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CVSOH BVSc4 > Urinary - pathology > Flashcards

Urinary - pathology Flashcards

1
Q

What are the main functions of the kidney?

A

Formation of urine
Acid-base, water and electrolyte homeostasis
Endocrine - renin-angiotensin-aldosterone, vitamin D

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2
Q

What are the 4 main structural components of the kidney?

A

Blood vessels
Glomerulus
Tubules
Interstitium

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3
Q

What proportion of the cardiac output goes to the kidneys?

A

25%

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4
Q

What are the arteries that make up the kidney?

A

Renal artery
Interlobar arteries
Interlobular arteries
Arcuate arteries

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5
Q

Where are the arcuate arteries located in the kidney?

A

At the corticomedullary junction - between the cortex and the medulla

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6
Q

What are the names of the vessels going to and from the glomerulus?

A

Afferent and efferent glomerular arterioles

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7
Q

What makes up the three layers of the glomerular filtration barrier?

A

Fenestrated capillary epithelium
Glomerular basement membrane
Podocytes

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8
Q

If injury occurs to the glomerular filtration barrier what is likely to start to appear in the urine?

A

Proteins - proteinuria

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9
Q

What can disrupt tubular function in the kidneys?

A

Disruption of the close apposition of the tubules and peritubular capillaries

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10
Q

What 4 things can enter the interstitium of the kidneys during disease processes?

A

Fluid
Cells
Connective tissue - collagen (fibrosis)
Other - calcium, amyloid

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11
Q

What are some potential causes of renal vascular injury?

A

Embolism
Vascular injury/vasculitis
Loss of autoregulation of renal perfusion - ischaemic injury
Compression of blood vessels

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12
Q

What does renal thromboembolism look like in the kidney?

A

Dark red area - less old infarction, acute
Regions of pallor - long time ischaemic
Wedge shaped

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13
Q

What is the most common place for thrombi to cause infarction in the kidney?

A

Interlobular vessels - small end arteries
Cause localised infarction of a segment of the cortex

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14
Q

What is the second most common place for thrombi to cause infarction in the kidney?

A

Arcuate or interlobar artery
Causes localised infarction of a segment of the cortex AND medulla

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15
Q

What is the most uncommon place for thrombi to cause infarction in the kidney?

A

Renal artery
Causes total infarction of the kidney or of one half of the kidney

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16
Q

Where are renal thromboemboli most likely to come from?

A

The heart - left side
e.g from hypertrophic cardiomyopathy or endocarditis

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17
Q

What viruses can cause vascular injury/vasculitis causing kidney damage?

A

Canine herpesvirus - 2-3 week puppy
African/classical swine fever
Feline infectious peritonitis

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18
Q

What controls perfusion of the kidney by vasodilating afferent arterioles in response to ischaemia to maintain perfusion?

A

Prostaglandin

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19
Q

What drug can inhibit prostaglandins causing disturbed perfusion and ischaemia in the kidney?

A

NSAIDs

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20
Q

What are some potential causes of compression of the renal vasculature and medullary necrosis?

A

Urinary obstruction
Pyelonephritis
Medullary amyloidosis

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21
Q

What does glomerulosclerosis look like?

A

Fibrosis and thickening of the bowmans capsule
Abnormal glomerulus

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22
Q

How does chronic kidney disease tend to change the gross appearance of the kidneys?

A

Granular appearance
Swollen with loss of cortical striation

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23
Q

What is the difference between glomerulonephritis and glomerulopathy?

A

Glomerulonephritis - glomerular disease with secondary changes to the nephron components
Glomerulopathy - glomerular disease without inflammation

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24
Q

What is the main cause of glomerulonephritis?

A

Glomerular deposition of immune complexes
Causing podocytes to lose foot processes and basement membrane to thicken, increasing permeability

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25
Q

What are the different classifications of glomerulonephritis?

A

Membranous - changes primarily to the basement membrane
Proliferative - cell components proliferate without changing the basement membrane
Membranoproliferative - both

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26
Q

What are the consequences of glomerulonephritis?

A

Proteinuria
Interstitial fibrosis
Reduced nephron function

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27
Q

What does glomerular amyloidosis look like on histology?

A

Pink blobs of amyloid protein inside the glomerulus

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28
Q

What causes glomerular amyloidosis?

A

Chronic inflammatory diseases
Neoplastic diseases

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29
Q

What is suppurative glomerulitis?

A

Bacteraemia - bacteria lodging in glomerular capillaries and interstitial capillaries forming microabscesses

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30
Q

What does suppurative glomerulitis look like on histology?

A

Mass of speckled purple in the glomerulus
Small white foci on cortical surface surrounded by pink hyperaemic area

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31
Q

What are the 3 causes of tubular damage in the kidneys?

A

Nephrotoxins
Ischaemia
Infectious agents

32
Q

What are some examples of nephrotoxins?

A

Drugs - NSAIDs, tetracyclins, aminoglycosides, cisplatin
Antifreeze
Raisins - dogs
Lillies - cats
Haemo/myoglobin

33
Q

What are 4 tubular epithelial cell responses to tubular injury?

A

Atrophy
Degeneration
Necrosis
Regeneration

34
Q

What does acute tubular degeneration and necrosis look like on histology?

A

Very eosinophilic - pink
Loss of nuclear detail
Very swollen

35
Q

What is a functional consequence of tubular injury?

A

Acute decrease in glomerular filtration rate and renal function causing oliguria/anuria - little to no urine production

36
Q

How does myoglobin and haemoglobin affect the kidneys? What does it look like?

A

Haemoglobin - from haemolysis
Myoglobin - from muscle injury
They are nephrotoxins, can stain kidneys dark red-black to blue-black

37
Q

What affects regeneration of tubular epithelial cells?

A

Whether the basement membrane is damaged or not
If not damaged then tubular regeneration of epithelial cells can occur
If damaged then fibrosis and tubular atrophy occurs

38
Q

What is the word for disruption of the tubular basement membrane?

A

Tubulorrhexis

39
Q

What occurs during epithelial regeneration following degeneration and necrosis of tubular epithelial cells?

A

Polyuria - limited reabsorption capacity

40
Q

What does metabolism of ethylene glycol (antifreeze) produce?

A

Nephrotoxic metabolites and oxalate produced from breaking it down in the liver

41
Q

What does oxalate cause in the kidney from metabolism of ethylene glycol (antifreeze)?

A

Tubular obstruction

42
Q

What causes interstitial injury in the kidney?

A

Secondary to injury of other renal components
Infectious agents
Toxins

43
Q

What are some interstitial responses to injury? When do you find them

A

Oedema
Inflammation - acute (neutrophils) or chronic (lymphocytes, macrophages)
Fibrosis - chronic kidney disease

44
Q

What is pyelonephritis?

A

Inflammation of the renal pelvis and the renal tubules/parenchyma (tubulointerstitial nephritis) simultaneously

45
Q

What causes pyelonephritis?

A

Ascending bacteria from a lower UTI

46
Q

What are some predisposing factors for pyelonephritis?

A

Increased pressure in bladder or ureter - reflux of urine

47
Q

What does pyelonephritis look like on gross histology?

A

Renal crest necrosis, hyperaemia
Dilation of renal pelvis
Cortical atrophy

48
Q

What are simple renal cysts?

A

Grossly visible thin walled fluid filled cavities in the kidney parenchyma

49
Q

What can cause simple renal cysts?

A

Congenital/aquired obstructive lesions of the nephrons
Tubular basement membrane abnormalities
Disorders of tubule epithelial cell growth

50
Q

What is polycystic kidney disease?

A

Multiple renal cysts bilaterally on kidneys which grow over time and can cause renal failure

51
Q

What does polycystic kidney disease look like?

A

Purple foci with semitransparent capsular surface

52
Q

What causes polycystic kidney disease? What are predisposed?

A

Heritable condition in some breeds
eg. bull terrier, persian cat
Can be sporadic

53
Q

What are juvenile nephropathies? What do they affect?

A

Variety of familial/hereditary conditions
Cause chronic progressive renal disease in young dogs (between 4-18 months)

54
Q

What are ectopic ureters?

A

When ureters dont empty into trigone of the bladder but instead into another area of the bladder eg. neck, urethra, repro tract

55
Q

What do ectopic ureters predispose to?

A

Urinary incontinance - steady dribble of urine
Ascending infections
Obstructive disease

56
Q

What is a retrocaval/circumcaval ureter?

A

Ureter has an abnormal spiral course around the caudal vena cava that occurs during development

57
Q

What is a consequence of retrocaval/circumcaval ureter?

A

Mostly asymptomatic but is predisposed to obstruction

58
Q

What is cystitis?

A

Urinary bladder inflammation

59
Q

What are predisposing factors for cystitis?

A

Female
Local infections
Obstructive urinary diseases
Diabetes mellitus - glucose in urine

60
Q

What can cystitis be in cats?

A

Sterile - feline interstitial cystitis
From stress causing neurogenic inflammation of the bladder wall

61
Q

What are two different types/appearances of chronic cystitis?

A

Polypoid cystitis - fibrous tissue and chronic inflammatory cells
Follicular cystitis - nodular proliferation of lymphoid tissue, grey white nodules surrounded by red hyperaemic zone

62
Q

What is follicular cystitis often seen alongside?

A

Urolithiasis

63
Q

What are more common - metastatic kidney tumours, or primary kidney tumours?

A

Metastatic are more common
Twice as common as primary in dogs
7 times more common than primary in cats

64
Q

What is the most common type of primary renal neoplasia?

A

Epithelial - carcinoma

65
Q

What is a type of embryonal primary tumour found in the kidney?

A

Nephroblastoma - from residual embryonal cells that would normally differentiate into nephrons

66
Q

What are the consequences of a nephroblastoma?

A

Mostly asymptomatic

67
Q

What is the most common secondary tumour to affect the kidney?

A

Lymphoma

68
Q

What is the most common urinary bladder neoplasia?

A

Urothelial carcinoma (transitional cell carcinoma) - primary tumours are most common in the bladder

69
Q

Where are urothelial carcinomas (transitional cell carcinoma) usually found?

A

Bladder trigone

70
Q

What are the consequences of Urothelial carcinoma (transitional cell carcinoma)?

A

Invasive and often metastasise
Predispose to infection
Can cause haematuria

71
Q

What is the definition of the term renal failure?

A

Failure of the kidneys to be able to carry out their normal excretory, metabolic and/or endocrine functions

72
Q

What is acute kidney injury?

A

Abrupt decrease in kidney function
May be reversible

73
Q

What is chronic kidney disease?

A

Abnormalities of kidney structure and function for a long time (>3 months)
Usually irreversible and often progressive

74
Q

What is azotemia?

A

Biochemical abnormality with elevated blood urea, creatinine

75
Q

What is uraemia?

A

Clinical SYNDROME resulting from impaired kidney function
Often accompanied by multisystemic extrarenal lesions

76
Q

What are the extra-renal lesions/syndromes of uraemia?

A

Ammonia causing caustic injury to oral and gastric epithelium - ulcer formation
Uraemic toxin causing injury to blood vessel endothelium - vasculitis, thrombosis, oedema
Altered calcium/phosphate metabolism - soft tissue mineralisation, secondary hyperparathyroidism, fibrous osteodystrophy
Reduced erythropoietin production - anaemia

CVSOH BVSc4 (86 decks)

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