Urinary System Pathology Flashcards Preview

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Flashcards in Urinary System Pathology Deck (170):
1

Renal Parenchyma is divided into

Cortex

Medulla

Pelvis

2

Descirbe the flow through the kidney

Renal papilla → renal calices → renal pelvis → ureters

3

Describe the cat kidney

Prominant Vascular Pattern

Unipyramidal

4

Describe the pig kidney

Multipyramidal 

No External Lobulation

5

Describe the bovine kidney

Multipyramidal

External Lobulation

6

Describe the dog kidney

Unipyramidal

7

Structure of gomerulus

Filtering mechanism

8

Structure of tubules

Selective reabsorption

9

Functions of the kidney

Regulation of fluid and electrolyte content

Endocrine function - renin and erythropoietin

10

Developmental abnormalities of the kidney

Renal aplasia

Renal hypoplasia

Renal dysplasia

Renal cysts

Polycystic kidney

Ectopic kidney

Fetal lobulation and fusion

11

Renal Aplasia

Absence of development of a kidney - can be unilateral or bilateral

12

Renal Hypoplasia

Quantitative defect caused by reduced mass of metanephric blastema - reduced in size but otherwise normal architecture

13

Renal hypoplasia is characterized by

Reduced number of histologically normal lobules and calyces

14

Differential diagnosis of renal hypoplasia

Renal dysplasia

 

15

Renal Dysplasia

Abnormal and asynchronous differentiation of renal tissue

16

Causes of renal dysplasia

Congenital infections (Feline Panleukopenia, Canine Herpes Virus, BVD)

Autosomal Dominance

Hypovitaminosis 

Intrauterine ureteral obstruction

17

Renal Cysts

Common congenital malformation

Variably sized, filled with fluid and lined by flat or cuboidal epithelium

18

Polycystic Kidneys

Numerous variably sized cysts in both cortex and medulla, filled with colorless fluid

"Honeycomb" appearance

19

Causes of polycystic kidneys

Congenital Causes

Inherited Causes

20

Consequences of renal cysts

May grow slowly or remain static

May increase in size/number causing compression atrophy

21

Differential diagnosis for Polycystic kidneys

Acquired Cysts - obstructed tubules in chronic renal disease

22

Ectopic Kidneys

Normal kidneys in abnormal locations

23

Ectopic kidneys are predisposing factors for 

Ureter obstruction and development of hydronephrosis

24

Retained Fetal Lobulation and Fusion

"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