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52 Cards in this Set
- Front
- Back
What are the 3 R's of the renal system?
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redundancy: 2 kidneys
reserve: only need 1/4 - 1/3 of total renal mass to survive regeneration: tubules (great) vs. glomerulus (none) |
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What is the most common sign of glomerular dysfunction?
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proteinuria
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What are the primary functions of the kidney?
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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+ |
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ADH
a. located of receptors b. effect c. where produced |
a. collecting tubules
b. reabsorption of H2O c. produced by hypothalamus, stored in pituitary |
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PTH
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 |
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aldosterone
a. located of receptors b. effect c. where produced |
a. tubules
b. reabsorption of Na, excretion of K c. adrenal glands |
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What are the 4 disorders that make up the nephrotic syndrome?
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proteinuria, hypoproteinemia, edema, hypercholesterolemia
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What are some non-renal lesions that are associated w/ uremia?
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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 stomatitis hemorrhagic, ulcerative lesions in GI tract mineralization parathyroid hyperplasia & hypertrophy: chronic renal osteodystrophy (rubber jaw): chronic pulmonary thrombosis anemia: mild to moderate nonregenerative (chronic) |
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familial progressive renal dystrophy
a. signalment b. lesions |
a. dogs (Lhasa Apso, Shih Tzu, Cockers, Norwegian Elkhounds, Dobermans, Samoyeds, etc.); common
b. -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) |
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What is the pathogenesis of congenital renal cysts?
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failure of mesonephros (collecting part) to fuse w/ metanephros (secretory part) --> blind ended tubule that fills w/ fluid
may be simple or polycystic |
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What is the pathogenesis of acquired renal cysts?
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some physical structure (ex. calculus, chronic inflammation, scar tissue) obstructs tubules --> tubules proximal to obstruction dilate & become cystic
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What are the gross lesions of hydronephrosis?
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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 |
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What is the pathogenesis of ascites d/t glomerular dz?
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↑ permeability of filter --> protein leakage --> proteinuria --> hypoproteinemia --> ↓ colloidal osmotic pressure --> edema, ascites
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What are the 2 mechanisms of glomerulonephritis?
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immune mediated
embolic |
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What is the pathogenesis of immune mediated glomerulonephritis?
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-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) |
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What is the pathogenesis of embolic glomerulonephritis?
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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 |
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What are the gross lesions of embolic glomerulonephritis?
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early: red dots (hyperemia, hemorrhage in glomeruli)
later: white foci late: multifocal abscesses |
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What is the pathogenesis of renal amyloidosis?
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deposition of unique protein (AA) assoc. w/ chronic bacterial infections, hyperimmune conditions (pyelonephritis, osteomyelitis, foot abscess, pleuritis, pneumonia, neoplasia, etc.)
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What is the name of dz in the tubules?
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nephrosis
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What are the 2 types of nephrosis?
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toxic
ischemic |
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What are some etiologies of toxic nephrosis?
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ethylene glycol, oakbud (cows), aminoglycosides, Phenylbutazone, Clostridium (pulpy kidney: sheep), endogenous, etc.
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What is the pathogenesis of ischemic nephrosis?
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↓ perfusion to lower nephron --> degeneration & necrosis of tubular epi: shock, severe DIC
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What is the pathogenesis of intravascular hemolysis --> ischemic necrosis?
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↓ O2 carrying capacity --> ↓ O2 to cells --> stimulation of renin release --> vasoconstriction --> further ↓ perfusion
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What is the one exception to the rule that interstitial nephritis is chronic?
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leptospirosis
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What are some etiologies assoc. w/ suppurative hematogenous interstitial nephritis?
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-endocarditis
-septicemia: Actinobacillosis in foals, white spotted kidney dz (E. coli) in cows, Erysipelothrix in pigs |
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What are some etiologies of granulomatous interstitial nephritis?
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FIP
early stage of leptospirosis |
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What is the pathogenesis of suppurative hematogenous interstitial nephritis?
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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)
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What are some causes of chronic interstitial nephritis?
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-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 |
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What are 2 etiologies for renal petechiae?
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septicemia
K9 herpes: neonatal pups (< 10 d.): petechiae in & on kidneys & other organs (ex. lungs): petechiae essentially diagnostic |
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What are the gross lesions of renal infarcts & why is infarction of kidney common?
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-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) |
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What is renal cortical necrosis?
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-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 |
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What are the 2 types of pyelonephritis?
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hematogenous (descending)
urogenous (ascending) |
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What are some causes of hematogenous (descending) pyelonephritis?
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endocarditis, septicemia (newborns), Actinobacillosis (foals)
just an advanced stage of suppurative embolic glomerulointerstitial nephritis that now has extended into pelvis |
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What is the pathogenesis of urogenous (ascending) pyelonephritis?
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infection ascends from lower urinary tract, penetrates pelvis --> necrosis --> extends into tubules, then interstitium
cystitis ascends via vesicoureteral reflux --> bacteria from bladder to pelvis |
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What type of inflammation is mostly commonly associated w/ pyelonephritis & what 2 species are most commonly affected?
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suppurative
dogs, cows |
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What are the gross lesions of pyelonephritis?
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-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) |
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What are etiologies of papillary necrosis?
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= 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 |
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What is the pathogenesis of central diabetes insipidus?
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structural lesion in pituitary --> ↓ ADH (ddx: idiopathic, tumor, abscess)
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What is the pathogenesis of nephrogenic diabetes insipidus?
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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))
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What are some causes of end stage kidneys?
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chronic GN, chronic pyelonephritis, chronic interstitial nephritis
-less common: severe amyloidosis, renal calculi |
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What are some causes of renal mineralization?
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renal failure, Vit. D toxicity, primary hyperparathyroidism, hypercalcemia of malignancy, Ca X P > 90, Cushing’s, dystrophic mineralization
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What is Fanconi syndrome & with what breed of dog is it associated?
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-tubular reabsorption defect (biochemical problem w/ no morphologic lesion)
-urine: ↑ glucose, protein, AAs, lipid, etc. Basenjis (up to 30%) |
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What are some predisposing factors for cystitis?
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-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 -parasites |
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What are some etiologies of acute hemorrhagic cystitis?
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trauma (catheter, calculi), blister beetles (horses)
cats: severe hemorrhage & necrosis makes bladder wall susceptible to rupture, esp. if calculus is blocking exit of urine |
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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 |
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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 |
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What contributes to the formation of uroliths?
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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 |
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What conditions may result from urolithiasis?
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pyelitis, cystitis, obstruction, uroabdomen, hydronephrosis, papillary necrosis, PAIN
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What is feline urological syndrome?
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common: blocked male cats
crystals --> uroliths --> obstruction death usually d/t hyperkalemia etiology: unknown (↓ H2O intake important) |
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What are some primary renal tumors?
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adenocarcinoma: most common PRIMARY renal tumor of dogs (uncommon)
also adenoma, embryonal nephroma, nephroblastoma |
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What is the most common tumor of the kidneys, what does it look like grossly, and what are the ddx in cows & cats?
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LSA
-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) |
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What are 2 common tumors of the urinary bladder?
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transitional cell carcinoma: most common; very malignant
squamous cell carcinoma -cattle: brackfern (80% of bladder neoplasms are carcinoma) |