Veterinary Pathology of the Urinary System 227.301 1st Sem
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| Signs of renal insufficiency occur only after loss of ____? | approximately 1/2 to 2/3 of nephrons
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| Renal failure is evident only after loss of ____? | 75% of nephrons.
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| Nephrons function as a ____. | unit
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| Localised damage to one portion of a nephron eventually leads to ____. | necrosis/failure of the entire nephron
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| The main functions of the kidney include production of ____ (i.e., ____ ), excretion of ____, regulation of ____, maintenance of normal ____, and production of ____. | concentrated urine, conservation of body water, metabolic waste, acid-base status, potassium concentration, regulatory hormones
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| What vitamins and hormones does the kidney produce? | Erythropoietin, renin, and active Vitamin D
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| Renal damage manifests as ____. | uraemia
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| The term uraemia is a term that refers to ____? | the multisystemic signs associated with renal failure
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| Signs of renal failure include ____, ____, metabolic ____, failure to excrete ____ resulting in ____, and decreased production of _____ and ____. | polyuria, polydipsia, acidosis, waste products of protein metabolism, azotaemia, erythropoietin, active Vitamin D
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| Increased urine production due to loss of urine concentrating ability = | polyuria
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| Increased thirst as manifested by increased water intake = | polydipsia
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| Increased levels of urea and creatinine in the blood = | azotaemia
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| Urea is derived from the breakdown of ____. | protein
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| Creatinine is derived from the breakdown of ____. | muscle phosphocreatine
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| Four types of azotaemia (based on where the problem occurs) are ____, ____, ____, and ____. | pre-renal, renal, post-renal, non-renal
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| Azotaemia that occurs in conditions that result in decreased bloodflow to the kidneys. | Pre-renal
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| Azotaemia that occurs with compromised renal function, when at least 75% of nephrons are damaged. | Renal
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| Azotaemia that occurs when there is an obstruction of urinary excretion. | Post-renal
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| Azotaemia that occurs when renal function is normal. | Non-renal
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| The gross lesions of renal disease can be divided into ____ and ____. | renal, non-renal
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| ____ lesions tend to appear in animals with both ____ and ___ renal failure. | Renal, acute, chronic
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| ____ lesions tend to appear only in cases of ____ renal failure. These lesions result from ____, and tend to become more severe with ____. | Non-renal, chronic, uraemia, chronicity
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| List 6 categories of non-renal lesions that may be seen in an animal with chronic renal failure. | BARN-VU: bleeding diathesis, anaemia, renal hyperparathyroidism, nephrotic syndrome, vascular lesions, ulcerative lesions
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| ____ syndrome occurs in a specific group of kidney diseases where the ____ are damaged in such a way that large amounts of ____ (especially ____) are lost into the ____. | Nephrotic, glomeruli, protein, albumin, urine
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| The typical signs of nephrotic syndrome are ____, ____, and ____. These signs are due to ____, ____ due to loss of ____, and ____. | oedema, ascites, pleural effusion, hypoalbuminaemia, thrombosis, antithrombin III, hypercholesterolaemia
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| Complete failure of development of one or both kidneys | Renal aplasia
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| Development of abnormally small kidneys | Renal hypoplasia
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| Abnormal architecture of one or both kidneys | Renal dysplasia
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| Misplaced kidneys | Ectopic kidneys
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| Fused kidneys | "Horseshoe" kidneys
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| Development of cysts within the nephron during nephrogenesis | Congenital cystic kidney disease
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| The components of the glomerulus are the capillary ____ with its ____ lining, the capillary ____, the ____ (made up of mesenchymal cells and matrix), and the ____ epithelial cells (called ____) with their ____ processes (____ processes). | tuft, endothelial, basement membrane, mesangium, visceral, podocytes, cytoplasmic, foot
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| Conditions in which damage to the glomerular filtration mechanism results in leakage of low-molecular weight proteins into the urine are called ____. | protein-losing nephropathies
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| If the ____ barrier is damaged, large amounts of ____ are lost into the urine, resulting in ____ and ____ (which, when severe, causes ____ and ____). These consequences are part of a clinical syndrome known as ____ syndrome. | filtration, albumin, proteinuria, hypoalbuminaemia, oedema, ascites, nephrotic
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| What are the two main types of protein-losing nephropathies? | Immune-mediated glomerulonephritis and glomerular amyloidosis
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| The presence of immune complexes in the glomerular basement membrane is indicative of what protein-losing nephropathy? | Immune-mediated glomerulonephritis
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| The presence of amyoid deposits in the glomerus or medullary interstitium is indicative of what protein-losing nephropathy? | Glomerular amyloidosis
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| In one form of protein-losing nephropathy, the presence of ____ in the ____ results in activation of the ____. This in turn causes attraction of ____ and production of ____ such as ____ and ____, which then damage the ____. | immune complexes, glomerular basement membrane, complement cascade, neutrphils, mediators, proteases, free radicals, glomerular filtration barrier
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| Name and decribe two mechanisms by which immune complexes become embedded in the glomerular basement membrane. | 1. Complexes formed in situ (anti-basement membrane disease) due to targeting of antigens in the membrane; 2. Complexes formed in circulation, then filtered & deposited. Usually idiopathic; may be due to underlying chronic disease w/+++ immune complexes.
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| Describe the gross lesions of chronic immune-mediated glomerulonephritis. | The surface of the kidney may be pitted or granular. On the cut surface there may be atrophy of the cortex and some degree of interstitial fibrosis.
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| Glomerular amyloidosis causes disruption of the ____ mechanism and loss of ____ (especialliy ____) into the urine. When severe, this can result in ____ syndrome. | filtration, protein, albumin, nephrotic
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| When large amounts of ____ are deposited in ____, the blood supply to the ____ nephron can be impeded, resulting in ____ and ____ of the tubules, and later in interstitial ____. | amyloid, glomeruli, distal, atrophy, degeneration, fibrosis
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| Describe the gross lesions seen in glomerular amyloidosis. | The kidneys are enlarged, pale, and waxy. On the cut surface, the cortex may be faintly granular.
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| ____ amyloidosis is the most common form in ____, while ____ amyloidosis is more common in _____. An exception is in ____, where both the _____ and ____ may be involved. | Medullary, cats, glomerular, other species, Abyssinian cats, medulla, glomeruli
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| Deposition of amyloid within the kidney may cause what important syndrome in domestic animals? | Renal amyloidosis
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| What are the 2 most common causes of renal amyloidosis? | 1. Idiopathic; 2. Overproduction of serum amyloid A (SAA)
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| SAA is an ____ protein that is produced in large amounts during ____ diseases. | actue phase, chronic inflammatory
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| Most cases of medullary amyloidosis are ____. | asymptomatic
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| In ____ cases of medullary amyloidosis, the deposition of large amounts of amyloid can cause ____ of the ____, leading to ____ and ____ of the renal ____. | severe, compression, blood supply, ischaemia, necrosis, papilla
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| Bacteria in the blood that lodge in the kidney can cause either ____ or ____, depending on whether they lodge in the ____ or the ____. | glomerulitis, interstitial nephritis, glomeruli, interstitial capillaries
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| Describe the gross lesions of acute glomerulitis. | Red or white spots are seen scattered throughout the cortex.
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| A form of glomerulitis that results in a marked neutrophilic response is called ____ glomerulitis. | suppurative
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| If an animal with suppurative glomerulitis survives longer than a few days, the inflammatory infiltrate will become dominated by ____ cells (____, ____, and ____). | mononuclear, lymphocytes, plasma cells, macrophages
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| The bacterium ____ causes a suppurative glomerulitis in neonatal foals called ____ disease. These foals present with ____, ____, and signs of systemic bacterial infection including ____, hot ____. The route of infection is usually the ____. | Actinobacillus equuli, sleepy foal, pyrexia, lethargy, swollen, joints, umbilicus
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| The cells, matrix, and vessels that lie between the tubules and glomeruli of the kidney | renal interstitium
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| Any inflammatory disease of the kidney that predominantly affects the interstitium | interstitial nephritis
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| Describe the gross lesions of interstitial nephritis. | The kidneys have multiple pale foci of inflammation.
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| Give 4 examples of interstitial nephritis. | 1. Leptospirosis in pigs; 2. E. coli septicaemia in cattle (white spotted kidney disease); 3. malignant catarrhal fever in cattle & deer; 4. granulomatous interstitial nephritis (e.g., FIP in cats)
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| Multifocal pale nodules on the capsular surface of the kidney of a cat suggests that the cat is suffering from either ____ or ____, caused by ____. If the nodules follow the vessels, the disease is likely ___. | lymphosarcoma, granulomatous interstitial nephritis, FIP, FIP
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| Besides FIPV in cats, what organisms can cause granulomatous interstitial nephritis? | Mycobacterium tuberculosis (esp. in cattle), migrating Toxocara canis larvae, fungal organisms (e.g., Aspergillus spp.)
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| A common "end point" for many types of renal disease is ___________. | interstitial fibrosis
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| A common condition affecting aged dogs and cats. Affected animals present with typical signs of uraemia. | Idiopathic chronic renal failure.
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| Describe the gross lesions of chronic renal failure. | The kidneys are small, firm, and pale.
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| Name several renal conditions that may cause Interstitial fibrosis. | Chronic interstitial nephritis, renal infarction, pyelonephritis, idiopathic chronic renal failure
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| What condition often results in wedges of fibrosis at the poles of the kidney? | pyelonephritis
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| What condition results in small, firm, pale kidneys? | chronic renal failure
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| What condition results in kidneys with multiple pale foci of inflammation in the cortex or over the capsular surface of the kidney? | interstitial nephritis (Lepto, E. coli, FIPV, malignant catarrhal fever)
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| What condition results in red or white spots of inflammation scattered throughout the cortex of the kidney? | acute glomerulitis
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| What condition results in a pitted or granular kidney surface, with atrophy of the cortex and some degree of interstitial fibrosis? | immune-mediated glomerulonephritis
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| What are the two general categories of renal tubular diseases? | Necrotising and inflammatory
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| Acute tubular degeneration and necrosis is commonly referred to as ____. | nephrosis
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| What are the two main causes of tubular necrosis? | Ischaemia and toxins
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| The ____ tubules are most prone to tubular necrosis because they have the highest ____. | proximal, metabolic rate
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| Animals with severe tubular damage affecting a large number of nephrons often show signs of ____, particularly ____ or ____. | uraemia, oliguria, anuria
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| Any insult that disrupts the ____ or ____ supply to the kidney can cause ____. | blood, oxygen, ischaemic tubular necrosis
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| Specific causes of ischaemic tubular necrosis include ____ disease (such as ____ toxicity in sheep, ____ in young calves, and ____ in dogs), severe ____ damage with ____ (such as ____ in wild animals), and conditions causing renal ____ (such as ____). | haemolytic, copper, leptospirosis, haemolytic anaemia, muscle, myoglobinuria, capture myopathy, vasoconstrivtion, shock
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| Nephrotoxins that can cause toxic tubular necrosis include: (name at least 4 of 7) | heavy metals, antibiotics, NSAIDs, plant toxins, oxalates, Vitamin D, fungal toxins
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| Inflammation of the renal pelvis and kidney parenchyma is called ____. | pyelonephritis
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| What is the usual cause of pyelonephritis? | An ascending infection originating in the lower uniary tract.
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| Name and describe a mechanism by which an infection of the lower urinary tract can ascend into the kidney. | Ureterovesicular reflux: when the sphincter mechanism between the bladder and ureters is compromised, urine from the bladder can reflux back up the ureters, carrying bacteria into the ureters. From there, the bacteria can reach the kidneys.
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| Name several conditions that predispose to ureterovesicular reflux. | increased pressure in the bladder (e.g., as in urethral obstruction), cystitis, congenital malformation of the sphincter, displacement of the ureter, gram - endotoxin inhibiting normal peristaltic movement of the ureters
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| ____ are more prone to lower urinary tract infections because of the ____ length and comparatively ____ diameter of the female ____. | Females, short, large, urethra
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| Certain strains of ____ are frequently isolated from cases of canine pyelonephritis. These strains express various ___ factors, including an ability to ____ to urinary tract ____. | E. coli, virulence, adhere, epithelium
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| Describe the gross lesions of pyelonephritis. | A dilated pelvis, often containing purulent material. The cortex is often hyperaemic. There may be necrosis of the inner medulla. In chronic cases the cortex and medulla may be atrophied. Interstitial fibrosis may cause wedges of fibrosis at the poles.
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| Dark red, swollen kidneys that ooze blood on the cut surface are called ____. When can this occur? | hyperaemic, in any inflammatory condition involving the kidneys
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| Animals that die in lateral recumbancy may exhibit ____ of the ____ kidney. | hypostatic congestion, down-side
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| What is a common kidney lesion caused by septicaemia? | Petechiae: small haemorrhages over the cortical surface of the kidneys
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| What is a common kidney lesion caused by canine herpes virus? | Both petechiae and slightly larger (echhymotic) hemorrhages
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| What conditions or events might cause a relatively large renal haemorrhage? | trauma, renal biopsy, or coagulopathies
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| What are two conditions that can cause wedges of fibrosis in the kidneys, and how can they be distinguished? | Pyelonephritis and renal infarcts can both cause wedges of fibrosis. In pyelonehpritis, the wedges usually occur at the poles of the kidney.
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| Renal cortical necrosis occurs as a result of ____ ____ to ____ cells. This might occur in cases of ____ or gram ____ ____. | widespread damage, endothelial, DIC, negative septicaemias
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| ____ necrosis (aka ____ necrosis) occurs as a result of ____ affecting the ____. | Papillary, renal medullary, ischaemia, renal medulla
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| The renal ____ has a poor vascular supply, so it is particulary prone to ____ damage when blood flow to the kidney is ____. | medulla, ischaemic, reduced
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| Describe the lesions of papillary necrosis. | Sharply demarcated areas of discolouration within the medulla. Necrotic tissue may slough.
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| Name 4 causes of papillary necrosis. | 1. NSAIDs; 2. increased intra-renal pressue causing compression of vessels; 3. dehydration; 4. shock
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| Haemoglobin in the urine (aka ____) is often assoicated with episodes of ____. | haemoglobinuria, intravascular haemolysis
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| Dilation of the renal pelvis is called ____. | hydronephrosis
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| Hydronephrosis is usually due to an ____ ____ in the ureter or lower unrianry tract, but can also be caused by ____ ____. | aquired obstruction, congenital abnormalities
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| Describe the gross lesions of hydronephrosis. | Kidneys appear enlarged and sometimes cystic on radiograph. The pelvis is dilated. The medulla may be atrophic, with firm parenchyma. In pyonephrosis, the kidney may be a pus-filled sac.
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| ____ refers to inflammation of the pelivs or calyces of the kidney, and is usually part of a more extensive ____. | Pyelitis, pyelonephritis.
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| In dogs, the most common primary renal tumour is ____ ____. | renal adenocarcinoma
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| In cats, the most common renal neoplasm is ____. | lymphoma
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| What is the most common malformation of the urinary bladder, and how does it present? | a patent urachus, which presents as persistent dribbling of urine from the umbilicus.
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| When the urachus fails to completely close, a ____ of the ___ may develop. ____ of urine within the ____ predisposes to ____ and formation of ____. | diverticulum, bladder, stasis, diverticulum, bacterial infection, urinary calculi
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| Name two events that commonly cause rupture of the urinary bladder. | 1. urethral obstruction in small animals; 2. partruition in foals
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| Aggregates of crystalline material that form within the urinary tract are called ____. | uroliths
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| Larger uroliths are called ___ or ___ while smaller ones are called ____. | calculi, stones, crystals
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| List some predisposing factors for urolithiasis. | Urinary stasis, dehydration, UTI, supersaturation of urine with specific minerals, urinary pH
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| Why are males predisposed to urinary tract obstruction? | because they have a long, thin urethra that is easily blocked
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| In the past, urolithiasis in cats predominantly was caused by ____ crystals, which are made up of ____. In recent years, the incidence of urolithiasis due to these crystals has been much reduced, due to the development of special ____. | struvite, magnesium ammonium phosphate, diets
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| Now, almost ____ of the cases of feline urolithiasis are caused by ____ crystals instead of struvite crystals. | half, calcium phosphate
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| In dogs with urolithiasis, about ____ of crystals are made of ___. Most of these cases are associated with ____ caused by bacteria that produce ____, which can change the urine pH, making ____ of crystals more likely. | half, struvite, UTIs, ureases, precipitation
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| Approximately ___% of dogs with urolithiasis have calcium ____ uroliths. Another ____% are due to calcium ____, urates, ____, or ____. | 30, oxalate, 20, phosphate, silica, cystine
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| Which are more prone to urolithiasis, male or female dogs? | female
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| List some factors that may increase the incidence of urolithiasis in sheep. | Feeding sheep on concentrated diets, hay, or pastures containing high concentrations of phosphates, oestrogens(e.g., subterranean clover), or oxalates (e.g., brassicas, sorrel, dock)
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| Crystalluria is normal in what species? | horses and rabbits
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| Horses have high urinary concentrations of what substance? | calcium carbonate
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| Rabbits have high urinary concentrations of what substance(s)? | calcium carbonate and struvite (magnesium ammonium phosphate)
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| List the clinical signs resulting from non-obstructive urolithiasis. | dysuria, straguria, haematuria, pollakuria, behavioural changes
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| List the clinical signs resulting from obstructive urolithiasis. | uraemia, shock, death, plus all sign associated with non-obstructive cases (dysuria, straguria, haematuria, pollakuria, behavioural changes)
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| What does FLUTD stand for, and what does it refer to? | Feline Lower Urinary Tract Disease: a clinical descriptive term that covers a variety of disease entities in cats that present with signs of lower urinary tract involvement (e.g., dysuria, straguria, haematuria, inappropriate urination, etc.)
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| What factors predispose a cat to FLUTD? | Overweight, middle-aged, inactive, indoor neuteredmale cats are predisposed to FLUTD
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| The incidence of FLUTD in cat populations in the US and UK varies from __ to __% | 1 to 6%
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| The majority of FLUTD cases are ____. Specific causes include ____, ____, and ____. | idiopathic, bladder infections, urolithiasis, neoplasia
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| FLUTD can be separated into ____ and ____ forms. | obstructive, non-obstructive
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| Obstructive FLUTD is usually due to either ____ or ____. | urethral plugs, uroliths
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| Urethral plugs are composed of varying proportions of ____ ____ material and ____ material. The ____ material is belived to be derived from a ____ that leaks out of an inflammed ____ ____. | proteinaceous matrix, crystalline, matrix, protein, bladder wall.
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| The most common presenting signs of obstructive FLUTD are ____ and ____. Owners often misinterpret this as ____, which is far less common than FLUTD. | stranguria, vocalization, constipation
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| Cases of suspected urinary tract obstruction should be treated as ____, because if not treated quickyly, ____ ____ ____, ____, or ____ ____ could result. | emergencies, acute renal failure, shock, bladder rupture
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| ____ and ___ FLUTD cannot be distinguished without a ____ ____, because the presenting signs are very similar. | Obstructive, non-obstructive, clinical examination
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| Cats with non-obstructiev FLUTD often have a history of relapsing ____ and ____, and typically have bouts of clinical signs lasting ___ days, with each bout ____ ____. | haematuria, dysuria, 5-10, resolving spontaneously
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| Another name for idiopathic, non-obstructive FLUTD is ____ ____ ____ or ____ ____ ____.. | feline interstitial cystitis, feline urological syndrome
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| Bacteria that are particulary well-suited for colonisation of the urinary tract are called ____. | uropathogens
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| Conditions that predispose to bacterial cystitis include ____, ____, urine ____, ____ urine, and changes in urine ____. | trauma, glucosuria, stasis, dilute, pH
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| Non-bacterial causes of cystitis include ____ agents, natural ____, ____, and ____ ____ ____. | chemical, toxins, urolithiasis, feline interstitial cystitis
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| list the signs of cystitis | frequent and painful urination, haematuria, and incontinence
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| Prolonged grazing on bracken fern can cause ____ cystitis (aka ____ ____) in cattle, ____ tumours, ____ suppression, and ____ deficiencies. | haemorrhagic, enzootic haematuria, bladder, bone marrow, vitamin B1
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