oliguria and anuria in acute renal failure (2)

A

Tubular ultrafiltrate leaks back into the interstitium (less excretion)
Necrotic tubular epithelial cells plug up tubular lumens, leading to obstruction

83
Q

Hyaline casts are an indicator of ___ leakage

A

Protein

84
Q

Granular casts are an indicator of ___ necrosis

A

Tubular

85
Q

What are granular casts made of?

A

Sloughed epithelial cells stuck together with Tamm Horsfall protein or serum

86
Q

T/F: toxic damage to renal tubules leads to necrosis of renal tubular epithelium and basement membrane

A

F; basement membrane remains intact

87
Q

T/F: ischemia of renal tubules leads to necrosis of renal tubular epithelium and basement membrane

A

T

88
Q

T/F: toxic damage to the renal tubules is reversible

A

T; the basement membrane is still intact

89
Q

In irreversible damage to the kidney, renal tubules are replaced by ___

A

Fibrosis

90
Q

Toxic and ischemic damage is most severe in the ___

A

Proximal tubules (they are very metabolically active)

91
Q

Why are kidneys so susceptible to toxic damage?

A

They receive a high amount of cardiac output and can concentrate toxins

92
Q

Plants that cause tubular damage (8)

A 
Easter, tiger, and other lilies (cats)
Daylilies (cats)
Oak leaves and acorns (herbivores)
Pigweed (herbivores)
Oxalate plants (rhubarb, sorrel, greasewood)
Red maple leaves (hemolysis)
Onions (hemolysis)
Raisins and grapes (dogs)
93
Q

Therapeutic drugs that can cause tubular damage (3 listed)

A

Doxorubicin
Aminoglycosides
Cisplatin
Etc.

94
Q

What is the mechanism for ethylene glycol toxicosis?

A

Serum hyperosmolality and metabolic acidosis -> metabolization by the liver to glycolate and oxalate -> oxalate precipitates with calcium -> Calcium oxalate monohydrate and dihydrate crystals -> blockage of tubules and tubular epithelial damage -> anuria, renal azotemia -> renal failure; similar mechanism to melamine/cyanuric acid toxicosis

95
Q

Causes of renal ischemia (3)

A

Lack of perfusion (dehydration/hypovolemia/shock)
Severe anemia
Vascular obstruction

96
Q

Nephrotoxic pigments (2)

A

Hemoglobin

Myoglobin

97
Q

How to distinguish hemoglobinuria, myoglobinuria, and hemorrhage

A

Hemorrhage will clear when centrifuged, as RBCs are intact, hemoglobin and myoglobin will not
If plasma is clear, it is myoglobin
If plasma is red, it is hemoglobin

98
Q

___ causes the kidney to have dark red streaks or look blue-black diffusely; microscopically, we can see red-orange or red-brown casts within tubular lumens

A

Pigmentary nephrosis

99
Q

Hemolytic diseases leading to pigmentary nephrosis (7)

A 
Incompatible blood transfusions
Neonatal isoerythrolysis
Chronic copper toxicity in sheep
Leptospirosis in cattle
Babesia in cattle and dogs
Red maple leaf toxicosis in horses
Autoimmune hemolytic anemia in dogs
100
Q

Myoglobin releasing diseases leading to pigmentary nephrosis (2)

A

Capture myopathy

Azoturia in horses (Monday morning disease)

101
Q

This lesion is observed grossly as a tan or brown color and is often seen as an incidental lesion in horses with NSAID toxicosis

A

Renal papillary necrosis

102
Q

What is the mechanism of renal papillary necrosis?

A

NSAIDS inhibit COX 1 and COX 2 -> prostacyclin vasodilator inhibition -> renal vasculature vasoconstriction -> renal papillary ischemia -> renal papillary necrosis

103
Q

Nephritis found just in the glomeruli is called ___ or ___

A

Embolic nephritis

Purulent glomerulitis

104
Q

Inflammation of the kidney that involves the tubules is called ___

A

Tubulointerstitial nephritis

105
Q

Inflammation that involves the renal pelvis is called ___

A

Pyelonephritis

106
Q

This type of nephritis appears as white, pinpoint spots in the renal cortex

A

Embolic nephritis

107
Q

Bacteria that are associated with embolic nephritis (3)

A

Actinobacillus equuli in foals
Erysipelothrix rhusiopathiae in pigs
Trueperella pyogenes in adult cows

108
Q

T/F: Causes of tubulointerstitial nephritis are typically infectious

A

T

109
Q

Bacterial causes of tubulointerstitial nephritis (3)

A

Leptospira interrogans
E. coli (white spotted kidney in calves)
Salmonella spp.

110
Q

Viral causes of tubulointerstitial nephritis (5)

A 
FIP
Malignant catarrhal fever virus
Canine herpes virus
Infectious canine hepatitis virus
Equine viral arteritis
111
Q

Fungal causes of tubulointerstitial nephritis (5)

A 
Aspergillus spp.
Prototheca spp.
Cryptococcus neoformans
Candida albicans
Histoplasma capsulatum
112
Q

Parasitic causes of tubulointerstitial nephritis (5)

A 
Toxocara canis larvae
Toxoplasma gondii
Micronema deletrix
Stephenarus dentatus
Encephalitozoan cuniculi
113
Q

Pathogenesis of canine leptospirosis

A

Leptospiremia -> localization to renal interstitial capillaries -> migration to renal tubules -> migration to lumen and association with epithelial microvilli -> necrosis and degeneration of tubules -> N0 infiltration -> lymphocytes and plasma cells invade interstitium

114
Q

Renal lesion of little clinical significance in calves caused by E. coli

A

White spotted kidney

115
Q

Renal lesion that usually results from ascending UTI

A

Pyelonephritis

116
Q

Causes of urinary stasis leading to pyelonephritis (3)

A

Pregnancy
Urolithiasis
Prostatic hyperplasia

117
Q

What is vesicoureteral reflex?

A

Retrograde flow of urine from the bladder into the ureters (can occur with micturation or manual expression of the bladder); puppies are predisposed

118
Q

What does pyelonephritis look like grossly?

A

Necrosis and hemorrhage of the renal crest and medulla; if chronic, fibrosis originating from the renal pelvis radiating into the cortex

119
Q

Bacteria that cause pyelonephritis (5)

A 
E. coli
Staph
Enterobacter
Proteus
Pseudomonas
120
Q

Important cause of bovine pyelonephritis

A

Corynebacterium renale

121
Q

Loss of nephrons (or an entire kidney) leads to ___

A

Compensatory hypertrophy

122
Q

These conditions cause small, pitted kidneys in young animals (4)

A

Hypoplastic kidneys (rare)
Progressive juvenile nephropathy
Fibrosis
Renal dysplasia

123
Q

T/F: Singular cysts are a significant renal finding

A

F

124
Q

What breeds are predisposed to polycystic kidneys? (2)

A

Cairn terriers

Persian cats

125
Q

This renal lesion looks like “Swiss cheese.”

A

Polycystic kidney

126
Q

T/F: Single renal cysts can be congenital or acquired

A

T

127
Q

T/F: Primary renal tumors are common in domestic animals

A

F (very rare)

128
Q

Most common primary renal tumor and species it affects most

A

Renal carcinoma

Older dog

129
Q

T/F: Metastatic lymphoma in cats and cattle often involves the kidney

A

T

130
Q

What feline illness results in lesions that appear similar to renal lymphoma?

A

Dry form of feline infectious peritonitis

131
Q

Primary epithelial renal tumors (4)

A

Renal adenoma
Renal adenocarcinoma
Embryonal nephroma (nephroblastoma)
Transitional cell carcinoma

132
Q

Primary mesenchymal renal tumors (4)

A

Fibroma
Fibrosarcoma
Renal interstitial cell tumors
Hemangiosarcoma

133
Q

These bilateral multifocal renal tumors are hereditary in German Shepherd dogs and is associated with nodular dermatofibrosis

A

Renal cystadenocarcinoma

134
Q

T/F: Nephroblastomas are typically bilateral

A

F (unilateral); they can metastasize though

135
Q

T/F: Urinary calculi can be found ANYWHERE along the urinary tract

A

T

136
Q

The initial step in forming a urolith is a ___

A

Nidus (exfoliated cells, precipitated crystalloid, bacteria, etc.)

137
Q

Things that predispose to renal calculi (6)

A 
Renal papillary necrosis
Cystitis
Liver failure
Dehydration
Diet
Urine pH
138
Q

Precipitation of uric acid in the renal medulla and papilla - grossly seen as white streaks in the papillae - is seen in ___

A

Dehydrated piglets

139
Q

What species has an inherited problem with metabolism of uric acid, leading to calculi?

A

Dalmations

140
Q

Dogs with portosystemic shunts often have high levels of circulating ammonia, leading to formation of ___

A

Ammonium biurate crystals

141
Q

What is the name of the common condition that causes obstruction in male cats?

A

Feline lower urinary tract disease

142
Q

Bladder rupture will lead to ___

A

Azotemia

143
Q

Compressive force during parturition can lead to ___ in male foals

A

Bladder rupture

144
Q

Obstruction of a ureter can cause backup of urine, parenchymal atrophy, and dilation of the renal pelvis; this is called ___

A

Hydronephrosis

145
Q

Predisposing factors to bacterial cystitis (4)

A

Female anatomy
Stagnant urine
Mucosal trauma
Glucose in the urine

146
Q

Glucose in the urine can lead to ___ cystitis

A

Emphysematous

147
Q

___ grossly appears as many white, raised, mucosal nodules surrounded by a red rim

A

Follicular cystitis

148
Q

These proliferations from the bladder mucosa are sometimes confused with transitional cell carcinoma

A

Polypoid cystitis

149
Q

Chemical cystitis can occur in horses due to ingestion of cantharidin from ___

A

Blister beetle ingestion

150
Q

Most common bladder malformation in which the apex of the bladder and the umbilicus is still open

A

Patent urachus

151
Q

Animals with ectopic ureters are more susceptible to ___

A

Pyelonephritis

152
Q

Bladder diverticula predisose to cystitis and calculi because of ___

A

Urine stasis

153
Q

Most common bladder tumor

A

Transitional cell carcinoma (usually in the trigone)

154
Q

Epithelial urinary bladder tumors (5)

A 
Transitional cell carcinoma
Transitional cell papilloma
Squamous cell carcinoma
Adenocarcinoma
Undifferentiated carcinoma
155
Q

Mesenchymal urinary bladder tumors (5)

A 
Fibroma/fibrosarcoma
Leiomyoma/leiomyosarcoma
Rhabdomyoma/rhabdomyosarcoma
Lymphosarcoma
Hemangioma/hemangiosarcoma
156
Q

Cattle can develop a tumor called hemorrhagic cystitis (enzootic hematuria) from ingesting ___

A

Bracken fern

Organ Systems Pathology (2 decks)

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