Term
|
Definition
presents with anuria/oligura
rapid decrease in renal function over a short period of time
kidney is pale and swollen
PRERENAL: ischemia
RENAL: infectious, toxin
POSTRENAL: obstruction
death due to hyperkalemia, metabolic acidosis, pulmonary edema |
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Term
|
Definition
a decline in renal function over time, and the replacement of function nephrons with fibrosis makes chronic renal failure irreversible
presents with PU/PD, dehydration, vomiting, diarrhea, melena |
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Term
|
Definition
the increase in the blood of nitrogenous waste products (urea and creatinine) that the kidney would normally help get rid of when making urine
increased serum BUN and creatinine
may not be due to renal disease |
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Term
|
Definition
| dehydration—with decreased perfusion of the kidneys, they can’t remove the wastes |
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Term
|
Definition
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Term
|
Definition
multisystemic lesions due to retention of the nitrogenous waste products
Uremic animals are also azotemic |
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Term
| Causes of Acute Renal Failure |
|
Definition
PRERENAL: Renal ischemia (e.g. shock)
RENAL: Tubular necrosis from infectious agents (e.g. Leptospira)
RENAL: Tubular necrosis from nephrotoxic drugs (e.g. aminoglycosides)
RENAL: Tubular necrosis from chemicals (e.g. ethylene glycol)
POSTRENAL: Obstructive nephropathy (e.g. urolithiasis) |
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Term
| Sequelae of Acute Renal Failure |
|
Definition
death due to:
retention of K+ (bad for the heart)
metabolic acidosis (the kidney’s inability to resorb bicarbonate and secrete protons)
pulmonary edema (due to overhydration with fluid therapy—the kidney can’t regulate water balance) |
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Term
| Sequelae of Chronic Renal Failure |
|
Definition
Production of erythropoietin is reduced, leading to a nonregenerative anemia
Hyperphosphatemia occurs as a result of poor secretion by the kidneys as glomerular filtration rate is reduced
Hyperphosphatemia leads to renal secondary hyperparathyroidism |
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Term
|
Definition
lumpy, bumpy, and shrunken
kidneys seen on gross examination that is small and pitted due to scarring and permanent loss of nephrons from chronic renal failure
have 2/3 loss of nephrons to clinically see issues with urine concentration on a urine specific gravity and you must have ¾ loss of nephrons to result in azotemia
replacement of the functional tissue with fibrosis and lymphocytes and plasma cells scattered throughout
glomerulosclerosis (scarring of glomeruli) and scattered hyaline casts due to protein loss |
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Term
| Causes of End Stage Renal |
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Definition
| glomerular disease, tubular disease, vascular disease, interstitial nephritis, or pyelonephritis |
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Term
| Clinical Signs of Renal Failure |
|
Definition
Azotemia, Uremia
Acidosis
Dehydration
Hyperkalemia (can cause fatal arrhythmias)
Hyperphosphatemia leading to hyperparathyroidism and contributing to soft tissue mineralization
Severely diseased kidneys have reduced capacity to convert vitamin D contributing to hyperparathyroidism
Moderate nonregenerative anemia
Glomerular disease results in proteinuria and if severe or prolonged the nephrotic syndrome may develop |
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Term
|
Definition
Filtering plasma and excreting wastes such as urea and other toxins
Acid base regulation by reclaiming bicarbonate from the filtrate
Conserves water by reabsorbing up to 99% of the water from the glomerular filtrate
Potassium concentration is maintained through secretion in the distal tubules
Major excretory route for phosphorus
Converts vitamin D to its active form
Produce erythropoietin
Filtration barrier in the glomerulus keeps proteins from escaping into the urine |
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Term
|
Definition
Large amounts of protein in the urine are GLOMERULAR disease
1-3 is consistent with tubular disease
>5 glomerular disease |
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Term
|
Definition
an indicator for diabetes mellitus
emphysematous cystitis- bacteria metabolize the glucose and produce carbon dioxide, forming bubbles in the mucosa |
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Term
|
Definition
| the absence of urine excretion |
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Term
|
Definition
| reduction in the amount of urine excreted |
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Term
|
Definition
| the passage of abnormally large amounts of urine |
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Term
|
Definition
| increased frequency of urination (the amount may be normal) |
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Term
|
Definition
| painful or difficult urination |
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Term
|
Definition
| the slow and painful discharge of urine due to spasm of the urethra or bladder |
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Term
|
Definition
| the presence of crystals in the urine |
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Term
|
Definition
| neutrophils in the urine (seen on sediment or as pus in the urine) |
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Term
|
Definition
| the presence of hemoglobin in the urine (due to conditions that cause erythrocyte lysis) |
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Term
|
Definition
| the presence of myoglobin in the urine (due to excessive muscle damage) |
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Term
|
Definition
| the presence of red blood cells in the urine |
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Term
| Nonrenal Lesions in Uremia |
|
Definition
Endothelial cells in vessels are damaged by uremic toxins --> degeneration and necrosis of endothelium--> vasculitis--> thrombosis--> infarction
Urea in oral cavity saliva or stomach gastric fluid is split to ammonia by bacteria --> caustic damage to epithelium in the oral cavity and stomach --> ulceration |
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Term
|
Definition
systemic nonrenal lesion of renal failure
cats/dogs-direct epithelial damage due to ammonia and necrosis of vessels are suspected to play a role in the development of the gastric ulceration and hemorrhage
cattle/horses-similar lesion can develop in the colon |
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Term
| Ulcerative stomatitis and glossitis |
|
Definition
systemic nonrenal lesion of renal failure
bilateral ulceration of the ventral surface of the tongue
Ischemic necrosis of the tip of the tongue can also occur due to vascular damage, thrombosis, and subsequent infarction |
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Term
| Urine Specific Gravity in Species |
|
Definition
Large animal >1.025
Dog >1.030
Cat >1.035 |
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Term
| Soft tissue mineralization |
|
Definition
systemic nonrenal lesion of renal failure
mineralization of Thoracic pleura-intercostal areas (uremic frosting), Epicardium,Atrial endocardium, Alveolar walls in the lung
metastatic mineralization, mineral deposits form due to excess calcium and phosphorus circulating in the blood that combine and deposit in the tissues due to inability to excrete P normally
Dystrophic mineralization occurs secondarily in tissues that are damaged and necrotic due to damage from uremic toxins |
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Term
|
Definition
occurs in renal failure because the kidney is the major excretory route for excess phosphorus
retention of phosphorus, serum calcium becomes lowered, resulting in hyperplasia and hypertrophy of the parathyroid gland
cause increased bone resorption leading to fibrous osteodystrophy
lack of Vitamin D conversion to the active form |
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Term
| Reason for Easy Renal Infarcts |
|
Definition
There are few anastomoses of renal blood vessels (each vessel is therefore critical for tissue nourishment)
A primary function of the kidney is blood filtration (thus it is continually exposed to emboli) |
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Term
|
Definition
| hemorrhagic or pale (necrosis) and are swollen, so they bulge beyond the renal capsule |
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Term
| Peracute Infarcts of Kidney |
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Definition
| the necrotic wedge of infarct becomes surrounded by a rim of red (inflammation) |
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Term
| Chronic Infarcts of Kidney |
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Definition
| As fibrosis starts to occur, the infarct becomes contracted and shrunken, so the chronic infarct appears as a divot in the kidney |
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Term
|
Definition
Endothelial lined capillaries that are fenestrated and sit on a basement membrane
Epithelial cells that cover the outside of the capillaries (podocytes)
Mesangial cells and the mesangial matrix
These 3 components that make up the glomerulus are surrounded by a space (Bowman’s space AKA the urinary space) that is made by Bowman’s capsule surrounding the glomerulus |
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Term
| Selective Filtration of Glomerulus |
|
Definition
SIZE of the molecule in circulation
CHARGE of the molecule (endothelium, basement membranes, and podocytes all are negatively charged so they repel negatively charged molecules—conveniently, proteins) |
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Term
| Mesangial Cell Function (4) |
|
Definition
Mesangial cells can contract resulting in changing the capillary perfusion
also phagocytic and help turn over basement membrane and phagocytize immune complexes that get trapped in the glomerulus
Mesangial cells make the matrix that holds the glomerulus together
mesangial cells also make cytokines that play a role in inflammatory diseases of the glomerulus |
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Term
| Sequelae of Glomeruls Disease |
|
Definition
protein losing nephropathy
nephrotic syndrome (occurs especially in cases of renal glomerular amyloidosis)
renal failure
procoagulant states (loss of antithrombin III) |
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Term
|
Definition
Proteinuria (disruption of glomerular filtration barrier is causing leakage into the urine)
Hypoproteinemia (protein lost in the urine)
Edema (decreased oncotic pressure from hypoproteinemia)
Hypercholesterolemia (alteration of cholesterol metabolism-mechanism unknown) |
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Term
| Glomerular Disease Diagnosis |
|
Definition
difficult to recognize grossly in the kidney
may see pinpoint tan/white cortical dots with glomerular disease, giving the cortex a granular appearance
can use transmission electron microscopy
see effacement of the podocyte foot processes secondary to the immune mediated damage
TEM tells you where deposits are
Trichrome, PAS, H&E stains tell you the difference between membranous glomerulonephritis and membranoproliferative glomerulonephritis |
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Term
|
Definition
| inflammation affecting ONLY the glomerulus |
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Term
| Tubulointerstitial nephritis |
|
Definition
| inflammation is affecting the renal tubules and interstitium |
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Term
|
Definition
glomeruli are filled with inflammatory cells, typically neutrophils (usually due to an embolic bacterial process that lodges in the glomeruli, AKA embolic glomerulitis or purulent glomerulitis)
Actinobacillus equuli in horses |
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Term
|
Definition
| an immune mediated group of diseases that affect the glomerulus |
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Term
| Membranous glomerulonephritis |
|
Definition
seen in cats/dogs
thickening of the glomerular basement membrane due to immune mediated mechanism
Subepithelial deposits |
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|
Term
| Proliferative glomerulonephritis |
|
Definition
seen in horses/pigs
an increase in the number of mesangial cells and matrix due to an immune mediated mechanism
Subepithelial and Subendothelial |
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Term
|
Definition
the glomerulus is shrunken and hyalinized because the capillary tuft is lost and there is only fibrosis and increased mesangial matrix left
an end-stage lesion for the glomerulus, you can’t tell what caused it |
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|
Term
| Membranous glomerulonephritis, membranoproliferative glomerulonephritis, and proliferative glomerulonephritis Pathogenesis |
|
Definition
Preformed antigen-antibody complexes (circulating) become trapped in the glomerulus - more common
Antibodies complex with an antigen present already in the glomerulus (complex formation in situ)
After the antigen-antibody complexes form, they fix complement which calls in neutrophils
Neutrophils damage basement membrane and podocyte foot processes
Disrupts filtration barrier allowing proteins to escape |
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Term
| Subendothelial Ag-Ab deposits |
|
Definition
more likely to fix complement
more severe glomerular injury
predominant region affected in cases of membranoproliferative glomerulonephritis in cats/dogs
proliferation of the mesangial cells and mesangial matrix
Glomerulus looks thick and hypercellular |
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|
Term
| Subepithelial Ag-Ab deposits |
|
Definition
predominant region affected in cases of membranous glomerulonephritis
induce thickening of the basement membrane and make the glomerular capillaries have a thick wall microscopically
confirm with PAS= pink bands of spikes
Trichrome stain= magenta bands of spikes |
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|
Term
|
Definition
a protein that can be deposited extracellularly in tissues throughout the body that can lead to dysfunction of that organ due to accumulation
Organs appear enlarged, pale, and waxy
Microscopically - eosinophilic, homogenous, hyaline substance
Congo Red stain confirms
Chronic inflammation --> Serum amyloid A (SAA) --> enzyme cleaves to amyloid A (AA)--> deposition |
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|
Term
|
Definition
In the glomerulus, medullary and papillary interstitium
glomerulus is the typical place for amyloid to deposit
amyloid deposition in interstitium is genetic problem
proteinuria is NOT found in interstitial deposition of amy |
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|
Term
| Systemic Reactive Amyloidosis |
|
Definition
| Chronic inflammatory disease--> acute phase reactant serum amyloid A (SAA) production in the liver--> cleavage by enzymes and amyloid A (AA) fibril formation--> deposition of AA and Protein P in organs |
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|
Term
| Other Conditions that Cause Amyloidosis |
|
Definition
| multiple myeloma, plasma cell tumors, and hereditary conditions |
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Term
|
Definition
located in ascending loop and first portion of the distal tubule
lines these tubules to prevent water loss to the interstitium |
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Term
|
Definition
proteinuria
hypoproteinemia
edema
hypercholesterolemia |
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Term
|
Definition
brightly eosinophilic, homogenous material that fills the lumen of the distal tubules
When there is protein loss through the glomeruli from glomerular disease or through the tubules due to lack of resorption from injury, Tamm Horsfall protein precipitates forming casts |
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Term
|
Definition
most important cause of acute renal failure
an indicator of protein leakage in the kidney into the filtrate
the tubular ultrafiltrate leaks back into the interstitium across the necrotic tubular epithelium and disrupted basemement membrane, so less is getting excreted
The necrotic tubular epithelial cells can plug up the tubular lumens, leading to obstruction, so no urine gets excreted
due to toxin/ischemia |
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Term
|
Definition
an indicator of tubular necrosis
look granular visually because they are made up of sloughed epithelial cells that have been broken down that are stuck together with protein (Tamm-Horsfall protein or serum) |
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Term
|
Definition
necrosis of the renal tubular epithelium with retention of the basement membrane
is reversible and tubules can regenerate
can do temporary dialysis |
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Term
| Ischemic Tubular Necrosis |
|
Definition
results in tubular epithelial necrosis AND rupture of the basement membrane
is irreversible and leads to fibrosis and loss off function
progresses to end stage renal
due to dehydration/hypovolemia, shock, acute hemolysis (IMHA), vascular obstruction, myoglobin, hemoglobin |
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Term
|
Definition
kidneys are very susceptible to toxic damage
high amount of cardiac output that the kidneys receive
the concentrating mechanisms of the kidney can concentrate the toxins to high levels there
Dehydration makes it much worse |
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|
Term
| Ethylene Glycol Toxicity Pathogenesis |
|
Definition
| Ethylene glycol serum hyperosmolality and metabolic acidosis (remember the ―E‖ in KULE) ataxia, depression, seizures (early after ingestion, 3-12 hours)--> metabolization by the liver to glycolate and oxalate--> oxalate combines with calcium in the blood--> precipitation of calcium oxalate (monohydrate and dihydrate) crystals in the renal tubules (no earlier than 3 hours after ingestion)--> blockage of tubules and tubular epithelial damage (later after ingestion, 24-72 hours)--> anuria, renal azotemia-->acute renal failure |
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|
Term
| Ethylene Glycol Toxicity Diangosis |
|
Definition
scrape the cut surface of the kidney with the edge of a scalpel blade
smear this material on a glass slide
If you see numerous crystals present, it is supportive of ethylene glycol toxicity |
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|
Term
| Melamine/cyanuric acid toxicosis |
|
Definition
similar mechanism of acute renal failure as ethylene glycol toxicity
necrosis of renal tubules
(specifically the distal tubule) and presence of intratubular crystals
crystals in melamine toxicity have a different microscopic appearance
need to send to pathologist to analyze |
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|
Term
|
Definition
due to hemoglobin/myoglobin
dark red streaks in kdiney
or blue/black diffuse color in cortex and medulla
red-orange to red-brown casts within the tubular lumens |
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Term
| Causes of Glomerulonephritis |
|
Definition
Lyme disease in dogs
Heartworm
FIP
Streptococcus in horses
Systemic lupud
IMHA |
|
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Term
|
Definition
necrosis that is isolated to the papillae
tan or brown color of the papillae
observed in horses with NSAID toxicosis
often an incidental lesion found at necropsy |
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|
Term
| Sequelae of Renal Papillary Necrosis |
|
Definition
necrotic papillary tissue may slough and mineralize, forming calculi that can cause kidney stones or result in ureteral obstruction
loss of the papillae can be a loss of protective barrier to ascending bacteria, and infection can occur resulting in pyelonephritis |
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Term
| Causes of Renal Papillary Necrosis |
|
Definition
| renal medullary amyloidosis leading to ischemia |
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Term
| NSAID Toxicosis Pathogenesis |
|
Definition
| NSAID toxicosis--> inhibition of COX 1 and COX 2--> inhibition of prostacyclin vasodilator activity--> renal vasculature vasoconstriction--> renal papillary ischemia-->renal papillary necrosis |
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Term
|
Definition
inflammation that involves the renal pelvis
due to ascending bacterial infections
can continue to affect the rest of the kidney
renal crest and medulla are necrotic with hemorrhage and inflammation (white) that radiates up into the cortex
pelvis and calyces are also often dilated
E. coli, Staphylococcus sp., Enterobacter sp., Proteus sp. and Pseudomonas sp |
|
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Term
|
Definition
white pinpoint spots in the cortex, since the glomeruli are filled with bacteria and neutrophils
due to blood borne bacteria |
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|
Term
| Causes of Embolic Nephritis |
|
Definition
Actinobacillus equuli in foals, Erysipelothrix rhusiopathiae in pigs, and Arcanobacterium pyogenes in adult cows
hematogenous in origin |
|
|
Term
| Causes of Tubulointerstitial Nephritis |
|
Definition
infections
hematogenous in origin |
|
|
Term
| Canine Leptospirosis Pathogenesis |
|
Definition
bacterial induced tubulointerstitial nephritis
Leptospiremia--> localization to the renal interstitial capillaries--> migration to renal tubules--> migration to tubular lumen and association with tubular epithelial microvilli--> necrosis and degeneration of renal epithelial tubules and neutrophils infiltrate in tubular lumens--> progression to chronicity-->lymphocytes and plasma cells infiltrate interstitium |
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Term
|
Definition
common lesion in calves that is most likely the result of a bacteremia
E.coli
little clinical significance
chronic/healing lesion consisting of collections of lymphocytes, plasma cells, and macrophages with some fibrosis
lesions resolved as adult |
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|
Term
| Pyelonephritis Predisposing Factors |
|
Definition
Urinary stasis can occur with many conditions including pregnancy, urolithiasis, and prostatic hyperplasia
Vesicoureteral reflux is when there is retrograde flow of urine from the bladder into the ureters that can occur when there is micturition or manual expression of the bladder
bacterial cystitis assists in providing a nice load of bacteria to reflux into the ureters |
|
|
Term
| Bovine Pyelonephritis Etiology |
|
Definition
Corynebacterium renale
thought to be carried by some cattle as it can be isolated from some normal cows |
|
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Term
|
Definition
due to agenesis/damage to one kidney
other kidney hypertrophies to compensate
nephrons do NOT increase in number, they increase in size due to hyperplasia of the cells within the renal tubules
the glomerulus can enlarge and the afferent arteriole can dilate to increase GFR |
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Term
|
Definition
rare condition
small kidneys in young animals |
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|
Term
|
Definition
Hypoplasia
progressive juvenile nephropathy
fibrosis
renal dysplasia |
|
|
Term
| Progressive juvenile nephropathy, Fibrosis, or renal dysplasia |
|
Definition
| kidneys are small, mishappen and pitted due to fibrosis |
|
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Term
|
Definition
often incidental findings at necropsy
develop secondary to fibrosis or tubular obstruction that leads to tubular dilation |
|
|
Term
| Progressive juvenile nephropathy |
|
Definition
| the development of severe bilateral renal fibrosis in dogs 4 months to 2 years old. |
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Term
|
Definition
inherited in some animals
numerous cysts all through the renal parenchyma
enlarge and compromise renal function
look like Swiss cheese grossly from all the holey cysts
possibly due to either obstruction of a nephron with subsequent dilation, defective tubular basement membranes that allow for tubular dilation, or focal tubular epithelial hyperplasia with production of new basement membrane that results in an enlarged, dilated tubule |
|
|
Term
|
Definition
most common out of renal tumors
frequently in older dogs |
|
|
Term
|
Definition
in cats and cattle can metastasize to kidney
lymphoma in the cat can be very difficult to tell from the dry form of feline infectious peritonitis in the kidney |
|
|
Term
| Renal cystadenocarcinoma. |
|
Definition
bilateral multifocal tumors that are hereditary
Nodular dermatofibrosis (proliferation of fibrous tissue in the dermis in multiple locations of the skin) is associated with this condition |
|
|
Term
|
Definition
occur in young animals, most often pigs and chickens, but also in cattle and dogs
unilateral, and they are composed of primitive tubules and glomerul
embyronal tissue origin
can metastasize |
|
|
Term
|
Definition
form an initial nidus (crystal, protein, exfoliated cells, bacteria, leukocytes)
Mineral salts are deposited on nidus |
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|
Term
| Predisposing Factors for Urinary Calculi |
|
Definition
renal papillary necrosis, cystitis, liver failure, dehydration, diet, and urine pH
inherited problem with metabolism of a substance (such as uric acid in Dalmations)
dogs with portosystemic shunts can develop ammonium biurate crystals in the urine due to high levels of circulating ammonia that are then excreted by the kidney
Dachshunds, Basset hounds, and Welsh corgis have a high incidence of cystine calculi due to defective resorption of cystine in the kidney |
|
|
Term
|
Definition
due to complete blockage of urine excretion
Males typically have a higher incidence of urethral obstruction from calculi because their urethras are more long and narrow |
|
|
Term
| Urethral Obstruction Sites in Different Species |
|
Definition
Steers/bulls=Sigmoid flexure
Rams/bucks=Urethral process
Male cats=Anywhere along the urethra
Dogs=Proximal to the os penis |
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|
Term
| Feline Lower Urinary Tract Disease/Feline Urologic Syndrome |
|
Definition
cause not clear
Blockage in these cats is typically due to protein plugs
Leads to obstruction
Causes rupture of urinary structures, hydronephrosis |
|
|
Term
|
Definition
happen in male foals due to parturition
Compressive forces on a male foal’s full bladder can cause rupture because the penis/urethra are also being compressed
Dorsal surface will rupture because it is the weakest |
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Term
|
Definition
occurs with obstruction
back pressure can cause atrophy of the renal parenchyma, and the pelvis then appears dilated |
|
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Term
|
Definition
can be due to blockage
with the back pressure that occurs, the ureter can become dilated |
|
|
Term
| Bacterial Cystis Predisposing Factors |
|
Definition
female urinary tract anatomy of a shorter urethra and closer anus
stagnant urine, mucosal trauma, glucosuria |
|
|
Term
|
Definition
In cases of cystitis with glucosuria
the bacteria degrade the glucose and produce gas |
|
|
Term
| Corynebacterium renale in cattle |
|
Definition
causes cystis without any predisposing factors
produces urease to break down urea and produce ammonia
ammonia injures the bladder epithelium and allows for bacterial colonization |
|
|
Term
|
Definition
chronic cystitis
many white, raised, mucosal nodules that are surrounded by a red rim on the bladder
white areas are collections of lymphocytes |
|
|
Term
|
Definition
chronic cystitis
polypoid proliferations from the bladder mucosa |
|
|
Term
|
Definition
Blister beetle ingestion
chemical cystitis because the cantharidin gets concentrated in the kidney
damages mucosal surfaces
affects esophagus, stomach, intestine, mycocardium |
|
|
Term
|
Definition
most common bladder malformation
connection between the apex of the bladder and the umbilicus is still open
predisposes animal to bacterial cystitis from ascending infections and abscess formation |
|
|
Term
|
Definition
common cause of urinary incontinence in young female dogs
ureter is connected to
the urethra, vagina, neck of the bladder, vas deferens, prostate, or vesicular gland
more prone to obstruction
increased incidence of pyelonephritis |
|
|
Term
|
Definition
Bladder diverticula are outpouches of the bladder that can be acquired or congenital
often found at the apex of the bladder
urine stasis in the diverticulum
can predispose to cystitis and calculi |
|
|
Term
| Transitional cell carcinoma |
|
Definition
malignant tumors of the bladder mucosal pithelium—transitional cell epithelium
most often in the trigone area
cause dysuria, hematuria, and obstruction
common than the benign form of bladder epithelial tumors
Taking aspirates of a bladder with transitional cell carcinoma percutaneously can lead to seeding of the needle tract with neoplastic cells
most common bladder tumor |
|
|
Term
| Chronic Bracken Fern Ingestion |
|
Definition
causes enzootic hematuria
Cattle that eat this plant begin to develop a hemorrhagic cystitis
quercetin is a carcinogen which induces epithelial, mesenchymal, or mixed tumors in the bladder |
|
|
Term
| Acute Bracken Fern Ingestion |
|
Definition
Acute ingestion of large amounts of bracken fern does NOT cause tumors
causes bone marrow suppression
thrombocytopenia, hemorrhage |
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|
