Lecture 10 Urinary 4 Flashcards Preview

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Flashcards in Lecture 10 Urinary 4 Deck (50):
1

With chronic renal failure, toxic metabolites can easily accumulate within the blood.

  1. When systemic lesions develop in response to this, what is that called?
  2. Name the 4 changes that occur within the body becuase of the toxin accumulation...

  1. Uremia
  2.  
  • Ulcerative gastritis
  • Ulcerative glossitis
  •  Fibrinoid vascular necrosis
  • Soft tissue metabolization

2

What the steps involved in the following pathway? :

Decreased GFR --> Mineralization of soft tissue

 

Decreased GFR --> Increases serum phosphorus levels --> Drives down serum calcium ion levels --> Calcium gets precipitated out as mineral --> Mineralization of soft tissue

3

True or False:

Visible lesions will develop due to uremia within both chronic and acute renal failure patients.

FALSE

Acute renal failure patients will often NOT live long enough for those changes to occur within the body.  

As for CRF patients, yes, they will devleop lesions associated with uremia.

4

What are the 3 specific possible outcomes of chronic renal failure, changes that would occur within the body but do not involve the death of the animal?

  1. Uremia
  2. Renal hyperparathyroidism (causing fibrous osteodystrophy)
  3. Non-regenerative anemia

5

The following is a flow chart of the changes that occur within a CRF patient that ultimately leads to the development of fibrous osteodystrophy.

Fill in the missing steps of the pathway:

CRF --> Increased serum phosphorus --> ___1___ --> ___2___ --> Increased osteoclastic activity --> ___3___ --> Proliferation of fibrous tissue in bone --> Fibrous osteodystrophy

  1. Decreased serum calcium & vitamin D3 production
  2. Increased PTH production
  3. Increased calcium & phosphorus liberation from bone

6

What type of anemia might you associate with a chronic renal failure patient?

Non-regenerative anemia

7

Why might a patient with CRF have RBCs with shorter lifespans?

Patients with CRF often will have toxins accumulating within their bloodstream.  These toxins can cause damage to the RBCs and decrease their overall lifespan.

8

  1. What might be your morphological diagnosis of the following? :
  2. What are some changes that have occured that might help in your diagnosis?
  3. What changes would you expect to see on the cut surface of this kidney?

Q image thumb

  1. Chronic renal fibrosis
  2.  
    • Fibrous connective tissue
    • Smaller than normal 
    • Multinodular
  3.  
    • Narrowed cortex
    • Irregularity to the capsule
      • Fibrous tissue causes changes within the capsule of the kidney that make the tissue appear as though it is being "pulled in"

 

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9

  1. What type of change has occured within this renal tissue?
  2. Because of the change that has occured, what can you call this nephron?

Q image thumb

  1. Nephron hypertrophy
  2. Supernephron

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10

  1. What is a name for these lesions?
  2. Why might these lesions have developed?
  3. Are these lesions most commonly unilateral or bilateral?

Q image thumb

  1. Ulcerative glossitis
  2. Uremia due to CRF
  3. Bilateral

A image thumb
11

  1. What changes in the mucosa can you see here?
  2. What condition can cause these changes?
  3. What other change could occur within the mucosa that is not present in this particular sample of tissue?

Q image thumb

  1. Mineralization of the mucosa (white areas) & hemorrhage
  2. Chronic renal failure
  3. Ulcerations

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12

This patient, who was previously diagnosed with chronic renal failure, appears to have an increadibly swollen face.  

  1. What is your diagnosis of the change you are seeing?
  2. What is the pathway?

Q image thumb

  1. Fibrous osteodystrophy
  2. CRF --> Increased serum [P] --> Decreased serum Ca and vitamin D3 production --> Increased PTH production --> Increased osteoclastic activity --> Increased resorption of bone and liberation of Ca & vitmain D --> Proliferation of fibrous tissue within the bone --> Fibrous osteodystrophy

A image thumb
13

This is tissue from a chronic renal failure patient:

  1. What is your diagnosis of this bilateral lesion?
  2. What might this lesion look like clinically?

Q image thumb

  1. Fibrous osteodystrophy
  2. Swollen face...

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14

In chronic renal failure patients, the parathyroid gland will enlarge.  What change is occuring at the cellular level in that gland?

Hyperplasia of the chief cells

15

The following is the process on how CRF causes polydipsia.  Fill in the missing steps:

Loss of nephrons over time --> Hypertrophy of nephrons -->  ___1___(clue: adaptations being made by the nephrons) -->  Decrease medullary interstitial osmolality --> Impaired counter current multiplier system --> Filtrate not modified --> __2__ -->  __3__ --> Polydispsia

  1. Increase in SNGFR, increase in solute load, increase in filtrate volume
  2. Large volume of unconcetrated urine
  3. Dehydration

16

With chronic renal failure, there is a loss of nephrons over time.  That loss of some nephrons causes which 2 changes within the remaining nephrons?

  1. Nephron hypertrophy (supernephrons)
  2. Fibrosis

17

With chronic renal failure, there will be a decrease in total GFR.  This will cause which products to increase within the blood?

  1. BUN
  2. Creatinine
  3. Phosphate
  4. Uremic toxins

18

This image illustrates the pathogenesis of chronic renal failure.  Fill in the missing pieces (labels a, b, and c) to complete the chart:

Q image thumb

a.  Overperfusion injury --> Sclerosis

b.  Non-regenerative anemia

c.  Fibrous osteodystrophy

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19

Which structures make up the "lower" urinary tract?

  1. Ureters
  2. Urinary bladder
  3. Urethra

20

Which cell type lines the interior of the structures that make up the lower urinary tract?

Transitional cell epithelium

21

What about the transitional cell epithelium makes it a good defense mechanism?

The cells of the epithelium are continually lost and replaced.  

For example, if a bacterium attaches to one of the cells, it will be flushed out with the urine once that cell is slughed from the epithelial layer.

22

What are the 3 denfense mechanisms of the lower urinary tract?

  1. Flushing action of the urine
  2. Epithelial turnover
  3. Mucosal immunity

23

Pyelonephritis is a form of what type of nephritis?

Tubulointerstitial nephritis

24

Dilation of the renal pelvis (hydronephrosis) and dilation of the bladder (cystomegaly) can occur secondary to what?

Obstruction

25

What (4) factors might predispose an animal to uroliths? 

  1. Bacterial infections
  2. Dietary factors
  3. Dehydration (decreased flushing action)
  4. Alkaline urine

26

Obstruction is most likely to occur at narrow points.  In what 3 specific areas might uroliths be more likely to form?

  1. Sigmoid flexure 
  2. Os penis
  3. Male feline urethra

27

You find a mass somewhere within the lower urinary tract.  You susepct neoplasia - what are your top differentials?

  1. Transitional cell carcinoma
  2. Leoimyoma
  3. Leiomyosarcoma

28

True or False:

  1. Leiomyomas can develop in either smooth or skeletal muscles.
  2. Leiomyomas are more common than leiomyosarcomas.
  3. Transitional cell carcinomas are most commonly at the apex of the urinary bladder.

  1. FALSE: leiomyomas are strictly "smooth muscle tumors"
  2. TRUE: the benign tumors are more common in this case
  3. FALSE: transitional cell carcinomas are usually in the area of the trigone

29

  1. Describe the visible changes that have occured within this urinary bladder.
  2. This animal presented with a severe fever as a result of this lesion.  What is your morphological diagnosis?

Q image thumb

  1. Hemorrhage (in a linear fashion) & hyperemia
  2. Hemorrhagic cystits

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30

What is the primary problem here?

Q image thumb

Urolithiasis

31

  1. The formation of stones or sandy precipitates anywhere in the urinary tract is termed what?
  2. The stones that form are called what?

  1. Urolithiasis
  2. Uroliths (or calculi)

32

Below, there is a mass within the trigone area of the urinary bladder.  What is your most likely differential?

Q image thumb

Transitional cell carcinoma

A image thumb
33

The image below illustrates sphirocytic bacteria within the tubules of kidneys.  

  1. What disease is associated with this? 
  2. Is this an acute or chronic stage of the disease process?

Q image thumb

  1. Leptospirosis
  2. Chronic

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34

Which type of glomerulonephritis is associated with Lyme's Disease?

Membranoproliferative

35

True or False:

  1. Canine herpesvirus is unable to withstand cool body temperatures.
  2. Canine herpesvirus is most commonly seen in puppies.
  3.  

  1. FALSE: canine herpesvirus actually replicates at lower body temperatures
  2. TRUE

36

  1. At what age are puppies more susceptible to canine herpesvirus?
  2. Why?

  1. < 3 weeks of age
  2. Canine herpesvirus is a TEMPERATURE SENSITIVE VIRUS that will replicate when body temperature is low.  New born pups, specifically, are inept at maintaining their own body temperature.

37

This is a gross example of glomerulonephritis.  What is ONE visible abnormaltity that may help you diagnose that?

Q image thumb

Granularity of the surface

38

  1. What is your morphological diagnosis based on the changes occuring within these nephrons?
  2. What specific abnormalities within this image lead you to your diagnosis?

Q image thumb

  1. Membranoproliferative glomerulonephritis
  2.  
    • Enlarged glomeruli
    • Thickened basement membrane of capillaries
    • Loss of urine space

39

  1. Describe the changes you can see here:
  2. If this kidney is from a dog with herpesvirus, would this be an acute or chronic lesion?

Q image thumb

  1. Multifocal hemorrhage & necrosis
  2. Acute

40

Which stage of Leptospirosis, acute or chronic, leads to hyperglobinuric nephrosis?

Acute

41

Which stage of Leptospirosis is more common, acute or chronic?

Chronic

42

Which organisms cause acute leptospirosis?

  1. L. canicola 
  2. L. icterohemorrhagica

43

Which organisms cause chronic leptospirosis?

  1. L. grippotyphosa
  2. L. bratislava

44

How will an animal with chronic leptospirosis present?

The animal will present with signs of CRF.  These will include azotemia and polyuria.  The urine will have detectable bacteria and a specific gravity within the isosthenuric range.

45

On necropsy, a kidney chronically infected with leptospirosis (as in the image attached) may look grossly similar to a kidney from an animal with what condition?

Q image thumb

Lymphoma

46

Grossly, this kidney is nodular and enlarged.  On histology, there are pockets of neutrophils as well as infiltration of lymphocytes and macrophages.  What is your diagnosis?

Q image thumb

Tubulointerstitial nephritis

(Due to Leptospira bratislava in a dog)

47

Leptospirosis causes a tubulointerstitial nephritis.  

  1. What type of tubulointerstitial nephritis does acute leptospiosis cause?
  2. What type(s) of tubulointerstitial nephritis can chronic leptospirosis cause?

  1. Acute tubulointerstitial nephritis
  2. Lymphogranulomatous & purulent tubulointerstitial nephritis

 Image: Lymphogranulomatous tubulointerstial nephritis 

A image thumb
48

Which bacterial species is the predominant causitive agent of Lyme's disease?

Borrelia burgdorferi

49

  1. Which type of glomerulonephritis is represented in this image?
  2. What is your reasoning?

Q image thumb

  1. Membranoproliferative GN
  2. Thickened basement membrane (such thickening that the urine space is lost), splitting of basement membrane, mesangial cell accumulation

A image thumb
50