Urinary System Pathology Flashcards
1
Q
Renal Parenchyma is divided into
A
Cortex
Medulla
Pelvis
2
Q
Descirbe the flow through the kidney
A
Renal papilla → renal calices → renal pelvis → ureters
3
Q
Describe the cat kidney
A
Prominant Vascular Pattern
Unipyramidal
4
Q
Describe the pig kidney
A
Multipyramidal
No External Lobulation
5
Q
Describe the bovine kidney
A
Multipyramidal
External Lobulation
6
Q
Describe the dog kidney
A
Unipyramidal
7
Q
Structure of gomerulus
A
Filtering mechanism
8
Q
Structure of tubules
A
Selective reabsorption
9
Q
Functions of the kidney
A
Regulation of fluid and electrolyte content
Endocrine function - renin and erythropoietin
10
Q
Developmental abnormalities of the kidney
A
Renal aplasia
Renal hypoplasia
Renal dysplasia
Renal cysts
Polycystic kidney
Ectopic kidney
Fetal lobulation and fusion
11
Q
Renal Aplasia
A
Absence of development of a kidney - can be unilateral or bilateral
12
Q
Renal Hypoplasia
A
Quantitative defect caused by reduced mass of metanephric blastema - reduced in size but otherwise normal architecture
13
Q
Renal hypoplasia is characterized by
A
Reduced number of histologically normal lobules and calyces
14
Q
Differential diagnosis of renal hypoplasia
A
Renal dysplasia
15
Q
Renal Dysplasia
A
Abnormal and asynchronous differentiation of renal tissue
16
Q
Causes of renal dysplasia
A
Congenital infections (Feline Panleukopenia, Canine Herpes Virus, BVD)
Autosomal Dominance
Hypovitaminosis
Intrauterine ureteral obstruction
17
Q
Renal Cysts
A
Common congenital malformation
Variably sized, filled with fluid and lined by flat or cuboidal epithelium
18
Q
Polycystic Kidneys
A
Numerous variably sized cysts in both cortex and medulla, filled with colorless fluid
“Honeycomb” appearance
19
Q
Causes of polycystic kidneys
A
Congenital Causes
Inherited Causes
20
Q
Consequences of renal cysts
A
May grow slowly or remain static
May increase in size/number causing compression atrophy
21
Q
Differential diagnosis for Polycystic kidneys
A
Acquired Cysts - obstructed tubules in chronic renal disease
22
Q
Ectopic Kidneys
A
Normal kidneys in abnormal locations
23
Q
Ectopic kidneys are predisposing factors for
A
Ureter obstruction and development of hydronephrosis
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
25
Described the texture of kidneys that have undergone autolysis
Soft and friable
26
Pseudomelanosis
Pigment staining the surface of the kidney
27
Postmortem changes seen in the kidney
Autolysis
Pseudomelanosis
28
Pigmentary disturbances seen in the kidney
Hemoglobinuria
Myoglobinuria
Lipofucin
Bile
29
Hemoglobinuria in kidney
Causes the kidney to be dark red to black
Consquence of sever intravascular hemolysis and hemoglobinuria
30
Etiologies for hemoglobin pigment in the kidney
Leptospirosis
Bacillary hemoglobinuria
Babesiosis
Chronic copper poisioning
31
Myoglobin pigmentation in the kidney
Dark red to black kidneys and dark red urine
Caused by high levels of myoglobin filtering into the tubules
32
Etiologies of Myoglobin pigmentation of the kidney
Rhabdomyolysis - Capture Myopathy
Equine Paralytic myoglobinuria
33
Lipofucsin pigmentation in the kidney
Kidneys dark brown to black
Incidental finding
34
Bile Pigmentation in the kidney
Kidneys are yellow-green
Kidneys excrete conjugated bilirubin resulting in choluria
35
Circulatory disturbances of the kidney
Hyperemia and Congestion
Hemorrhage
Ischemia
36
Describe the appearance of hyperemic kidneys
Bright red or dark red
37
Hypostatic congestion is a common result of
Prolonged prostration and circulatory failure
38
Hermorrhages of the kidney are commonly the result of
Vasculitis
Vascular necrosis
39
Describe the appearance of hemorrhagic kidneys
Turkey Egg
Speckled appearance
Petechial or ecchymotic
40
Causes of renal hemorrhage
* 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
41
Renal ischemia is caused by
Renal torsion
Renal infarct
42
Renal Infarct
Typically triangular in shape with the apex pointing towards teh medulla
43
Renal infarcts are associated with
Thrombosis of the renal vessels
44
Valvular endocarditis commonly causes what renal lesion?
Renal Infarct
45
Chronic Renal Infarcts
Prolonged ischemia leads to infarction and coagulative necrosis
Affected area will heal by fibrosis
46
Fibrosis has what effect on the kidney
Causes retraction of the parenchyma and characteristic depressions on the renal cortex
47
Most common etiologies for renal infarcts
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
48
Amyloidosis
Heterogenous group of diseases due to deposition of amyloid in tissues
49
Types of amyloidosis
Primary Amyloidosis
Secondary Amyloidosis
50
Primary Amyloidosis
Very rare
Due to deposition of amyloid AL, derived from Ig light chains produced by abnormal plasma cells
51
Secondary Amyloidosis
Deposition of amyloid AA that originates from serum alpha-globulin
Associated with chronic antigenic stimulation
52
Gross appearance of kidneys with amyloidosis
Enlarged, pale and have finely granular appearance
53
Microscopic appearance of amyloidosis
Pink amorphous material in glomeruli (medullary interstitium - cats and cattle)
Amyloid deposited in the mesangial matrix and along the adjacent basement membrane
54
Special stains used to microscopically confirm amyloidosis
Congo Red
Thyoflavin-T
55
56
Renal Cortical Necrosis
Acute and severe ischemia of the renal cortex due to vasospasm of cortical vessels
57
Discribe the appearance of kidne with renal cortical necrosis
Renal cortex has a mosiac appearance with intermixed areas of red and yellow discoloration
58
Renal Meduallary (Papillary) Necrosis
Caused by localized ischemia of the renal medulla
59
Causes of Medullary Necrosis
Amyloidosis
Pyelonephritis
Diabetes Mellitus
Use of anti-inflammatory and analgesic drugs
60
Acute Tubular Necrosis
Primary process of nephrosis
Renal tubular epithelium - highly susceptible to ischemia or to toxic damage
61
Describe the appearance of kidneys affected by acute tubular necrosis
Kidneys swollen, capsular surface is pale and moist, bulges on cut surface
62
Differential diagnosis for diffusely pale kidneys
Amyloidosis
Acute Nephrosis
Glomerulonephritis
Lymphosarcoma
63
Histological appearance of nephrosis
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
64
Outcome of tubular necrosis
If basement membrane is intact, regeneration of the proximal convoluted tubules is seen as early as three days after the toxic insult is removed
65
Causes of nephrosis
Ingestion of exogenous substances
Precipitates
66
Cause of Oxalate Nephrosis
Ethylene Glycol Toxicity
67
Causes of toxic nephrosis
Heavy metals
Carbon tetrachloride, chlorinated-hydrocarbon insecticides
68
Nephrotoxic Plants
Pigweed
Oaks
69
Pigweed causes what renal lesions
Tubular degeneration and peri-renal edema
70
Oak Poisoning
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
Classifications of nephritis
Glomerulitis
Glomerulonephritis
Interstitial nephritis
Pyelonephritis
72
Embolic Nephritis - Suppurative Glomerulitis
Glomerulitis
Caused by bacteremia
Bacterial colonies are seen in glomerular and interstitial capillaries
73
Describe the appearance of embolic nephritis
Multifocal, suppurative glomerulitis
74
Embolic nephritis may result in
Chronic renal microabscess developement
75
Glomerulonephritis are largely associated with
Immune-mediated injury
76
Two main mechanisms of immune mediated glomerulitis and glomerulonephritis
Deposition of antigen-antibody complexes
Autoantibodies directed against the GBM
77
Describe the process of glomerulonephritis due to deposition of antigen-antibody complexes
Persistant antigens in the blood result in deposition of antigen-antibody complexes in glomerular basement membranes
78
Describe the process of glomerulonephritis due to autoantibodies against the glomerular basement membrane
"Anti-Basement Membrane Disease"
Formation of auto antibodies against GBM → Complement fixation → leukocyte infiltration
Rare in domestic animals
79
Gross lesions associated with acute glomerulonephrits
Kidney appears swollen and pale
80
Gross lesions associated with chronic glomerulonephritis
Kidneys shrunken and granular
81
Three morphological types of glomerulonephritis
Membranous
Proliferative
Membrano-Proliferative
82
Membranous glomerulonephritis characterized by
thickening of basement membrane
83
Proliferative glomerulonephritis characterized by
increased cellularity
84
Membrano-proliferative glomerulonephritis often leads to
Glomerular sclerosis
85
Definitive diagnosis for glomerulonephritis by
Fluorescent antibody test
86
Interstitial (Tubulo-Interstitial) Nephritis
Inflammatory infiltration in the interstitium affects tubular functions
87
Gross appearance of multifocal interstitial nephritis
Off-white foci randomly scattered throughout the renal cortex and medulla
88
Multifocal Interstitial Nephritis may represent
Sequel of resolved bactermia/septicemia
89
"White Spotted Kidney"
Multifocal Interstitial Nephritis of Cattle
Residual lesions of E. Coli
90
Pathogenesis of Interstitial Nephritis
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
Causes of interstitial nephritis in dogs
Leptospiral interrogans
Infectious canine hepatitis virus
Theileria parva
92
Causes of interstitial nephritis in cattle
E coli septicemia
Leptospiral interrogans
Malignant Catarrhal Fever
93
Causes of interstitial nephritis in sheep
Sheeppox
94
Causes of interstitial nephritis in pigs
Leptospiral interrogans
Porcine Reproductive and Respiratory Syndrome
PCV-2
95
Cause of intersitial nephritis in horses
Equine Viral Arteritis
96
Gross appearance of chronic interstitial nephritis
Kidney shrunken, pale and firm with capsule firmly adhered to cortex
97
Histologic appearance of chronic interstitial nephritis
Interstitial fibrosis
Tubular atrophy
Tubular dilation
Aggregates of lymphocytes and plasma cells
98
Pyelonephritis
Inflammation of the renal pelvis and renal parenchyma
99
Pathogenesis of pyelonephritis
Bacteria ascend ureters → invade renal pelvis → move through the renal tubules → reach renal parenchyma
100
Predisposing factors of Pyelonephritis
Urinary obstruction
Renal medulla susceptibility to infecction
Abnormal Vesico-ureteral reflux
Sequel to cystitis
101
Gross appearance of pyelonephritis
Suppurative exudate in pelvic cavity, partial destruction of medulla, irregular discoloration of cortex
Marked scarring and firbosis
Inflammation in ureter and urinary bladder
102
Microscopic features of acute pyelonephritis
Neutrophils
Bacteria within lumen of renal tubules
Necrosis and exfoliation of the tubular epithelium
103
Microscopic features of chronic pyelonephritis
White bands of scar tissue extending from cortex to medulla
Interstitial fibrosis
Loss of tubules
End stage kidney
104
Granulomatous Nephritis
Form of chronic nephritis characterized by predominance of macrophages in the inflammatory infiltrate
105
Etiology of granulomatous nephritis
Viruses
Fungal organisms
Bacteria
Parasite migration
106
Dioctiophyma renale
Giant Kidey Worm
Nematode resides in the renal pelvis
107
Stephanurus dentatus
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
Hydronephrosis
Abnomal and permanent dilation of the renal pelvis and calyces with progressive atrophy of renal parenchyma
109
Cause of hydronephrosis
Increase pressure following partial or complete obstruction of the urine flow
110
Causes of urine outflow obstruction
Congenital malformation
Calculi
Iatrogenic
Inflammation
Neoplasia
Torsion
111
Pathogenesis of hydronephrosis
Urine filtrate diffuses to renal interstitium → absorbed by lymphatic vessles → increased pressure shuts down blood vessels → papillary necrosis → atrophy of renal parenchyma
112
Urolithiasis
Process of formation of solid or semisolid concretions anywhere in the urinary collecting system
113
Uroliths
Composed of a wide variety of minerals, often mixed with protein material
114
Predisposing factors to urolithiasis
Increased urinary concentration of stone constituents
Low urine volume
Urine pH
UTI
High phosphate diets
High levels of silica
115
Struvites
Magnesium, Ammonium, Phosphate
Most common in dogs
LInked to urinary bladder infection
116
Common signs of urinary obstruction
Dysuria
Stranguria
Pollakicuria
Hematuria
117
Consequences of urolithiasis
Hydronephrosis
Chronic cystitis
Bladder distention - rupture
Acute hemorrhagic urethritis
118
Familial renal disease can be the result of
Abnormal structure
Abnormal function
119
Describe familial renal disease due to abnormal function
Biochemical defects in renal tubules
Grossly and microscopically normal
120
Renal response to injury
Tubular regeneration
Healilng by fibrosis
Nephrosclerosis if fibrosis is severe
121
Defense mechanisms of the urinary system
Barrier system
Glomerular mesangial cells
Immune response
122
RCommon sequelae to chronic renal inflammation
Renal fibrosis
Nephrosclerosis
123
End Stage Kidney
Kidneys that are severely affected by chronic inflammation and fibrosis
124
Renal Disease
Any deviation from normal renal structure or function
125
Renal Failure
inability of the kidney to maintain normal function
126
Renal failure requires loss of what percentage of renal function
70-75%
127
Metabolic waste products that are used clinically to detect renal malfunction
Urea and Creatine
128
Urea
Produced in the liver from nitrogenous byproducts of the protein metabolism
129
Creatinine
Normal byproduct of phosphocreatine, a substance involved in the contraction of muscle fibers
130
Azotemia
Abnormal elevation of urea and creatinine in the blood without clinical manifestations of renal disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Biochemical abnormality due to decreased GFR
131
Uremia
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
Clinical signs of uremia
Vomiting
Dehydration
Polydypsia, anuria, oliguria, poliuria
Ammoniacal breath
Malaise due to Uremic toxins
133
Non Renal Lesions of uremia
Uremic stomatitis / glossitis
Hemorrhagic ulcerative gastritis and colitis
Endocarditis mucoarteritis
Tissue mineralization
Pulmonary Edema
Secondary hyperparathyroidism
134
Uremic Stomatitis / Glossitis
Due to fibrinoid arteriolar necrosis and bacterial production of ammonia
135
Pathogenesis of uremic stomatitis/glossitis
Oral bacteria transform urea into ammonia → irritation of the oral epithelium → ulceration of the mucosa
136
Ulcerative and necrotizing stomatitis is characterized by
Brown, foul smelling mucoid material adhered to the eroded and ulcerated lingual and oral mucosa
137
Hemorrhagic Ulcerative Gastritis occurs as a result of
Arteriolar necrosis with mucosal infarction and mineralization of the gastric glands and submucosal blood vessels
138
Uremic gastritis is seen in what species
Dogs cats
139
Colitis is seen in what species
Horses
Cattle
140
Mucoarteritis / Endocarditis
Non-inflammatory conditition due to deposition of glycosaminoglycans with subsequent fibrinoid degeneration of the subendocardial connective tissue
141
In the heart, uremic mucoarteritis is most common in
Left Atria and proximal aorta
142
Describe the gross appearance of mucoarteritis/endocarditis
Opaque light yellow roughened endocardial plaques
143
Dystrophic and Metastatic Calcification causes
deposition of mineral on the walls of the alveolar septa, pulmonary arterioles, pericardium, soft tissues, parietal pleura in the cranial intercostal spaces
144
Dystrophic and Metastatic Calcification may be associated to
Deposition of calcium secondary to cell injury, hypercalcemia or hyperphosphatemia
145
Pulmonary Edema results from
Damage to the air-blood barrier and plasma fluid leaks into the alveoli
146
Cause of death in uremic animals, usually
Pulmonary edema
147
Gross appearance of uremic pneumopathy
Lungs fail to collapse, have rounded edges, would be heavy and moist at cut surfaces
148
Histologic appearance of uremic pneumopathy
Eosinophilic material within alveoli
Basophilic material present in alveolar walls
149
Pathogenesis of Secondary Renal Hyperparathyroidism
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
Normal antibacterial activity of normal animal urine
Normal voiding
Low pH
High osmolality
151
Causes of cystitis
Bacterial infections
Formation and accumulation of uroliths
Exposure to toxic compounds
152
Toxic compounds that can cause cystitis
Cantharidin Toxin - Blister Beetles - Equine
Bracken Fern - Bovine
Cyclophosphamide - Dog/Cat
153
Chronic Enzootic Hematuria
Braken fern ingestion
Cattle
Severe syndrome due to prolonged ingestion of toxic principles of bracken fern
Carcinogenic
154
Characteristics of acute cystitis
Mucosal hemorrhage and ulceration
Production of exudate - hemorrhagic, fibinopurulent
155
Characterisitics of chronic cystitis
Mucous metaplasia of transitional epithelium
Follicular Cystitis
Polypoid Cystitis
156
Follicular Cystitis
Multifocal lymphoid hyperplasia
157
Polypoid cystitis
Formation of mucosal polyps
158
Emphysematious cystitis develops in some dogs and cats secondarily to
Diabetes Mellitus
159
Feline Lower Urinary Tract Disease / Feline Urological Syndrome
Obstruction of the urethra by a urethral plug
160
Urethral plug associated with feline urological syndrome composed of
Mixture of protein
Cellular debris
Struvite
161
Predisposing factors to feline urological syndrome
Diet high in magnesium and phosphate
Alkaline urine pH
Decreased fluid consumption
162
Pathogenesis of feline urological syndrome
Bladder infection by virus
Inhibition of urethral growth by early castration
163
Gross features of feline urological syndrome
Bladder is distended
Mucosa has red discoloration, often diffuse and transmural
164
Primary tumors of the urinary tract are (common/rare)
Rare
165
Primary Epithelial Tumors of the Kidney
Renal Adenoma
Renal Adenocarcinoma
Renal Cystadenocarcinoma
166
Nephroblastoma
Primary urinary tumor
Benign but space occupying
167
Primary Urinary Tumors
Nephroblastoma
Transitional Cell Carcinoma
168
Describe the appearance of transitional cell carcinoma of the bladder
Multifocal raised nodules or focal thickening of the urinary bladder, commonly in the trigone area
169
Possible causes of transitional cell carcinoma in the bladder
Exposure to insecticide dips
Enzootic Hematuria
170
Primary Mesenchymal Tumors of the bladder
Leiomyoma/ Leiomyosarcoma
Fibroma / Fibrosarcoma
Hemangioma/ Hemangiosarcoma
