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RUSVM Pathology II > Urinary System Pathology > Flashcards

Urinary System Pathology Flashcards

1
Q

Renal Parenchyma is divided into

A

Cortex

Medulla

Pelvis

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2
Q

Descirbe the flow through the kidney

A

Renal papilla → renal calices → renal pelvis → ureters

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3
Q

Describe the cat kidney

A

Prominant Vascular Pattern

Unipyramidal

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4
Q

Describe the pig kidney

A

Multipyramidal

No External Lobulation

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5
Q

Describe the bovine kidney

A

Multipyramidal

External Lobulation

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6
Q

Describe the dog kidney

A

Unipyramidal

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7
Q

Structure of gomerulus

A

Filtering mechanism

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8
Q

Structure of tubules

A

Selective reabsorption

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9
Q

Functions of the kidney

A

Regulation of fluid and electrolyte content

Endocrine function - renin and erythropoietin

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10
Q

Developmental abnormalities of the kidney

A

Renal aplasia

Renal hypoplasia

Renal dysplasia

Renal cysts

Polycystic kidney

Ectopic kidney

Fetal lobulation and fusion

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11
Q

Renal Aplasia

A

Absence of development of a kidney - can be unilateral or bilateral

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12
Q

Renal Hypoplasia

A

Quantitative defect caused by reduced mass of metanephric blastema - reduced in size but otherwise normal architecture

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13
Q

Renal hypoplasia is characterized by

A

Reduced number of histologically normal lobules and calyces

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14
Q

Differential diagnosis of renal hypoplasia

A

Renal dysplasia

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15
Q

Renal Dysplasia

A

Abnormal and asynchronous differentiation of renal tissue

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16
Q

Causes of renal dysplasia

A

Congenital infections (Feline Panleukopenia, Canine Herpes Virus, BVD)

Autosomal Dominance

Hypovitaminosis

Intrauterine ureteral obstruction

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17
Q

Renal Cysts

A

Common congenital malformation

Variably sized, filled with fluid and lined by flat or cuboidal epithelium

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18
Q

Polycystic Kidneys

A

Numerous variably sized cysts in both cortex and medulla, filled with colorless fluid

“Honeycomb” appearance

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19
Q

Causes of polycystic kidneys

A

Congenital Causes

Inherited Causes

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20
Q

Consequences of renal cysts

A

May grow slowly or remain static

May increase in size/number causing compression atrophy

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21
Q

Differential diagnosis for Polycystic kidneys

A

Acquired Cysts - obstructed tubules in chronic renal disease

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22
Q

Ectopic Kidneys

A

Normal kidneys in abnormal locations

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23
Q

Ectopic kidneys are predisposing factors for

A

Ureter obstruction and development of hydronephrosis

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24
Q

Retained Fetal Lobulation and Fusion

A

“Horseshoe Kidney”

Congential malformation that results from a fusion of the cranial or caudal poles of the kidneys

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25
Q

Described the texture of kidneys that have undergone autolysis

A

Soft and friable

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26
Q

Pseudomelanosis

A

Pigment staining the surface of the kidney

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27
Q

Postmortem changes seen in the kidney

A

Autolysis

Pseudomelanosis

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28
Q

Pigmentary disturbances seen in the kidney

A

Hemoglobinuria

Myoglobinuria

Lipofucin

Bile

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29
Q

Hemoglobinuria in kidney

A

Causes the kidney to be dark red to black

Consquence of sever intravascular hemolysis and hemoglobinuria

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30
Q

Etiologies for hemoglobin pigment in the kidney

A

Leptospirosis

Bacillary hemoglobinuria

Babesiosis

Chronic copper poisioning

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31
Q

Myoglobin pigmentation in the kidney

A

Dark red to black kidneys and dark red urine

Caused by high levels of myoglobin filtering into the tubules

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32
Q

Etiologies of Myoglobin pigmentation of the kidney

A

Rhabdomyolysis - Capture Myopathy

Equine Paralytic myoglobinuria

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33
Q

Lipofucsin pigmentation in the kidney

A

Kidneys dark brown to black

Incidental finding

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34
Q

Bile Pigmentation in the kidney

A

Kidneys are yellow-green

Kidneys excrete conjugated bilirubin resulting in choluria

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35
Q

Circulatory disturbances of the kidney

A

Hyperemia and Congestion

Hemorrhage

Ischemia

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36
Q

Describe the appearance of hyperemic kidneys

A

Bright red or dark red

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37
Q

Hypostatic congestion is a common result of

A

Prolonged prostration and circulatory failure

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38
Q

Hermorrhages of the kidney are commonly the result of

A

Vasculitis

Vascular necrosis

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39
Q

Describe the appearance of hemorrhagic kidneys

A

Turkey Egg

Speckled appearance

Petechial or ecchymotic

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40
Q

Causes of renal hemorrhage

A
  • Coagulopathies
    • DIC
    • Acquired or Congenital
  • Viral Infections
    • Hog cholera
    • African Swine Fever
    • Canine Herpes Virus
  • Septicemia
    • Erysipelas
    • Streptococcus
    • Salmonellosis
  • Toxins
    • Oak
    • Endo and entero-toxins
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41
Q

Renal ischemia is caused by

A

Renal torsion

Renal infarct

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42
Q

Renal Infarct

A

Typically triangular in shape with the apex pointing towards teh medulla

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43
Q

Renal infarcts are associated with

A

Thrombosis of the renal vessels

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44
Q

Valvular endocarditis commonly causes what renal lesion?

A

Renal Infarct

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45
Q

Chronic Renal Infarcts

A

Prolonged ischemia leads to infarction and coagulative necrosis

Affected area will heal by fibrosis

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46
Q

Fibrosis has what effect on the kidney

A

Causes retraction of the parenchyma and characteristic depressions on the renal cortex

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47
Q

Most common etiologies for renal infarcts

A

Vegetative Valvular Endocarditis

Left atrial thrombosis due to cardiomyopathy

Renal amyloidosis due to loss of plasma anticoagulants

Endotoxin mediated thrombosis due to gram negative sepsis or endotoxic shock

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48
Q

Amyloidosis

A

Heterogenous group of diseases due to deposition of amyloid in tissues

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49
Q

Types of amyloidosis

A

Primary Amyloidosis

Secondary Amyloidosis

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50
Q

Primary Amyloidosis

A

Very rare

Due to deposition of amyloid AL, derived from Ig light chains produced by abnormal plasma cells

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51
Q

Secondary Amyloidosis

A

Deposition of amyloid AA that originates from serum alpha-globulin

Associated with chronic antigenic stimulation

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52
Q

Gross appearance of kidneys with amyloidosis

A

Enlarged, pale and have finely granular appearance

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53
Q

Microscopic appearance of amyloidosis

A

Pink amorphous material in glomeruli (medullary interstitium - cats and cattle)

Amyloid deposited in the mesangial matrix and along the adjacent basement membrane

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54
Q

Special stains used to microscopically confirm amyloidosis

A

Congo Red

Thyoflavin-T

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55
Q
A
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56
Q

Renal Cortical Necrosis

A

Acute and severe ischemia of the renal cortex due to vasospasm of cortical vessels

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57
Q

Discribe the appearance of kidne with renal cortical necrosis

A

Renal cortex has a mosiac appearance with intermixed areas of red and yellow discoloration

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58
Q

Renal Meduallary (Papillary) Necrosis

A

Caused by localized ischemia of the renal medulla

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59
Q

Causes of Medullary Necrosis

A

Amyloidosis

Pyelonephritis

Diabetes Mellitus

Use of anti-inflammatory and analgesic drugs

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60
Q

Acute Tubular Necrosis

A

Primary process of nephrosis

Renal tubular epithelium - highly susceptible to ischemia or to toxic damage

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61
Q

Describe the appearance of kidneys affected by acute tubular necrosis

A

Kidneys swollen, capsular surface is pale and moist, bulges on cut surface

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62
Q

Differential diagnosis for diffusely pale kidneys

A

Amyloidosis

Acute Nephrosis

Glomerulonephritis

Lymphosarcoma

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63
Q

Histological appearance of nephrosis

A

Mimimal to absent inflammatory cell infiltration

Fibrosis

Tubular loss

Architectural disorganization

Regeneration

Swelling of tubular epithelium

Cytoplasm vacuolated

Nucleus pyknotic, karyolytic or karyorrhectic

Tubules hypocellular, dilated and contain cellular debris

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64
Q

Outcome of tubular necrosis

A

If basement membrane is intact, regeneration of the proximal convoluted tubules is seen as early as three days after the toxic insult is removed

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65
Q

Causes of nephrosis

A

Ingestion of exogenous substances

Precipitates

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66
Q

Cause of Oxalate Nephrosis

A

Ethylene Glycol Toxicity

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67
Q

Causes of toxic nephrosis

A

Heavy metals

Carbon tetrachloride, chlorinated-hydrocarbon insecticides

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68
Q

Nephrotoxic Plants

A

Pigweed

Oaks

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69
Q

Pigweed causes what renal lesions

A

Tubular degeneration and peri-renal edema

70
Q

Oak Poisoning

A

Cattle and Horses

Tannins and or their metabolites are likely cause.

Proposed that tannic acid binds to endothelial cells causing necrosis of the epithelium

71
Q

Classifications of nephritis

A

Glomerulitis

Glomerulonephritis

Interstitial nephritis

Pyelonephritis

72
Q

Embolic Nephritis - Suppurative Glomerulitis

A

Glomerulitis

Caused by bacteremia

Bacterial colonies are seen in glomerular and interstitial capillaries

73
Q

Describe the appearance of embolic nephritis

A

Multifocal, suppurative glomerulitis

74
Q

Embolic nephritis may result in

A

Chronic renal microabscess developement

75
Q

Glomerulonephritis are largely associated with

A

Immune-mediated injury

76
Q

Two main mechanisms of immune mediated glomerulitis and glomerulonephritis

A

Deposition of antigen-antibody complexes

Autoantibodies directed against the GBM

77
Q

Describe the process of glomerulonephritis due to deposition of antigen-antibody complexes

A

Persistant antigens in the blood result in deposition of antigen-antibody complexes in glomerular basement membranes

78
Q

Describe the process of glomerulonephritis due to autoantibodies against the glomerular basement membrane

A

“Anti-Basement Membrane Disease”

Formation of auto antibodies against GBM → Complement fixation → leukocyte infiltration

Rare in domestic animals

79
Q

Gross lesions associated with acute glomerulonephrits

A

Kidney appears swollen and pale

80
Q

Gross lesions associated with chronic glomerulonephritis

A

Kidneys shrunken and granular

81
Q

Three morphological types of glomerulonephritis

A

Membranous

Proliferative

Membrano-Proliferative

82
Q

Membranous glomerulonephritis characterized by

A

thickening of basement membrane

83
Q

Proliferative glomerulonephritis characterized by

A

increased cellularity

84
Q

Membrano-proliferative glomerulonephritis often leads to

A

Glomerular sclerosis

85
Q

Definitive diagnosis for glomerulonephritis by

A

Fluorescent antibody test

86
Q

Interstitial (Tubulo-Interstitial) Nephritis

A

Inflammatory infiltration in the interstitium affects tubular functions

87
Q

Gross appearance of multifocal interstitial nephritis

A

Off-white foci randomly scattered throughout the renal cortex and medulla

88
Q

Multifocal Interstitial Nephritis may represent

A

Sequel of resolved bactermia/septicemia

89
Q

“White Spotted Kidney”

A

Multifocal Interstitial Nephritis of Cattle

Residual lesions of E. Coli

90
Q

Pathogenesis of Interstitial Nephritis

A

Following bacteremia bacteria localize in renal interstitial capillaries → migrate through vascular endothelium → persist in interstitial spaces → migrate via lateral intercellular junctions to reach tubular lumina

91
Q

Causes of interstitial nephritis in dogs

A

Leptospiral interrogans

Infectious canine hepatitis virus

Theileria parva

92
Q

Causes of interstitial nephritis in cattle

A

E coli septicemia

Leptospiral interrogans

Malignant Catarrhal Fever

93
Q

Causes of interstitial nephritis in sheep

A

Sheeppox

94
Q

Causes of interstitial nephritis in pigs

A

Leptospiral interrogans

Porcine Reproductive and Respiratory Syndrome

PCV-2

95
Q

Cause of intersitial nephritis in horses

A

Equine Viral Arteritis

96
Q

Gross appearance of chronic interstitial nephritis

A

Kidney shrunken, pale and firm with capsule firmly adhered to cortex

97
Q

Histologic appearance of chronic interstitial nephritis

A

Interstitial fibrosis

Tubular atrophy

Tubular dilation

Aggregates of lymphocytes and plasma cells

98
Q

Pyelonephritis

A

Inflammation of the renal pelvis and renal parenchyma

99
Q

Pathogenesis of pyelonephritis

A

Bacteria ascend ureters → invade renal pelvis → move through the renal tubules → reach renal parenchyma

100
Q

Predisposing factors of Pyelonephritis

A

Urinary obstruction

Renal medulla susceptibility to infecction

Abnormal Vesico-ureteral reflux

Sequel to cystitis

101
Q

Gross appearance of pyelonephritis

A

Suppurative exudate in pelvic cavity, partial destruction of medulla, irregular discoloration of cortex

Marked scarring and firbosis

Inflammation in ureter and urinary bladder

102
Q

Microscopic features of acute pyelonephritis

A

Neutrophils

Bacteria within lumen of renal tubules

Necrosis and exfoliation of the tubular epithelium

103
Q

Microscopic features of chronic pyelonephritis

A

White bands of scar tissue extending from cortex to medulla

Interstitial fibrosis

Loss of tubules

End stage kidney

104
Q

Granulomatous Nephritis

A

Form of chronic nephritis characterized by predominance of macrophages in the inflammatory infiltrate

105
Q

Etiology of granulomatous nephritis

A

Viruses

Fungal organisms

Bacteria

Parasite migration

106
Q

Dioctiophyma renale

A

Giant Kidey Worm

Nematode resides in the renal pelvis

107
Q

Stephanurus dentatus

A

Larvae migrate from intestine to liver and then across the peritoneal cavity to the peri-renal fat and adjacent tissue

Cysts communicate with the renal pelvis

108
Q

Hydronephrosis

A

Abnomal and permanent dilation of the renal pelvis and calyces with progressive atrophy of renal parenchyma

109
Q

Cause of hydronephrosis

A

Increase pressure following partial or complete obstruction of the urine flow

110
Q

Causes of urine outflow obstruction

A

Congenital malformation

Calculi

Iatrogenic

Inflammation

Neoplasia

Torsion

111
Q

Pathogenesis of hydronephrosis

A

Urine filtrate diffuses to renal interstitium → absorbed by lymphatic vessles → increased pressure shuts down blood vessels → papillary necrosis → atrophy of renal parenchyma

112
Q

Urolithiasis

A

Process of formation of solid or semisolid concretions anywhere in the urinary collecting system

113
Q

Uroliths

A

Composed of a wide variety of minerals, often mixed with protein material

114
Q

Predisposing factors to urolithiasis

A

Increased urinary concentration of stone constituents

Low urine volume

Urine pH

UTI

High phosphate diets

High levels of silica

115
Q

Struvites

A

Magnesium, Ammonium, Phosphate

Most common in dogs

LInked to urinary bladder infection

116
Q

Common signs of urinary obstruction

A

Dysuria

Stranguria

Pollakicuria

Hematuria

117
Q

Consequences of urolithiasis

A

Hydronephrosis

Chronic cystitis

Bladder distention - rupture

Acute hemorrhagic urethritis

118
Q

Familial renal disease can be the result of

A

Abnormal structure

Abnormal function

119
Q

Describe familial renal disease due to abnormal function

A

Biochemical defects in renal tubules

Grossly and microscopically normal

120
Q

Renal response to injury

A

Tubular regeneration

Healilng by fibrosis

Nephrosclerosis if fibrosis is severe

121
Q

Defense mechanisms of the urinary system

A

Barrier system

Glomerular mesangial cells

Immune response

122
Q

RCommon sequelae to chronic renal inflammation

A

Renal fibrosis

Nephrosclerosis

123
Q

End Stage Kidney

A

Kidneys that are severely affected by chronic inflammation and fibrosis

124
Q

Renal Disease

A

Any deviation from normal renal structure or function

125
Q

Renal Failure

A

inability of the kidney to maintain normal function

126
Q

Renal failure requires loss of what percentage of renal function

A

70-75%

127
Q

Metabolic waste products that are used clinically to detect renal malfunction

A

Urea and Creatine

128
Q

Urea

A

Produced in the liver from nitrogenous byproducts of the protein metabolism

129
Q

Creatinine

A

Normal byproduct of phosphocreatine, a substance involved in the contraction of muscle fibers

130
Q

Azotemia

A

Abnormal elevation of urea and creatinine in the blood without clinical manifestations of renal disease

___________________

Biochemical abnormality due to decreased GFR

131
Q

Uremia

A

Clinical syndrome of toxemia due to intravascular accumulation of endogenous toxic waste substances usch as urea, creatinine, uric acid, guanidine, phenolic acid, high molecular weight alcohols and other metabolites

132
Q

Clinical signs of uremia

A

Vomiting

Dehydration

Polydypsia, anuria, oliguria, poliuria

Ammoniacal breath

Malaise due to Uremic toxins

133
Q

Non Renal Lesions of uremia

A

Uremic stomatitis / glossitis

Hemorrhagic ulcerative gastritis and colitis

Endocarditis mucoarteritis

Tissue mineralization

Pulmonary Edema

Secondary hyperparathyroidism

134
Q

Uremic Stomatitis / Glossitis

A

Due to fibrinoid arteriolar necrosis and bacterial production of ammonia

135
Q

Pathogenesis of uremic stomatitis/glossitis

A

Oral bacteria transform urea into ammonia → irritation of the oral epithelium → ulceration of the mucosa

136
Q

Ulcerative and necrotizing stomatitis is characterized by

A

Brown, foul smelling mucoid material adhered to the eroded and ulcerated lingual and oral mucosa

137
Q

Hemorrhagic Ulcerative Gastritis occurs as a result of

A

Arteriolar necrosis with mucosal infarction and mineralization of the gastric glands and submucosal blood vessels

138
Q

Uremic gastritis is seen in what species

A

Dogs cats

139
Q

Colitis is seen in what species

A

Horses

Cattle

140
Q

Mucoarteritis / Endocarditis

A

Non-inflammatory conditition due to deposition of glycosaminoglycans with subsequent fibrinoid degeneration of the subendocardial connective tissue

141
Q

In the heart, uremic mucoarteritis is most common in

A

Left Atria and proximal aorta

142
Q

Describe the gross appearance of mucoarteritis/endocarditis

A

Opaque light yellow roughened endocardial plaques

143
Q

Dystrophic and Metastatic Calcification causes

A

deposition of mineral on the walls of the alveolar septa, pulmonary arterioles, pericardium, soft tissues, parietal pleura in the cranial intercostal spaces

144
Q

Dystrophic and Metastatic Calcification may be associated to

A

Deposition of calcium secondary to cell injury, hypercalcemia or hyperphosphatemia

145
Q

Pulmonary Edema results from

A

Damage to the air-blood barrier and plasma fluid leaks into the alveoli

146
Q

Cause of death in uremic animals, usually

A

Pulmonary edema

147
Q

Gross appearance of uremic pneumopathy

A

Lungs fail to collapse, have rounded edges, would be heavy and moist at cut surfaces

148
Q

Histologic appearance of uremic pneumopathy

A

Eosinophilic material within alveoli

Basophilic material present in alveolar walls

149
Q

Pathogenesis of Secondary Renal Hyperparathyroidism

A

Abnormal renal function results in excessive retention of phosphorus → body responds by increasing calcium → parathyroid glands activated to compensate and promote reabsorption of calcium

150
Q

Normal antibacterial activity of normal animal urine

A

Normal voiding

Low pH

High osmolality

151
Q

Causes of cystitis

A

Bacterial infections

Formation and accumulation of uroliths

Exposure to toxic compounds

152
Q

Toxic compounds that can cause cystitis

A

Cantharidin Toxin - Blister Beetles - Equine

Bracken Fern - Bovine

Cyclophosphamide - Dog/Cat

153
Q

Chronic Enzootic Hematuria

A

Braken fern ingestion

Cattle

Severe syndrome due to prolonged ingestion of toxic principles of bracken fern

Carcinogenic

154
Q

Characteristics of acute cystitis

A

Mucosal hemorrhage and ulceration

Production of exudate - hemorrhagic, fibinopurulent

155
Q

Characterisitics of chronic cystitis

A

Mucous metaplasia of transitional epithelium

Follicular Cystitis

Polypoid Cystitis

156
Q

Follicular Cystitis

A

Multifocal lymphoid hyperplasia

157
Q

Polypoid cystitis

A

Formation of mucosal polyps

158
Q

Emphysematious cystitis develops in some dogs and cats secondarily to

A

Diabetes Mellitus

159
Q

Feline Lower Urinary Tract Disease / Feline Urological Syndrome

A

Obstruction of the urethra by a urethral plug

160
Q

Urethral plug associated with feline urological syndrome composed of

A

Mixture of protein

Cellular debris

Struvite

161
Q

Predisposing factors to feline urological syndrome

A

Diet high in magnesium and phosphate

Alkaline urine pH

Decreased fluid consumption

162
Q

Pathogenesis of feline urological syndrome

A

Bladder infection by virus

Inhibition of urethral growth by early castration

163
Q

Gross features of feline urological syndrome

A

Bladder is distended

Mucosa has red discoloration, often diffuse and transmural

164
Q

Primary tumors of the urinary tract are (common/rare)

A

Rare

165
Q

Primary Epithelial Tumors of the Kidney

A

Renal Adenoma

Renal Adenocarcinoma

Renal Cystadenocarcinoma

166
Q

Nephroblastoma

A

Primary urinary tumor

Benign but space occupying

167
Q

Primary Urinary Tumors

A

Nephroblastoma

Transitional Cell Carcinoma

168
Q

Describe the appearance of transitional cell carcinoma of the bladder

A

Multifocal raised nodules or focal thickening of the urinary bladder, commonly in the trigone area

169
Q

Possible causes of transitional cell carcinoma in the bladder

A

Exposure to insecticide dips

Enzootic Hematuria

170
Q

Primary Mesenchymal Tumors of the bladder

A

Leiomyoma/ Leiomyosarcoma

Fibroma / Fibrosarcoma

Hemangioma/ Hemangiosarcoma

RUSVM Pathology II (12 decks)

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