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Pathology > Urinary System > Flashcards

Urinary System Flashcards

1
Q

which part of the kidney should always be removed during necropsy in order to do a full examination

A

external fibrous capsule

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2
Q

in what species does the outer cortex of the kidney parenchyma turn pale yellow due to large lipid content over time

A

cats

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3
Q

what is the functional unit of the kidney

A

nephron

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4
Q

what are the parts of the nephron

A

renal corpuscle
renal tubule

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5
Q

what can be observed macroscopically only when accentuated by inflammation

A

glomerulus

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6
Q

what specialized cells are found within the glomerulus

A

mesangial cells
podocytes

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7
Q

what are formed between podocyte pedicles and fenestrated endothelial cells with shared basal lamina

A

glomerular filtration barriers

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8
Q

what is the glomerular basement membrane composed of

A

type IV collagen and numerous glycoproteins

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9
Q

what is the cup-shaped sac that enclosed the glomerulus

A

Bowman’s capsule

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10
Q

what is the reticular meshwork of connective tissue stroma

A

interstitium

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11
Q

true or false:
the amount of connective tissue in the interstitium increases with age, chronic inflammation and ischemic damage

A

true

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12
Q

what are the terminal arteries that do not contain anastomoses and are therefore more susceptible to embolism leading to renal infarction

A

interlobular arteries

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13
Q

describe a renal infarction

A

wedge-shaped
well demarcated
dark red or white
inflammation / chronically contracted

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14
Q

what are the 5 functions of the kidney

A

produce urine
acid-base regulation
conservation of water
maintain normal extracellular potassium ion concentration
control of endocrine

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15
Q

what hormone is responsible for the maintenance of normal extracellular potassium ion concentration

A

aldosterone

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16
Q

what endocrine function produced by the kidney is used to regulate the blood pressure and fluid balance of the body

A

renin-angiotensin-aldosterone system

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17
Q

if there is a decrease in the control of endocrine function of the kidney, what 5 hormones are impacted

A

renin-angiotensin- aldosterone
erythropoietin
vitamin D
PTH degradation

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18
Q

what qualifies as renal failure

A

only under significant loss of renal function

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19
Q

true or false:
the kidney will maintain endocrine and metabolic function up until 75% of it is lost

A

true

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20
Q

what are some clinical indicators of renal failure

A

altered urine quantity
altered urine quality

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21
Q

when it comes to altered urine quantity, when is polydipsia seen

A

chronic kidney disease

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22
Q

in cases of acute renal failure, how is urine quantity affected

A

oliguria or anuria

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23
Q

what are some clinical signs often associated with a decrease in renal function

A

proteinuria
azotemia
uremia

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24
Q

what is characterized by the toxic levels of urea in the blood associated with renal failure

A

uremic syndrome

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25
Q

what are some way renal failure can lead to death

A

cardiotoxicity by elevated potassium
metabolic acidosis
pulmonary edema

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26
Q

what is the elevated serum concentration of nitrogenous waste products

A

azotemia

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27
Q

what kind of renal failure is due to reduced glomerular filtration due to impaired renal perfusion

A

prerenal

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28
Q

what can cause pre-renal kidney failure

A

circulatory collapse
shock
hypovolemia
severe dehydration
decreased cardiac output

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29
Q

what type of renal failure is due to damage to renal tissue such as the tubules and glomerulus

A

renal

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30
Q

what are some causes of renal kidney failure

A

acute tubular necrosis
acute glomerulonephritis
tubulointerstitial nephritis
acute pyelonephritis

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31
Q

which type of renal kidney failure is due to hypoxia/ischemia, nephrotoxicity and infections

A

acute tubular necrosis

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32
Q

what are the 2 mechanisms of acute tubular necrosis

A

leakage of tubular ultrafiltrate
intratubular obstruction

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33
Q

what are the intrarenal causes of renal kidney failure

A

acute glomerulonephritis
tubulointerstitial nephritis
acute pyelonephritits

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34
Q

what is the most common cause of acute glomerulonephritis

A

immune complex glomerulonephritis

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35
Q

what causes acute pyelonephritis

A

ascending bacterial infection from urethra, ureters and renal pelvis

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36
Q

what type of kidney failure is caused by urinary obstruction with pressure atrophy and necrosis

A

post renal kidney failure

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37
Q

what is the ‘medical terminology’ for post renal kidney failure

A

obstructive nephropathy

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38
Q

what are some causes of post renal kidney failure

A

urolithiasis (urinary stones)
tumors (transitional cell carcinoma)
iatrogenic (accidental ligation of ureter)

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39
Q

what can the obstructions of the kidney lead to

A

hydroureter and hydronephrosis

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40
Q

what can a hyroureter and hydronephrosis lead to

A

organ rupture with resulting uroabdomen

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41
Q

what are the 2 mechanisms uremic syndrome can cause `

A

endothelial injury
epithelial injury

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42
Q

what are the potential results of endothelial injury due to uremic syndrome

A

vasculitis thrombosis and infarction

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43
Q

what causes the epithelial injury of uremic syndrome

A

caustic effect of ammonia accumulation at mucosal surfaces

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44
Q

where are the epithelial injuries seen with uremic syndrome

A

mouth

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45
Q

true or false:
severe acute renal failure may lead to death without supportive therapy

A

true

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46
Q

what are some causes of death due to acute renal failure

A

cardiotoxicity of elevated serum potassium
metabolic acidosis
pulmonary edema

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47
Q

what is the pathogenesis of acute renal failure

A

ischemia or nephrotoxicity leads to acute tubular necrosis

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48
Q

what is the pathogenesis of chronic kidney disease

A

progressive interstitial fibrosis, tubular atrophy and loss of functional nephron

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49
Q

what is the gross pathology of chronic kidney disease

A

shrunken, firm, pale, fibrotic kidney with irregular surface
“end stage kidney”

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50
Q

what are the lab abnormalities with chronic kidney disease

A

azotemia
proteinuria
isosthenuria
nonregenerative anemia
hyperparathyroidism

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51
Q

what does ckd progress to

A

end stage kidney

52
Q

what are the characteristics of chronic kidney disease

A

chronic
advanced
generalized
progressive
irreversible

53
Q

what are the gross characteristics of chronic kidney disease

A

fibrotic
atrophic
shrunken renal parenchyma with massive loss of functional nephrons
replacement with scar tissue

54
Q

what are some metabolic and biochemical alterations due to chronic kidney disease

A

non-regenerative anemia
altered calcium-phosphorus metabolism

55
Q

how is phosphorus and calcium affected with chronic kidney disease

A

hyperphosphatemia
hypocalcemia

56
Q

what process is related to the alteration of calcium-phosphorus metabolism in relation to chronic kidney disease

A

renal secondary hyperparathyroidism

57
Q

what are some outcomes of renal secondary hyperparathyroidism

A

hyperphosphatemia
hypocalcemia
bilateral parathyroid gland hyperplasia
fibrous osteodystrophy

58
Q

what are 4 portals of entry to the kidney

A

ascending from ureter
hematogenous
glomerular filtration
direct penetration

59
Q

what often results form the ascending bacterial infection from the ureter

A

suppurative pyelonephritis

60
Q

what are common cases of hematogenous entry into the kidney

A

neoplastic metastases
bacterial embolization

61
Q

what are some common cases causes damage to the glomerular filtration decreasing the protection barrier to the kidney

A

toxins
drugs
anti-freeze and other insecticides

62
Q

what is the most important barrier of the kidney

A

renal corpuscle / glomerular basement membrane

63
Q

what is the role of the glomerular basement membrane

A

protect the nephron by filtering out most circulating bacteria and inflammatory cells

64
Q

what defense mechanism of the kidney prevents ascending bacteria from gaining access to the interstitium

A

tubular basement membrane

65
Q

what can usually destroy the TBM and cause permanent scarring with loss of tubules

A

ischemia / infarction

66
Q

which part of the kidney provides protection through humoral antibodies, macrophages, lymphocytes and plasma cells

A

interstitium

67
Q

glomerular injury results from deposition of …

A

immune complexes (type III)
thromboemboli
bacterial emboli
amyloid

68
Q

true or false:
prolonged systemic hypertension can cause damage to the glomerular filtration of the kidney

A

true
glomerular injury may also be caused by hyperfiltration

69
Q

what is the expected outcome from damage of the glomerular filtration

A

proteinuria

albumin
antithrombin III

70
Q

what condition can cause hypoproteinemia with reduced plasma oncotic pressure leading to ascites, pleural effusion and generalized edema

A

protein losing nephropathy

71
Q

what is the result of losing antithrombin III to nephrotic syndrome

A

results in a hypercoagulable state with thromboembolic disease

72
Q

what are the acute responses to injury to the kidney

A

mesangial hypertrophy and hyperplasia
increased vascular permeability
infiltration of leukocytes
necrosis

73
Q

what are the chronic responses to injury to the kidney

A

atrophy
fibrosis (glomerulosclerosis)
renal tubular atrophy due to blood supply loss

74
Q

what are the top 2 things that cause tubular damage

A

toxins
infarctions/ ischemia

75
Q

after what events could you expect to see atrophy of the kidney tubules

A

interstitial fibrosis
diminished glomerular perfusion (shock, hypovolemia, fibrosis)
reduced oxygen tension (anemia, hypoxemia)

76
Q

which tubular damage response occurs due to loss of tubular epithelial cells due to injury and apoptosis

A

degeneration

77
Q

when is tubular regeneration only possible

A

when tubular basement membrane is left intact

78
Q

in cases of toxic injury, how is the TBM normally affected

A

generally preserved which allows for regeneration

79
Q

in cases of ischemic injury, how is the TBM normally affected

A

TBM is destroyed causing permanent scar with no regeneration

80
Q

what is the single most important cause of acute renal failure in animals

A

acute tubular necrosis

81
Q

what can cause acute tubular necrosis

A

ischemia
nephrotoxicity

82
Q

what are the clinical manifestations of acute tubular necrosis

A

oliguria
anuria

83
Q

how does nephrotoxic injury occur

A

chemicals and/or toxic metabolites become concentrated in the tubules to toxic levels

84
Q

what 3 mechanisms do nephrotoxins use to cause damage

A

direct damage to epithelium
produce reactive metabolites
indirectly stimulate vasoconstriction (nephrotoxin-associated ischemia)

85
Q

what is the most common way to indirectly stimulate vasoconstriction in the kidney leading to nephrotoxicity

A

drugs such as NSAIDs

86
Q

what is a form of acute tubular necrosis that is not caused by an inflammatory process

A

nephrosis

87
Q

what causes nephrosis

A

hypoxic injury combined with nephrotoxicity

88
Q

true or false:
hypoxic injury is exacerbated by hemoglobinuria during a hemolytic crisis

A

true

89
Q

what are 5 responses to injury of the interstitium

A

hyperemia
edema
inflammation
lymphofollicular inflammation
fibrosis

90
Q

what type of inflammation is typically seen in the interstitium in response to injury

A

nonsuppurative, lymphoplasmacytic

91
Q

what disease/infection is most commonly associated with lymphofollicular inflammation of the kidney

A

leptospirosis

92
Q

true or false:
progressive fibrosis leads to progressive loss of renal function

A

true

93
Q

what are some infectious examples that cause interstitial nephritis

A

canine ehrlichiosis
leptospirosis
equine infectious anemia

94
Q

what is tubulointerstitial nephritis

A

inflammation directed against the interstitium and the tubules

95
Q

what are some infections that lead to tubulointerstitial nephritis

A

leptospirosis
adenoviruses
lentiviruses
herpesviruses

96
Q

what is a localized area of coagulative necrosis that results from vascular occulsion

A

infarction

97
Q

how would you describe an infarction

A

well-demarcated, cone shaped area of coagulative necrosis

98
Q

what is the most important lesion associated with acute kidney injury and acute renal failure

A

acute tubular necrosis

99
Q

where do the ureters enter the bladder wall

A

trigone

100
Q

what type of epithelium lines the ureters

A

transitional epithelium

101
Q

what are sources of bacteria that can cause ascending infection in the lower urinary tracts

A

GI tract
genital tract
bacterial dermatitis

102
Q

what is the asynchronous differentiation of nephrons and/or the persistence of primitive mesenchyme and metanephric ducts

A

renal dysplasia

103
Q

what is an inherited disease described in Lhasa Apso, Shih Tzu, and Golden Retrievers

A

juvenile progressive nephropathy

104
Q

what is juvenile progressive nephropathy

A

a specific form of renal dysplasia

105
Q

what is the abnormal migration of renal tissue during fetal development

A

ectopic kidney

106
Q

describe a fused kidney

A

“horse shoe shaped”
result from the fusion of the left and right kidneys during nephrogenesis

107
Q

what are spherical, thin-walled, distended tubules filled with clear watery fluid

A

renal cysts

108
Q

what do renal cysts result from

A

tubular obstruction or tubular dysplasia

109
Q

in what specie are renal cysts more common

A

pigs
cows

110
Q

what is defined as many renal cysts affected numerous nephrons

A

polycystic kidneys

111
Q

in what species is inherited polycystic kidney more common

A

persian cats
bull terries

112
Q

what are the 6 diseases of the glomerulus

A

immune-mediated glomerulonephritis
glomerulosclerosis
glomerular amyloidosis
acute suppurative glomerulitis
viral glomerulitis
chemical glomerulitis

113
Q

what is associated with persistent infections or other causes of prolonged antigenemia that enhances the formation of abundant soluble immune complexes in the blood plasma

A

immune complex glomerulonephritis

114
Q

what is the true issue causing the damage associated with immune complex glomerulonephritis

A

deposition of soluble immune complexes within glomeruli

115
Q

what diseases are associated with ICGN with cats

A

FeLV
FIV
FIP

116
Q

what diseases are associated with ICGN with horses

A

streptococcus infections
equine infectious anemia

117
Q

what are the gross lesions associated with ICGN

A

subtle or non-existent
may see swollen, enlarged glomeruli as red or pale pin-point foci in the cortex

118
Q

what is a condition of aging and chronic renal injury characterized by increased extracellular mesangial matrix leading to obliteration of capillaries and consolidation of the tuft

A

glomerulosclerosis (GS)

119
Q

what is glomerulosclerosis associated with

A

high blood pressure
unrestricted dietary protein

120
Q

what is the outcome of GS

A

reduces the blood flow to the tubules causing secondary tubular degeneration and atrophy

121
Q

what urinary disorder is associated with reactive systemic amyloidosis

A

glomerular amyloidosis

122
Q

what breeds/species are genetically predisposed to reactive amyloidosis

A

abyssinian cats
chinese shar-pei

123
Q

what disorder would you suspect kidneys to be enlarged, pale and have a waxy smooth to finely granular capsular surface

A

glomerular amyloidosis

124
Q

what stain is specific for glomerular amyloidosis

A

congo red stain

125
Q

what disease is the result of bacteremia

A

acute suppurative glomerulitis
bacterial embolic nephritis

126
Q

what is characteristic of a kidney with bacterial embolic nephritis

A

multiple, randomly distributed foci of suppurative inflammation

Pathology (18 decks)

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