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SYSTEMIC PATHOLOGY 3 > Urinary System II > Flashcards

Urinary System II Flashcards

1
Q

What is azotemia?

A
  • Increased concentration of urea and creatinine (non-protein nitrogenous wastes) in the BLOOD
    o May or may not be related to alteration of renal function
    o *COULD indicate a renal problem
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2
Q

What are the 3 causes of azotemia?

A
  1. Pre-renal
  2. Renal
  3. Post renal
    *if not corrected, can eventually lead to renal failure
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3
Q

Pre-renal azotemia

A
  • Decreased blood supply to kidney
    o BUN and creantinine are not being delivered to kidney=not being delivered
  • Kidney function is normal
  • Ex. dehydration, heart failure and hemorrhage
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4
Q

Renal azotemia

A
  • Problem in kidney leading to decreased extraction of BUN and creatinine from blood
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5
Q

Post renal azotemia

A
  • Lower UT obstruction causing decreased excretion
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6
Q

If azotemia in blood and low USG, what do you have?

A
  • renal failure
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7
Q

What is renal failure?

A
  • **Impaired renal function associated with azotemia
  • 75-80% of renal function is lost
  • Acute or chronic
  • Can be reversible
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8
Q

What are pre-renal causes of renal failure?

A
  • Shock
  • Hemorrhage
  • Heart failure
  • Severe dehydration
  • DIC
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9
Q

What are the renal causes of renal failure?

A
  • Damage to tubules or glomeruli by many industrial or natural toxins and metals
  • Acute glomerulonephritis
  • Renal infection
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10
Q

What are the post renal causes of renal failure?

A
  • Obstruction within lower urinary tract
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11
Q

*What is the clinical syndrome that renal failure can lead to?

A
  • UREMIA
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12
Q

What is uremia?

A
  • Syndrome associated with multisystemic lesions and clinical signs b/c of renal failure
  • *different from azotemia
    o Azotemia can be associated with normal renal function
    o Uremia indicates renal sickness (acute and chronic renal failure)
    o *BUN and creatinine is high in both
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13
Q

What is end stage renal disease or kidney?

A
  • renal function is less than 5% of normal
  • animal is in terminal stages of uremia
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14
Q

**What is the morphological diagnosis for an end stage kidney?

A
  • Diffuse renal fibrosis
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15
Q

What is acute renal failure characterized by?

A
  • Rapid onset of oliguria or anuria (decreased or no urine output) and azotemia
    o Low urine SG
  • May result from acute glomerular or interstitial injury OR from acute tubular necrosis
  • Often have reduced blood pH (metabolic acidosis)
  • *often reversible
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16
Q

What are the common causes of acute renal failure?

A
  1. Ischemia: shock, cardiac arrest, trauma, deep anesthesia
  2. Toxic injury: antimicrobials, chemotherapeutic agents, hemoglobin, myoglobin, ethylene glycol
  3. Other disease states: infection, hypercalcemia, immune mediated disease
17
Q

Why do animals that die from acute renal failure die?

A
  • Cardiotoxicity of elevated serum potassium
  • Metabolic acidosis
  • Pulmonary edema
  • *reflected clinically by signs
18
Q

What signs clinically reflect the alterations that occur during acute renal failure?

A
  • Polyuria and polydipsia
  • Vomiting and diarrhea
  • Ammoniacal-smelling breath
  • Array of non-renal lesions
19
Q

What does the kidney look like grossly with acute tubular necrosis?

A
  • Pale
  • Cortex is ‘bulging’ or convex appearance
  • (histo to confirm: necrotic tubules)
  • *may not see if animal dies quickly
20
Q

Chronic renal failure

A
  • Similar to acute BUT longer duration and IRREVERSIBLE
  • Most common renal disorder in dogs and cats
  • Usually progressive loss of renal function
  • Usually high blood phosphate and low Ca, normal to low potassium
21
Q

What are the 2 changes that MAY also be seen with chronic renal failure (and NOT seen with acute renal failure)?

A
  1. Non-regenerative anemia
  2. Soft bones (fibrous osteodystrophy)
22
Q

What is the differences in urine output between chronic and acute renal failure?

A
  • Chronic: increased
  • Acute: decreased
23
Q

What does chronic renal failure look like grossly in the kidney?

A
  • Pale
  • Misshapen
  • Irregular surface reflecting fibrosis
  • *shrunken kidney
24
Q

What are the 2 main mechanisms by which uremia produces lesions?

A
  1. Vascular endothelial injury
  2. Alteration in Ca/P balance
25
Q

What are the 3 potential things that vascular injury can cause?

A
  1. Thrombosis, ischemia, necrosis, and hemorrhage
  2. Increased vascular permeability (edema)
  3. Leakage of urea and its conversion to cause ammonia by bacteria leading to ULCERATION
26
Q

What happens to Ca and P levels with chronic renal failure?

A
  • Low Ca
  • High P
  • *chronic renal failure causes DECREASED Vit D production leading to DECREASED gut ABSORPTION of Ca
27
Q

What are the consequences of low Ca and high P? (3)

A
  • PT hyperplasia (bilateral white masses on thyroid gland) and increased PTH
  • Fibrous osteodystrophy (ie. If can bend a rib)
    o Release of Ca from bone and with time Ca is replaced by fibrous tissue
  • Widespread mineralization (white gritty spots everywhere)
28
Q

What could white masses on the thyroid be?

A
  • Parathyroid tissue=bilateral masses and have renal failure
  • Thyroid tissue=solitary, unilateral mass
29
Q

What are some things that can occur in dogs (and other animals) with renal failure?

A
  • Tongue tip necrosis
  • Ulcerative uremic glossitis
  • Uremic gastritis
  • Intercostal mineralization
  • Enlarged maxilla
  • Pulmonary edema
  • Uremic colitis
30
Q

Tongue tip necrosis

A
  • More common in dogs
  • *result of vascular injury leading to ischemia and necrosis
31
Q

Ulcerative uremic glossitis

A
  • Secondary to release of urea and its conversion to ammonia
  • Little inflammation but mainly necrosis
  • *mainly in dogs and cats, but also other species
  • Ischemia could also be a mechanism
  • Can also get ulcers on gingiva
32
Q

Uremic gastritis

A
  • Mainly in dogs and cats (large animals get colitis)
  • Necrosis and hemorrhage secondary to vascular injury
  • Gastric folds are wet and thickened secondary to edema
  • Ulceration
  • *cause upset stomach with vomiting and may be diarrhea
  • Review stomach if have renal failure=mineralization
33
Q

Intercoastal mineralization

A
  • Dogs mainly
  • Result of chronic uremia
34
Q

Enlarged maxilla due to fibrous osteodystrophy

A
  • Enlarged and filled with fibrous tissue
  • Jaw becomes rubbery and easy to bend (can bend ribs and bone too)
  • Teeth in maxilla and mandible become very lose
35
Q

What is pulmonary edema and uremic COLITIS in large animals due to in chronic renal failure?

A
  • Vascular injury
36
Q

Why are the lesions of uremia important?

A
  • May tell you to look at the kidney more closely

SYSTEMIC PATHOLOGY 3 (6 decks)

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