Renal Pathology Flashcards Preview

Pathology > Renal Pathology > Flashcards

Flashcards in Renal Pathology Deck (56):
1

What does pre-renal functional problems cause?

Compromised renal perfusion - Reduced RBF leading to Renal Ischemia

2

What does functional problems intrarenally cause?

Compromised kidney function

3

What does post-renal functional problems cause?

Obstruction of urine outflow

4

When does acute renal failure occur?

When over 75% of renal function is abruptly impared

5

What are the main signs of acute renal failure?

Azotaemia - Cardiac dysrrythmia (due to to K retention) - Muscle tremors and coma (due to phosphate retention) - Metabolic acidosis (due to failure of pH control) - Hypertension - Oliguria

6

What is chronic renal failure characterised by?

Prolonged signs of uraemia

7

Define azotemia. How is it caused?

Retention of nitrogenous metabolites - Insufficient glomerular filtration

8

What are the clinical signs of chronic renal disease?

Polyuria - Isosthenuria - Polydipsia - Halitosis - Dribbling - Lank coat - Weight loss

9

Define uraemia

Urea in the blood

10

Give the progression of normal renal function to uraemia

1- Diminished renal reserve, GFR 50% of normal 2- Renal reserve, GFR 20-50%, azotaemic and polyuric 3- Renal failure, 20-25%, kidneys can't maintain homeostasis = uraemia 4- End-stage renal disease, 5%, terminal stages of uraemia

11

What are the systemic effects of uraemia?

Causes retention of electrolytes (esp Ca) - Plasma protein loss - Hyperphosphataemia - Secondary renal hyperparathyroidism - Reduced erythropoietin - Hypertension

12

How does uraemia cause Secondary renal hyperparathyroidism?

Reduced GFR - inadequate secretion of phosphate - Precipitation of ionised calcium concentration - Reduced activation of Vit D - Reduced Ca absorption - PTH stimulated - Osteoclastic bone resorption

13

How does uraemia cause non-renal lesions?

Endothelial degeneration and necrosis = vasculitis and secondary thrombosis Large amounts of ammonia/bacteria in saliva

14

What are the portals of entry for infection into the kidney?

Haematogenous - Glomerular infiltrate - Ascending ureter - Direct penetration

15

What are the defence mechanisms within the kidney?

Urine flow flushes out bacteria - pH of urine - basement membrane

16

What are the categories of renal disorders?

Glomerular - Tubular - Interstitial - Vascular system

17

What condition is affecting these kidneys?

Q image thumb

Hydronephrosis

18

What is the pathogenesis of hydronephrosis?

Obstruction of outflow tract - Increased pressure in renal pelvis - Tubules undergo necrosis and atrophy - Interstitial fibrosis - Pale radiatiing rays

19

What is the condition of this cows kidney? What are the gross problems?

Q image thumb

Pyelonephritis - Renal calyces contain supprative exudate bordered by red rim of haemorrhage

20

What infectious agents are involved in pyelonephrotitis in cows?

E. coli - Arcanobacterium pyogens - Cornyebacterium renale

21

When are cows most likely to get pyelonephrititis? What other species is susceptible?

Post-partum period - Sows

22

  What is this condition called? What are the microscopic features of this disease?

Q image thumb

Acute tubular necrosis - Diffuse degeneration and necrosis of epithelial cells of convoluted tubules

23

What can cause acute tubular necrosis?

Ischaemia - Nephrotoxins - Inflammation - Certain infectious agents

24

What causes chronic renal failure?

Uraemia

25

This is a histological section of a cat's pancreas - What has happened and what could cause it?

Q image thumb

Vacuolated beta cell islets consistent with hydropic degeneration - Type 2 diabetes

26

This is the bladder of a cat with type 2 diabetes - what has caused this?

Q image thumb

Glycosuria in diabetes mellitus enhances bacterial growth

27

What is the common name for this disease? What can cause it?

Q image thumb

Renal infarction - Blockage of artery (neoplasia, embolism), damage of vasculature (toxins)

28

Describe the gross appearance of this kidney

Q image thumb

Multifocal small pale/white nectrotic foci

29

Describe what is in these microscopic images of the kidney with multifocal white/red lesions. What is this condition know as?

Q image thumb

Microabscesses centered on glomeruli - Bacterial, neutrophils and necrotic debris - Suppurative glomerulitis (embolic nephritis)

30

What causes supprative glomerulitis?

Bacterial invasion - Haematogenous route and lodge in capillaries of glomeruli - Replicate and induce necrosis & inflammation

31

How can immune mediated glomreulonephritis occur?

Formation of antibodies against entrapped nonspecific antigens withing the glomerular basement membrane

32

What is glomerular amyloidosis commonly associated with? Why?

Chronic inflammatory disorders, systemic infectious diseases or neoplasia - Acute phase proteins cause amyloid deposits in glomeruli

33

How can you diagnose that there is amyloid deposition in the kidney?

Stain with congo red - Amyloid is apple green when viewed under polarised light

34

What is acute supprative glomerulitis also known as?

Bacterial or embolic nephritis

35

What is seen in the kidney during acute suppurative glomerulitis?

Formation of microabscesses throughout the cortex

36

What is glomerulosclerosis?

Reduction in number of functional glomeruli

37

What is the most common cause of tubular disease?

Ischemia

38

What is the response of tubules to injury?

Degeneration - Necrosis - Apoptosis - Cells slough into lumen forming cellular casts - Compensatory hypertrophy

39

Why is it detrimental if the basement membrane undergoes necrosis as well as the tubule?

Nephrons don't regenerate

40

Name 3 congenital disorders of renal tubular function

Primary renal glycosuria (reduced glucose reabsorption) - Fanconi syndrome (reduced protein, glucose, phosphate and amino acid reabsorption) - Cystinuria (calculus formation & obstruction in male dogs)

41

What is the most important cause of acute renal nacrosis? What causes it?

Acute tubular necrosis - Nephrotoxic or ischemic injury

42

Why can muscle damage cause acute tubular necrosis?

Myoglobinuric nephrosis released from damaged muscle cells - Amplifies effects of toxins in combination with ischemia

43

Give examples of toxins that can cause acute tubular necrosis

Heavy metal - Pharmaceutical agents (NSAIDs) - Fungal and plant toxins - Ethylene glycol (antifreeze) - Vitamin D - Bacterial toxins

44

What is the renal interstitium?

Fibrovascular stroma that surrounds the nephron

45

What can cause renal interstitial disease?

Ascending infection (pylonephritis) - Haematogenous (E. coli, Leptospira, Canine adenovirus) - Secondary to injury of vasculature/tubules/glomeruli

46

What are the responses to interstitial injury?

Oedema - Haemorrhage - Inflammation - Fibrosis

47

Why is any disease or damage to the renal vascular system detrimental?

Arterial blood supply to the cortex is terminal (no anastomoses) so will have a knock on effect to nephron blood supply

48

What is the difference between hyperaemia and congestion?

Hyperaemia is an active processs where arterial dilation causes increased blood flow (inflammatory response) - Congestion is a passive process where blood accumulates in venous system (secondary to hypovolaemic shock/cardiac insufficiency/hypostatic)

49

What is Virchow's triad?

Major determinants of thrombosis - Endothelial injury, Dynamics of blood flow, Hypercoagulability of blood

50

What is disseminated intravascular coagulation? What can cause it?

Serious manifestation of abnormal coagulation, generation of excess thrombin - Complication of any condition associated with widespread thrombin activation

51

Whata re the main diseases of the renal pelvis?

Hydronephrosis - Pyelonephritis - Papillary necrosis

52

What is the main cause of hydronephrosis?

Obstruction of urine outflow

53

What has occured on this photo?

Q image thumb

Hydronephrosis

54

What is pyelonephritis?

Bacterial infection of the renal pelvis

55

What has occured on this photo?

Q image thumb

Pyelonephritis

56