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74 Cards in this Set

  • Front
  • Back

Can new nephrons form once renal maturity has been established?

NO although renal compensation can occur by tubular hypertrophy

What is end stage kidney

Irreversable changes in chronic renal failure

Why are kidneys susceptable to toxic injury

20% of cardiac output


Large glomerular capilliary surface area for toxin-endothelial reaction


High metabolic rate of PCT and Thick ascending loop of henle

How can kidneys be damaged

Ascending insults


Haematogenous


Metabolic insults

What are the features of an end stage kidney

Shrunken and fibrosed


Pale and firm - difficulty removing the capsule post mortem


Non renal changes to the whole body

What is an ideal corticomedullary ratio

1:2 and 1:3

What is azotaemia

Abnormal increase in non protein nitrogenous substances in the blood


Principally urea and creatinine

What is uraemia

Group of clinical signs resulting from azotaemia

Pre-renal azotaemia

Decreased renal perfusion or increased protein catabolism


Urea is increased, creatinine is not

Why is urea but not creatinine increased in pre-renal azotaemia

Decreased flow rate in tubules allows increased resorbtion of urea but not creatinine. Creatinine is not absorbed by the renal tubules

What is the cause of increased protein catabolism associated with pre-rental azotaemia

Sepsis


Starvation


Fever


Glucocorticoid administration

What is renal azotaemia

Decreased glomerular filtration rate due to acute or chronic renal disease


Both creatinine and urea increase

Why does both urea and creatinine increase with renal azotaemia

Decreased glomerular filtration rate results in decreased clearence of both urea and creatinine

How is creatinine cleared

Glomerular filtration and proximal tubular excretion


No reabsorbtion

What causes post renal azotaemia

Obstruction of the urinary tract distal to the kidneys


Both urea and creatinine are decreased

Increased synthesis of urea is caused by what

Intestinal haemorrhage


High protein diet


Protein catabolism


Hypersthenuric

USG higher than normal

Isosthenuric

USG normal

Features of pre renal azotaemia

Hypersthenuraemic (1.030 - 1.035)


Urine volume decreased


Serum urea increased


Normal serum creatinine

Features of renal azotaemia

Increased serum volume of creatinine and urea


Increased urine volume USUALLY


Isosthenuric

Features of postrenal azotaemia

Variable USG


Decreased urine volume


Increased serum urea / creatinine

Features of increased urea synthesis

Variable USG


Variable urine volume


Increased serum urea with normal creatinine

What are the types of non renal pathology associated with renal failure

Epithelial lesions


CV changes


Pulmonary lesions


Altered calcium and phosphorus metabolism


Abnormal biochemistry

What are the 2 causes of epithelial lesions

Degeneration and necrosis of endothelial cells resulting in vasculitis, leading to thrombosis and infarction


Production of ammonia via bacterial action un urea - epithelial damage

What are the manifestations of epithelial lesions

Stomatitis - ulcerative necrotic


Gastritis


Cardiovascular changes associated with renal failure

Uraemic lesions of the wall of the left auricle, proximal aorta and pulmonary trunk (erosion and thrombi formation)


Hypertensive lesions - cardiac hypertrophy (left sided)


Fibrinous pericarditis


Anaemia

WHat can cause anaemia in renal failure

Multifactorial aetiology


Increased RBC fragility

What causes increased serum phosphate

Decreased GFR


Decreased clearence - post renal, renal and pre renal disease

What causes increased serum calcium?

Decreased synthesis of calcitriol


Result is decreased absorbtion of calcium from intestine and decreased resorbtion from bone


Stimulation of PTH - compensatory hyperparathyroidism

What is the result of decreased calcium

Parathyroid hyperplasia


Soft tissue mineralisation


Osteodystrophy

What causes increased serum potassium in renal failure

Oliguria and decreased potassium output


oliguria

lowered urine output

Aldosterone action

Increase potassium absorbtion

Metabolic acidosis is caused by?

Decreased renal hyrogen excretion


Increased potassium uptake into cells - cells then lose hyrdogen compensatory to maintain charge balance

Congenital renal conditions

Renal aplasia or agenesis


Ectopic kidneys


Dysplasia


Cysts

What is renal aplasia

Failure to develop


Familial condition in the doberman and the beagle

What is renal hypoplasia

Incomplete renal development


Clinical manifestations depend on severity

What is ectopic kidney

Anomolous development of kidneys


Usually in pigs and dogs


Pelvic or inguinal location


Incontinence, hyronephrosis, pyelonephritis

What is horseshoe kidney

Fused kidneys


One large kidney with 2 ureters


Abnormal nephrogenesis

What is a congenital renal cyst

Common incidental finding in pigs and calves


Usually solitary

Polycystic kidney disease

Both kidneys contain many cysts and such there is a progressive compromise in renal function


Slow development, cysts become numerous and enlarge

What are acquired renal cysts

Sequel to interstitial fibrosis


Obstruction of tubules with scar tissue

Perinephric pseudocysts

Between the renal capsule and the renal reflection of the peritoneum

What is juvenile nephropathy

Cause of renal failure in young animals


Familialy in the wheaten terrier


Not associated with inflammation

What are the circulatory disturbances of the kidney

Hyperaemia


Haemorrhage


Infarction


What are the types of hyperaemia

Active


Passive


Hypostatic

Haemorrhage sequalae

Gross haemorrhage = Complete renal failure


Causes of petechial haemorrhages

Septicaemic disease


Renal cortical haemorrhages common in=

Significant in neonatal herpes virus in puppies

Consequences of renal artery infart

Total necrosis

Consequences of arcuate artery infarct

Necrosis of a wedge in the cortex and medulla

Arteries in the kidney size order

Renal artery


Interlobar artery


Arcuate artery


Interlobular arery

Where are most infarctsq

Smaller arteries - most blockages due to smaller size for passage of emboli

Consequences of interlobular infarct

Cortical necrosis only - both tubules and glomeruli

Stages of infacts

Acute stage with swelling and haemorrhage


Pallor with surrounding hyperaemia


Chroni infarct - shrunken and fibrotic with contour distortion

Renal papillary necrosis cause

Reduced medullary blood flow


Primary Disease following NSAID therapy

Cause of hydronephrosis

Obstruction at any level between the pelvis and urethra

Sequalae to hydronephrosis

Ischaemic lesions develop in addition to persistance of glomerular filtration that causes pressure atrophy

Renal cortical necrosis cause

DIC


Endotoxaemia


G- septicaemia

How do nsaids cause medullary necrosis

decrease in prostaglandins


no maintainence of GFR


hyertonicity of medulla


apoptosis and necrosis

What causes haemoglobin pigmentation of kidneys

Floowing any haemolytic crisis


Blakc discolouration - concentrated haemoglobin

Haemosiderosis

Occurs in asscoication with chronic haemoltic anaemia or haemaglobinurea (acute)


Brown discolouration

How do we demonstrate haemoglobin in the tissues

Perls prussian blue reaction


Ferric iron blue reaction

Renal dysplasia


Disorganised development of parenchyma

Congenital renal cyst


Solitary

Polycystic kidney disease


Both kidneys contain many cysts and there is progressive comporomise


Renal function - persian cats and cairn terriers


Slowly developing

Acquired cysts as a sequel to interstitial fibrosis


Tubules obstructed by scar tissue

Renal cortical ecchymoses


Significant lesion of neonatal herpesvirus of pups

Interlobular


Arcuate


Interlobar


Renal

Necrotic on the left and normal on the right

Hydronephrosis

Bladder stones - causing local irritation of the walls/mucosa


If one of these caliculi were to become lodged in the ureter (unilateral) or urethra (bilateral) hydronephrosis would result

Haemosiderosis

Fatty change