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52 Cards in this Set

  • Front
  • Back
What are the 3 R's of the renal system?
redundancy: 2 kidneys

reserve: only need 1/4 - 1/3 of total renal mass to survive

regeneration: tubules (great) vs. glomerulus (none)
What is the most common sign of glomerular dysfunction?
What are the primary functions of the kidney?
excrete nitrogenous & other metabolic wastes: BUN, creatinine, ammonia, P, K

conserve body water, electrolytes (Na, Cl, Ca), AAs, proteins, glucose

regulate pH: conserve HCO3-, excrete H+, NH3+

a. located of receptors
b. effect
c. where produced
a. collecting tubules
b. reabsorption of H2O
c. produced by hypothalamus, stored in pituitary

a. located of receptors
b. effect
c. where produced
a. tubules responsible for Ca-P homeostasis
b. reabsorption of Ca, excretion of P
c. parathyroid glands

a. located of receptors
b. effect
c. where produced
a. tubules
b. reabsorption of Na, excretion of K
c. adrenal glands
What are the 4 disorders that make up the nephrotic syndrome?
proteinuria, hypoproteinemia, edema, hypercholesterolemia
What are some non-renal lesions that are associated w/ uremia?
vasculitis: more characteristic of ACUTE uremia (lesions: petechiae, ecchymosis, GI hemorrhage, edema, ascites, necrosis of tip of tongue, oral ulcers)

edema: primarily in dog & cat

hemorrhagic, ulcerative lesions in GI tract
parathyroid hyperplasia & hypertrophy: chronic
renal osteodystrophy (rubber jaw): chronic
pulmonary thrombosis
anemia: mild to moderate nonregenerative (chronic)
familial progressive renal dystrophy

a. signalment
b. lesions
a. dogs (Lhasa Apso, Shih Tzu, Cockers, Norwegian Elkhounds, Dobermans, Samoyeds, etc.); common
-CRF, chronic lesions, despite young age
-kidneys normal at birth
-kidneys undergo severe fibrosis & atrophy, often at a young age
-may be hypercalcemic (rather than usual hypocalcemia assoc. w/ renal failure)
What is the pathogenesis of congenital renal cysts?
failure of mesonephros (collecting part) to fuse w/ metanephros (secretory part) --> blind ended tubule that fills w/ fluid

may be simple or polycystic
What is the pathogenesis of acquired renal cysts?
some physical structure (ex. calculus, chronic inflammation, scar tissue) obstructs tubules --> tubules proximal to obstruction dilate & become cystic
What are the gross lesions of hydronephrosis?
hydroureter, symmetrical dilation of pelvis on cut surface, bilaterally symmetrical (if obstruction is distal enough)

can see calices & interstitium: shouldn’t be able to see
What is the pathogenesis of ascites d/t glomerular dz?
↑ permeability of filter --> protein leakage --> proteinuria --> hypoproteinemia --> ↓ colloidal osmotic pressure --> edema, ascites
What are the 2 mechanisms of glomerulonephritis?
immune mediated
What is the pathogenesis of immune mediated glomerulonephritis?
-immune complexes (ICs) in circulation trapped in walls of small caps in glomeruli, eyes, synovium
-ICs --> chemotaxis of WBCs & activation of inflammatory cascades
-Igs deposited (positively charged) --> BM thickens & becomes more permeable --> area loses net negative charge --> loss of filtering function
-net negative charge normally contributes large part to functional barrier of glomerulus to circulating anions like albumin
-Abs directed against these Ags form ICs: heartworm dz, FelV, pyometra, endocarditis, SLE, Ehrlichia canis, etc. (most cases: IDIOPATHIC)

-anti-GM: Abs against glomerular basement mem (rare)
What is the pathogenesis of embolic glomerulonephritis?
septicemia --> bacteria lodge in glomeruli & interstitial caps & expand to adj. parenchyma

-sources of sepsis: endocarditis, umbilicus (neonates: FPT), Actinobacillosis (foals)
-infection usually disseminated: joints, adrenals, lungs
What are the gross lesions of embolic glomerulonephritis?
early: red dots (hyperemia, hemorrhage in glomeruli)
later: white foci
late: multifocal abscesses
What is the pathogenesis of renal amyloidosis?
deposition of unique protein (AA) assoc. w/ chronic bacterial infections, hyperimmune conditions (pyelonephritis, osteomyelitis, foot abscess, pleuritis, pneumonia, neoplasia, etc.)
What is the name of dz in the tubules?
What are the 2 types of nephrosis?
What are some etiologies of toxic nephrosis?
ethylene glycol, oakbud (cows), aminoglycosides, Phenylbutazone, Clostridium (pulpy kidney: sheep), endogenous, etc.
What is the pathogenesis of ischemic nephrosis?
↓ perfusion to lower nephron --> degeneration & necrosis of tubular epi: shock, severe DIC
What is the pathogenesis of intravascular hemolysis --> ischemic necrosis?
↓ O2 carrying capacity --> ↓ O2 to cells --> stimulation of renin release --> vasoconstriction --> further ↓ perfusion
What is the one exception to the rule that interstitial nephritis is chronic?
What are some etiologies assoc. w/ suppurative hematogenous interstitial nephritis?
-septicemia: Actinobacillosis in foals, white spotted kidney dz (E. coli) in cows, Erysipelothrix in pigs
What are some etiologies of granulomatous interstitial nephritis?
early stage of leptospirosis
What is the pathogenesis of suppurative hematogenous interstitial nephritis?
hematogenous spread of infection to kidney where bacterial emboli usually lodge in glomeruli & interstitial caps (usually an embolic suppurative GN along w/ interstitial suppurative inflammation)
What are some causes of chronic interstitial nephritis?
-idiopathic: most common
-Leptospirosis: see granulomatous interstitial dz
-K9 herpes virus: rare
-cats: most common renal dz assoc. w/ renal failure (develop hypokalemia)
-horses: any renal dz is uncommon, but CIN can occur & may be assoc. w/ hypercalcemia & hypophosphatemia
What are 2 etiologies for renal petechiae?
K9 herpes: neonatal pups (< 10 d.): petechiae in & on kidneys & other organs (ex. lungs): petechiae essentially diagnostic
What are the gross lesions of renal infarcts & why is infarction of kidney common?
-focal or multifocal, often wedge shaped
-only so many nephrons function at a time (only those will be plugged w/ emboli)
-dehemoglobinization: removal of Hb causes color change from red to white

-common in kidney d/t little or no collateral circulation (rarely produces renal failure)
What is renal cortical necrosis?
-thrombosis in many glomerular caps --> sudden ischemic necrosis (multifocal or diffuse depending on # of nephrons involved)
-severe lesion, will kill patient unless you treat DIC & primary dz vigorously
-cause: DIC
What are the 2 types of pyelonephritis?
hematogenous (descending)
urogenous (ascending)
What are some causes of hematogenous (descending) pyelonephritis?
endocarditis, septicemia (newborns), Actinobacillosis (foals)

just an advanced stage of suppurative embolic glomerulointerstitial nephritis that now has extended into pelvis
What is the pathogenesis of urogenous (ascending) pyelonephritis?
infection ascends from lower urinary tract, penetrates pelvis --> necrosis --> extends into tubules, then interstitium

cystitis ascends via vesicoureteral reflux --> bacteria from bladder to pelvis
What type of inflammation is mostly commonly associated w/ pyelonephritis & what 2 species are most commonly affected?

dogs, cows
What are the gross lesions of pyelonephritis?
-acute: small suppurative foci
-chronic: abscess: can be large & make kidneys huge; fibrosis w/ time
-cut surface: erosion, ulceration of pelvis, pus in pelvis
-progresses to multiple abscesses scattered thru out cortex & medulla
-can look like LSA, infarcts, or white spotted kidney dz on natural surface (cut surface is diagnostic)
What are etiologies of papillary necrosis?
= necrosis of papilla d/t ischemia

-pyelonephritis: most common cause (papillary necrosis insignificant compared to pyelonephritis)
-vascular: edema in kidney, amyloid in kidney (esp. in cats), diabetes mellitus
-chemicals: Bute, sulfonamides (↓ H2O intake required to produce lesions)
-obstruction: esp. d/t renal calculi
What is the pathogenesis of central diabetes insipidus?
structural lesion in pituitary --> ↓ ADH (ddx: idiopathic, tumor, abscess)
What is the pathogenesis of nephrogenic diabetes insipidus?
CRF --> cells that respond to ADH are gone OR cells present but something interferes w/ ADH (ex. steroids (Cushing’s), hypercalcemia, E. coli toxin (pyometra))
What are some causes of end stage kidneys?
chronic GN, chronic pyelonephritis, chronic interstitial nephritis
-less common: severe amyloidosis, renal calculi
What are some causes of renal mineralization?
renal failure, Vit. D toxicity, primary hyperparathyroidism, hypercalcemia of malignancy, Ca X P > 90, Cushing’s, dystrophic mineralization
What is Fanconi syndrome & with what breed of dog is it associated?
-tubular reabsorption defect (biochemical problem w/ no morphologic lesion)
-urine: ↑ glucose, protein, AAs, lipid, etc.

Basenjis (up to 30%)
What are some predisposing factors for cystitis?
-anatomic: short urethra in females w/ wide lumen favors ascending infection
-trauma: induced by calculi
-neurogenic: d/t loss of innervation (ex. dogs (IVDD), horses (Sorghum cystitis))
- lack of innervation --> bladder atony --> urine pooling/stasis
-bacteria: esp. urea splitting bacteria --> alkalotic urine
-concurrent infection
-chronic steroid administration: --> hypotonic urine, ↓ neutrophil function
What are some etiologies of acute hemorrhagic cystitis?
trauma (catheter, calculi), blister beetles (horses)

cats: severe hemorrhage & necrosis makes bladder wall susceptible to rupture, esp. if calculus is blocking exit of urine
What are common causes for uroabdomen in:

a. foals
b. cats
c. cows
a. newborn male foals, may occur during parturition
b. feline urological syndrome: necrotic bladder wall prone to iatrogenic rupture
c. “water belly”, usually d/t calculus lodged at sigmoid flexure
Where are uroliths likely to lodge in:

a. cattle
b. rams
c. cats
a. sigmoid flexure
b. sigmoid flexure &/or urethral process
c. tip of penis
What contributes to the formation of uroliths?
need a nidus for rest of elements to precipitate on (ex. matrix of bacteria, fibrin, mucus, protein, dead cells, etc.)

other factors: ↓ H2O intake (KEY!!), diet, acid vs. alkaline pH, diseases, familial
What conditions may result from urolithiasis?
pyelitis, cystitis, obstruction, uroabdomen, hydronephrosis, papillary necrosis, PAIN
What is feline urological syndrome?
common: blocked male cats
crystals --> uroliths --> obstruction
death usually d/t hyperkalemia
etiology: unknown (↓ H2O intake important)
What are some primary renal tumors?
adenocarcinoma: most common PRIMARY renal tumor of dogs (uncommon)

also adenoma, embryonal nephroma, nephroblastoma
What is the most common tumor of the kidneys, what does it look like grossly, and what are the ddx in cows & cats?
-multiple white nodules in any species (fairly common in dogs, cats, cows)
-will always be in other tissues as well

-cow ddx: pyelonephritis, white spotted kidney dz, LSA, infarct

-cat ddx: FIP, LSA
-differentiate by histology/cytology, FIP (peritonitis, pleuritis, polyclonal gammopathy), LSA (big lymph nodes, thymus, BM leukemia)
What are 2 common tumors of the urinary bladder?
transitional cell carcinoma: most common; very malignant

squamous cell carcinoma
-cattle: brackfern (80% of bladder neoplasms are carcinoma)