Pathology of the Renal System: Tubular Diseases Flashcards
(135 cards)
1
Q
What are causes of tubular epithelium damage?
A
2
Q
Why are tubules commonly affected by sepsis?
A
Tubules closely related to peritubilar capillaries.
3
Q
What kind of tubule is this?
A
Proximal -> Brush border
4
Q
What kind of tubule is this?
A
Distal -> no brush border
5
Q
What is the most important cause of acute renal failure?
A
Acute tubular necrosis
6
Q
What causes acute tubular necrosis?
A
Nephrotoxins/ Ischemia
7
Q
What is the resulting signs of acute tubular necrosis?
A
Oliguria and Anuria
8
Q
When you have a toxic insult to the kindey, How does the tissue heal?
A
Basement membrane is intact, and so it heals via regeneration
9
Q
When you have an ischemic insult to the kidney, how does the tissue heal?
A
Basement membrane is not intact, and so it heals via fibrosis (non regenerative)
10
Q
What is the likely cause of the acute tubular necrosis in this image?
A
11
Q
What is the likely cause of the acute tubular necrosis in this image?
A
12
Q
Why do toxins preferentially damage kidneys?
A
1) 25% of cardiac output goes to the kidney
2) The substance is filtered into the urine by the glomerulus
3) The toxin or its metabolites within the renal tubular lumina are concentrated
13
Q
Why are toxins/metabolites concentrated in the kidneys?
A
14
Q
What are the common nephrotoxins of domestic animals?
A
15
Q
What is the number one cause of acute renal failure in dogs and cats?
A
Antifreeze (ethylene glycol)
16
Q
What are the common pigment nephrotoxins?
A
- Hemoglobin
- Myoglobin
- Bile/ Bilirubin
17
Q
What are the common heavy metal nephrotoxins?
A
- Lead
- Mercury
18
Q
What are the common pharmaceutical agents that are nephrotoxins?
A
Pharmaceutical agents (e.g., chemotherapeutic and antimicrobial agents): Cisplatin,
Aminoglycosides, Oxytetracycline, Amphotericin B, Sulfonamides, Monensin, NSAIDs
NSAIDs - usually high doses/ frequent administration
19
Q
What are common fungal agents that are nephrotoxins?
A
(Aspergillus and Penicillium: ochratoxin)
20
Q
What are common plants that are nephrotoxic?
A
Plant toxins:
Pig: Pigweed (Amaranthus retroflexus)
Cattle: Oxalate-containing plants, Oak tannins
Cats: Lilies
21
Q
What vitamins and minerals can be nephrotoxic?
A
- Vitamin D
- Elevated Calcium (Hypercalcemia)
22
Q
What is a bacterial toxin that is nephrotoxic?
A
Epsilon Toxin - Clostridium Perfringes Type D
23
Q
What bacteria has epsilon toxic?
A
C. Perfringes Type D
24
Q
What are contaminants of pet food that are nephrotoxic?
A
Pet food contaminants: Melamine, Cyanuric acid, Raisins and Grapes
25
What is hemoglobinuric nephrosis? What is the cause?
26
What are the mechanisms that cause acute tubular necrosis with hemoglobinuric nephrosis?
- increased heme is toxic to kidneys
- decreased blood cells = hypoxia
27
What are examples of causes of hemoglobinuric nephrosis?
28
What will the urine look like in a patient with myoglobinuric nephrosis?
Port wine urine
29
What is intravascular hemolysis?
Lysis of red blood cells within blood vessels
30
What is chronic copper toxicity in sheep? What are characteristic signs?
31
What is the pathology causing the changes to this kidney?
32
What is seen in this image? What is indicated by the blue arrow ?
chronic copper toxicity in sheep -> blue arrow: you can see hemoglobin casts in tubule lumens
33
What is seen in this image? What is the cause of the changes to this kidney?
Immune-mediated hemolytic anemia in
a dog
34
Why is jaundice typically seen with IMHA?
Prehepatic icterus
increased bilirubin free in blood
35
What is seen in this image? What is the reasons for the changes here in this image?
36
What is the cause of myoglobinuric nephrosis?What is the mechanism of injury?
37
What are some causes of myoglobinuric nephrosis?
Downers syndrome in cows
Porcine Stress Syndrome - Malignant hyperthermia
**
38
What is the cause of the changes in this kidney? What is seen indicated by the blue arrows?
Cause: Exertional Rhabdomyolysis
39
What is seen in this image?
Intraluminal myoglobin casts
40
What is easier to ID Hemaglobinuric nephrosis, or Myoglobinuric nephrosis? How can you tell them apart?
Hemoglobinuric nephrosis is easier to ID -> Histologic lesions are pretty much the same so must compare with gross visual to differentiate.
41
What is seen in this image?
Cholemic Nephrosis
- Acute fulminant hepatic failure > icterus > bile cast nephropathy
42
What is the cause of lead toxicity? What is the resulting damage that occurs?
43
What is an important finding in patients with led toxicosis?
Intranuclear inclusion bodies that are acid fast positive
44
What is seen in this image? What does it indicate?
This is showing intranuclear inclusion bodies that are acid fast positive.
This indicates led toxicosis.
45
What are the lead inclusion bodies made of in cases of lead toxicosis?
- lead- protien complexes
46
What is engine antifreeze posioning? Why do animals ingest it?
Constituent of engine antifreeze solution (95%), sweet, voluntarily consumed,
especially by young animals
47
What animals are the most suceptible to antifreeze posioning?
Cats
48
What is antifreeze posioning?
Ethylene Glycol Toxicosis
49
Why is ethylene glycol toxic to the kidneys?
It is not, it is actually the metabolites from oxidation within the liver that is toxic (glycoaldhyde, glycolic acid glyoxalate )
50
What damage is caused to the kidneys by ethylene glycol toxicity?
51
What are the pathamogomic lesions from ethylene glycol toxicity?
52
What is seen on histology of ethylene glycol?
53
What is seen in this image? What is the cause?
54
What are causes of ischemic renal tubular damage?
55
What is renal infarction? What is the obstructive material that can obstruct the lumen of the blood vessels? What is the predisposing conditions for renal infarction?
- Renal Infarction - localized areas of coagulative necrosis
- Obstructive material: thrombi (hypercoagulable state), septic emboli, neoplastic emboli
- Predisposing conditions: Valvular endocarditis, Feline cardiomyopathy (HCM), endotoxemia, neoplasia
56
What is the mechanism of feline cardiomyopathy (HCM)?
57
What are the areas of the kidney is susceptible to infarct?
1. Renal artery- Occlusion of the renal artery: entire kidney will be necrotic. (Rare)
2. Arcuate artery - wedge
shaped necrosis of cortex
and medulla.
3. Interlobular artery -
necrosis of cortex only.
58
Why is the kidney more susceptible to infarct?
- No anastamosis
- Right angle connections
59
Where will the damage be seen in the kidney for an infarct in a renal artery?
Whole kidney
60
Where will the damage be seen in the kidney for an infarct in an arcuate artery?
Wedge shaped
61
Where will the damage be seen in the kidney for an infarct in an interlobular artery?
Cortex only
62
What stage is this kidney infarction? What is the artery affected?
Arcuate artery is affected. This is an acute early infarct ( swollen/ dark red)
63
What stage is this kidney infarction? What is the artery affected?
Arcuate artery is affected. This is a 2-3 day old infarct. It is pale and surrounded by a thin zone of hyperemia -> phagocytes clean up
64
What stage is this kidney infarction? What is the artery affected?
Arcuate artery is affected. Chronic - pale, shrunken (depressed) due to loss of tissue and replacement with fibrosis
65
What is seen in this image? What is the typical cause?
66
What are causes of renal medullary/ papillary/ crest necrosis?
1.) NSAIDs
2.) Medullary Amyloidosis
3.) Chronic Pyelonephritis
67
What is the mechanism of injury/ pathogenesis of NSAIDs causing ischemia?
68
What is analgesic nephropathy?
69
What is the mechanism of injury for medullary amyloidosis? What type of amyloidosis is seen in this instance?
70
What is the mechanism of injury for chronic pyelonephritis?
71
What is seen in this image?
72
What is the issues with this kidney? What is the cause? What is the likely breed of this patient?
73
What are the causes of inflammatory tubulointerstitial disease? How do the causes get into the kidneys?
74
What may be the damage resulting from inflammatory tubulointerstitial disease? What is the cause/ pathogenesis?
May result as secondary to acute tubular necrosis or GN
May result from bacterial or viral septicemia (bypass the glomeruli) > infect the kidney tubules and damage them > incites an inflammatory response in the
interstitium.
75
What are acute examples of inflammatory tubulointerstitial diseases?
Acute (neutrophils, edema and tubular necrosis): Leptospira spp., canine adenovirus and herpesvirus.
76
What are chronic examples of inflammatory tubulointerstitial diseases?
- Chronic (mononuclear inflamm. cells, interstitial fibrosis, tubular atrophy/dilation): Leptospira spp., E. coli septicemia in cattle, Malignant Catarrhal Fever.
77
What is the clincial characterization of inflammatory tubulointerstitial diseases?
Clinically characterized by loss of concentrating ability (isosthenuria)
78
What are the types of inflammation that can be present with inflammatory tubulointerstitial diseases?
*Nonsuppurative interstitial nephritis (lymphocytes, plasma cells and macrophages)
* Suppurative interstitial nephritis
◦ Embolic suppurative nephritis
◦ Pyelonephritis
79
What is nonsuppurative interstitial nephritis?
-Multifocal or Generalized (depending upon the intensity of the
insult and the efficiency of the host’s response) -> usually chronic
80
What are examples of nonsuppurative interstitial nephritis?
Causes:
◦ Leptospirosis, white-spotted kidneys in calves (E.coli or Salmonella), larval migration of Toxo cara canis, malignant catarrhal fever, FIP, Lyme disease
◦ Vicia spp. - hairy vetch – systemic granulomatous inflammation (skin,
heart, spleen, kidney, liver, intestines)
81
What is seen here in this image?
Lymphoplasmacytic inflammation
82
What is seen here in this image?
Interstitial fibrosis with tubular dilation and atrophy – Trichrome stain
83
What kind of nephritis is seen here?
84
What kind of nephritis is seen here?
85
What kind of nephritis is seen here? What is the likely cause?
Type of nephritis: nonsuppurative interstitial nephritis
86
What kind of nephritis is seen here? What is the likely cause?
Type of nephritis: nonsuppurative interstitial nephritis
87
What kind of nephritis is seen in this image?
88
What is seen in this image? What is the cause?
89
What is seen in this image? What is the cause?
90
What is seen in this image? What is the cause? Hint: Neonatal puppy
91
What are the common causes of suppurative embolic nephritis?
92
What are common sources of suppurative embolic nephritis?
Common sources = septic omphalophlebitis (umbillical cord infection) or endocarditis (in adults)
93
What are common gross and microscopic findings of suppurative embolic nephritis?
94
What is seen in this image? What is the likely affected structures?
95
What is seen in this image that is taking up the purple stain?
Bacteria, this is one of the microabcesses.
96
What is pyelonephritis? What is the usual cause? What are the common causes?
97
What is seen in this image? What is the definition of this term?
98
What are the predisposing factors to pyelonephritis?
Predisposing factors
◦ Urinary obstruction, urolithiasis,
prostatic hyperplasia, transitional cell carcinoma of urinary bladder
99
How does bacteria reach the renal pelvis in pyelonephritis?
Abnormal vesicoureteral reflux ◦ Reverse peristalsis
100
What is occuring in this image? What is the likey cause?
101
In pyelonephritis, what will be the location of the most severe lesions?
102
What is the sequale of pyelonephritis?
103
What is pyonephrosis?
104
What is occuring in this image? What is a result of ?
Pyonephrosis -> Sequale of Pyelonephritis
105
Is the discharge in this kidney normal? Why?
106
What is hydronephrosis? What is the result? Does it affect only one side?
107
What are the causes of hydronephrosis?
108
What is seen in this image?
Mild Hydronephrosis
109
What is seen in this image?
Severe Hydronephrosis
110
What are the parasitic diseases of the kidneys?
Toxocara canis
Stephanurus dentatus in pigs Dioctophyma renale in dogs Halicephalobus gingivalis in horses
111
What parasite is seen in this kidney?
112
What parasite is seen in this kidney?
113
What parasite is seen in this kidney?
114
What is the prevelance of neoplasms of the kidney in dogs and cats? What is more common?
115
What are the cell lines renal neoplasias may arrise from?
116
Do primary neoplasms usually affect both kidneys?
117
What percent of primary neoplasms in the kidneys are bilateral?
< 5 %
118
What is the most common primary renal neoplasm in dogs, cattle and horses? What is its origin? What is its invasion habits? Is it metastatic?
119
What is seen in this image? Is it common?
120
What is renal cystadenocarcinoma-nodular dermatofibrosis syndrome? What breeds are prone to this? What can you see as other extrarenal lesions?
121
What breeds are prone to renal cystadenocarcinoma-nodular dermatofibrosis syndrome?
German Shepherds
122
Case example:
You have a 7 year old neutered male German Shepherd come in with multiple masses on its hind limbs (seen below). What is your concern and how would you investigate next?
- Concern for renal cystadenocarcinoma-nodular dermatofibrosis syndrome
Why? masses, breed, age, ect.
- Check kidneys
- Ultrasound
- Bloodwork
- Ionized calcium level will probably be ideal.
123
What is seen in this image? What is the likely cause? What breed is the dog likely?
Bonus:
- Pattern of inheritence?
- Common extrarenal lesions?
Renal cystadenocarcinoma-nodular dermatofibrosis syndrome
Breed: German shepherd
Extra renal lesions: urterine leiomyoma, and multiple cystic masses on hind legs.
Pattern of inheritence: Autosomal dominant
124
What is the most common primary renal neoplasm in pigs and chickens? What animals are they normally found in? When?
125
What is seen in this image of a pig kidney?
126
What is an ectopic nephroblastoma? What does it cause clinically?
127
Where is ectopic nephroblastomas found? What animals?
* Thoracolumbar junction (T13/L1) in young dogs (5 months -4 years, the median age being 14 months)
128
What is seen in this image?
129
What primary renal tumor can result in hind limb paresis in young dogs?
Ectopic Nephroblastoma
130
What are other possible renal neoplasms?
131
In what animals is renal involvement for lymphoma common? Is it found bilaterally or unilaterally?
Cats
Bilaterally
132
What is seen in this image?
Lymphoma feline kidney
133
What is seen in this image?
Attacks blood vessels Hematogenous spread.
134
What neoplasm can arrise in cattle with bovine leukemia virus?
Multicentric Lymphoma
135
What is seen in this image of a cow kidney who has bovine leukemia virus?
