Path 1 - Urinary 3

drraythe's version from 2015-05-04 10:34

Lecture 5

Question Answer
*What are 2 out of the 5 developmental anomalies he mentioned that the key notes stresses we should know?Renal Dysplasia & Polycystic Kidney REVIEW THEM
*What is going on in 1° renal Glucosuria? WHO IS PRONE to this?Reduced capacity of tubules to reabsorb glucose (no lesions, just a fxnal deficit & needs to be distinguished from DM) it is an inherited disorder of Norwegian Elkhounds!!! (Sporadic occurrence in other sp)
Basenji dog Fanconi syndrome → What is happening here? What does it clinically cause?Abnormal brush border membrane structure of the proximal tubular epithelium. Clinically causes Glucosuria, proteinuria, metabolic acidosis & endocrine disorder
Most important cause of Acute Renal Failure in animals?Acute Tubular Necrosis
*CS of Acute Tubular Necrosis??CS include Oliguria or Anuria w/ severe Azotemia
What are the causes (main & then list some others) of Acute Tubular Necrosis?Mostly ischemic or nephrotoxic injury, can also be from nephrotoxic pigments, heavy metals, pharmaceutical agents, fungal toxins, plant toxins, chemicals, Vitamins & minerals, bacterial toxins, ischemia
Hemoglobinuric Nephrosis → What is this caused by? What does it result in?Caused by ↑ serum concentration of hemoglobin which results in Hemoglobinuria when the renal threshold for resorption is exceeded. ↑ Concentrations of hemoglobin in the glomerular filtrate exacerbates ischemic injury of the renal tubules (hemoglobin itself is not nephrotoxic)
**Hemoglobinuria occurs w/ hemolysis. NAME THE MOST COMMON CAUSE FOR SHEEP, CATTLE, DOG & HORSESheep: Copper toxicity
Cattle: Leptospirosis or Babesiosis
Dog: Babesiosis or autoimmune hemolytic anemia
Horse: Red Maple Toxicity
Two mentioned nephrotoxic pigments which can cause Acute Tubular Necrosis?Myoglobin, Hemoglobin (not toxic in itself, but exacerbates ischemic injury of the renal tubules when there is hemolysis)
Myoglobinuric Nephrosis → What is this caused by? What does it result in?Basically same as the Hb 1 (caused by ↑ serum concentration of hemoglobin which results in Myoglobinuria when the renal threshold for resorption is exceeded)
**Myoglobinuria occurs in what general situation? What are 3 specific situations this occurs in?Occurs w/ extensive acute muscle necrosis & is seen w/:
(1) Exertional myopathy in horses (Azoturia, tying-up)
(2) Capture myopathy in wild animals (Rhabdomyolysis)
(3) Severe muscle trauma
What are some heavy metals which cause Acute Tubular Necrosis? When is this important? What are common sources of lead?Lead, Mercury, Cadmium, Thallium
These are important in wildlife dz & common sources of lead in animals include: used oil, grease, machine parts, old batteries, lead paint, linoleum, lead weights, lead shot, environmental contamination by smelting plants
How do you confirm a Dx of Acute Tubular Necrosis from heavy metals?Toxicology report
*What are the effects & histological changes which occur from heavy metal Acute Tubular Necrosis?Can cause direct injury to tubular epithelial cell membranes & mitochondria. histologic changes include tubular necrosis, degeneration & intranuclear inclusion bodies
Intranuclear inclusion bodies in the tubule cells might indicate what?Heavy metal poisoning
**When do nephrotoxic drugs cause Acute Tubular Necrosis? How does the dmg happen?When they are administered at excessive doses or too frequently. Cause direct tubular epithelial injury or cause hypoxic injury by vasoconstriction & reduced renal blood flow (Nephrotoxin-Associated Ischemia)
What are some nephrotoxic drugs?Antimicrobials drugs (Aminoglycosides: streptomycin, neomycin, gentamycin; tetracyclines; Amphotericin B), NSAIDs (Aspirin, Phenylbutazone, carprofen, flunixin, Ibuprofen, naproxen), immunosuppressive drugs (cyclosporin), antineoplastic chemotherapeutics (cisplatin, carboplatin, cyclophosphamide, ifosfamide, mitomycin C, methotrexate, gemcitabine)
**What is the pathogenesis of NSAID toxicity?NSAIDs ↓ the synthesis of renal prostaglandins which are responsible for maintaining normal renal blood flow → the result is renal vasoconstriction that causes ischemic injury leading to tubular degeneration & necrosis & Acute Renal Failure. In addition to Acute Tubular Necrosis, NSAIDS also cause Renal Papillary Necrosis (covered later)
*What is a mycotoxin which causes Acute Tubular Necrosis? (What makes this mycotoxin?) How does the ingestion often take place? What kind of dmg does this mycotoxin do?AFLATOXIN which comes from Aspergillus & Penicillium, is often a common feed contaminant. Aflatoxin causes tubular degeneration & necrosis (as well as hepatocellular necrosis & liver failure)
*What are 5 plants/plant toxins which cause Acute Tubular Necrosis?Pigweed, oxalate-rich plants, grapes & raisins, lilies, oak tannins
Who does Pigweed affect, in what way?Pigweed can cause Acute Tubular Necrosis & Perirenal Edema in pigs & cattle
What are some oxalate rich plants? What does consuming these cause?Halogeton, Sarcobatus, Rheum, Rumex, they cause Oxalate Nephrosis
**Explain Oxalate NephrosisCa oxalates precipitate in the renal tubules forming oxalate crystals w/ subsequent epithelial injury & renal failure
How, what, who & why do grapes & raisins cause?ACUTE TUBULAR NECROSIS, ingestion by dogs can lead to Acute Renal Failure & Uremia. Accompanied by vomiting, lethargy, anorexia & diarrhea. Tannins suspected as causative agents.
Lilies cause what in who? How?Cause Acute Renal Failure when cats ingest them. Unknown cause.
Who does oak harm? How?Causes toxicity in ruminants & horses, by ingestion, tannins suspected
**What are 3 chemicals which can cause acute kidney failure?Ethylene Glycol (antifreeze)
Cyanuric Acid
How does Ethylene Glycol (antifreeze) cause Acute Tubular Necrosis?Dogs & cats often drink it bc of its sweet taste. The chemical then has many NEPHROTOXIC METABOLITES (including oxalate & glycolic acid). These metabolites cause Oxalate Nephrosis & renal failure
*What are 2 pet food contaminants which cause Acute Tubular Necrosis? What do they do?Melamine & Cyanuric Acid (were used to artificially elevate protein levels), causes distal tubular necrosis w/ characteristic irregular brown birefringent crystals
Which Vitamin can cause Acute Tubular Necrosis?Vitamin D
How might a dog or cat get Vitamin D toxicosis? Ruminant?DOG/CAT: usually from excessive dose of Vit D, or ingestion of Calciferol-containing rodenticides. RUMINANT: ingestion of calcinogenic plants (Cestrum diurnum (USA), Solanum sp., Trisetum sp
**What is the PATHOGENISIS of Vitamin D toxicosis?Leads to HYPERCALCEMIA & causes METASTATIC mineralization of tubular & glomerular basement membranes followed by degeneration, necrosis, fibrosis & loss of fxn
SPECIFICALLY: Enteric proliferation of Clostridium perfringens Type D w/ production of **Epsilon exotoxin**
**Epsilon exotoxin is from what, causes what, w/ what lesions?Causes PULPY KIDNEY (usually in sm rumis) & is a toxin from Clostridium perfringens D which is growing enterically. Causes bilateral acute tubular degeneration & necrosis, w/ interstitial edema & hemorrhage
*What is Hydronephrosis?Dilation of the renal pelvis due to obstruction of urine outflow
If there is a bilateral blockage of the renal pelvis causing Hydronephrosis, what will happen?DEATH FROM UREMIA & HYPERKALEMIA
**What is Pyelonephritis? Is it usually unilateral or bilateral? What are the gross lesions? Microscopic lesions?~Ascending bacterial infxn leads to infxn of the renal pelvis w/ extension to the renal tubules. Usually bilateral. Gross lesions: expansion of the renal pelvis by purulent exudate (pus). Microscopic lesions: suppurative inflammation of pelvis & medulla w/ necrotic transitional epithelium
*Papillary necrosis Happens when?ISCHEMIC INJURY CAUSED BY NSAIDs. Most frequent in HORSES (Phenylbutazone, Flunixin Meglumine), can also happen in dogs & cats w/ accidental ingestion or wrongful usage (Ibuprofen, Aspirin, Acetaminophen)
Granulomatous Nephritis → Bacteria?Mycobacteriosis
Granulomatous Nephritis → Fungi?Aspergillosis, Histoplasmosis, Blastomycosis, Encephalitozoonosis, etc
Granulomatous Nephritis → Viruses?FIP, Porcine Circovirus
Granulomatous Nephritis → Toxins?Hairy Vetch Toxicosis in cattle
Granulomatous Nephritis → Parasites?Toxacara canis
Xanthogranulomas → What part of the kidney does this affect? Who does this usually affect & what happens?DZ OF THE RENAL INTERSTITIUM! Cats w/ inherited Hyperlipoproteinemia have Xanthogranuloma formation in various tissues including the kidney. Similar lesions are observed in dogs w/ hypothyroidism & severe atherosclerosis
Renal Interstitial Amyloidosis → Who does this usually occur in?It’s especially in Abyssinian cats w/ Medullary Interstitial Fibrosis (otherwise, usually it's GLOM deposition, not intersititum)
**What IS THE most common 1° renal neoplasm of the kidney?? Who do they usually occur in?Renal Carcinoma (adenomas are usually rare & asymptomatic). Occur frequently in older dogs
**What is the notable species thing about Renal Carcinoma?German shepherd - Renal Carcinoma is associated w/ nodular dermatofibrosis
*Which urinary system tumor has VERY HIGH METASTATIC POTENTIAL?Transitional Cell Carcinoma
*What are the epithelial tumors of the urinary system? Where do they usually occur?Transitional Cell Papilloma & Carcinoma they are most common in the urinary bladder but may also occur in ureters & renal pelvis
How common are mesenchymal tumors in the kidney? What are the ones that occur in the kidney?Rare, but they are fibromas, fibrosarcomas, or hemangiosarcomas
What is the Embryonal tumor which occurs in the kidney? Who does it affect?Nephroblastoma. Common in pigs, chickens, some fish. Less frequent in dogs & cattle
What is the most common metastasized tumor to end up in the kidney?Renal Lymphoma is a common neoplasm that may be 1° or metastatic, may be nodular or diffuse
What are 2 malignant adrenal tumors in close proximity to kidney, which become invasive into the kidney?Pheochromocytoma, Adrenocortical Carcinoma
*Focus on the 2 dzs of the tubules that are inherited abnormalities of tubular fxn & Acute Tubular Necrosis (nephrotoxic & ischemic)Key concepts
*Know Pathogenesis of NSAID nephrotoxicityKey concepts
*Know Oxalate Nephrosis (Ethylene Glycol & oxalate-rich plants)Key concepts
*Know the 3 Dzs of the renal pelvis: Hydronephrosis, Pyelonephritis, Renal Papillary Necrosis (NSAIDS)Key concepts
*Know the 3 Dzs of the interstitium: Granulomatous Nephritis, Xanthgranuloma, AmyloidosisKey concepts


  = Lecture 6
Question Answer
What are the 5 developmental anomalies of the lower urinary tract?Aplasia, hypoplasia, ectopic ureters, Patent urachus, urinary bladder diverticulum
Lower tract → Aplasia → Whats going on here?Lack of formation of a recognizable ureter. Rare, may occur in conjunction w/ renal aplasia
Lower tract → Hypoplasia → Whats going on here?Smaller than normal ureter w/ reduced diameter
What are ectopic ureters?Ureters empty in the wrong place such as urethra, vagina, neck of bladder, ductus deferens, prostate, etc.
**WHAT IS the most common malformation of the urinary bladder??Patent urachus!!!!
**Explain Patent urachus. Who’s most affected?**the most common malformation of the urinary bladder**! The fetal urachus fails to close & involute completely which forms a channel b/t the bladder’s apex & the umbilicus → Allows urine to dribble from the umbilicus. Frequently observed w/ neonatal omphalitis & abscess formation. FOALS most commonly affected
What’s going on in a urinary bladder diverticulum?Out-pocketing of the bladder wall, can be congenital or acquired (acquired diverticulae are associated w/ obstructive dz). Can predispose to cystitis & calculi formation due to urine stasis & predispose to rupture
Hydroureter & Hydrourethra → What is this? What might occur concurrently? CS?Dilation of the ureter & urethra caused by urine outflow obstruction. May occur concurrently w/ Hydronephrosis. CS consistent w/ urinary obstruction (Post Renal Azotemia, pain, hyperkalemia)
What is Urolithiasis?A syndrome that occurs when familial, congenital, &/or pathophysiological factors ↑ the precipitation of stone-forming salts resulting in urinary calculi formation (uroliths). Most common in the bladder, but can be anywhere & can affect any sp
List some factors (many) which are associated w/ urolithiasis?genetic factors, diet composition, metabolism & liver fxn, urine pH, urine temperature, dehydration, bacterial infxn, urinary obstruction, anatomic abnormalities, drug excretion
**What is the absolutely necessary occurrence to form uroliths?Supersaturation of urine is the essential precursor to initiation of crystal formation & urolith formation → Supersaturation of **Mineral salts & protein**
How are crystals & calculi related? Which is more common?Crystals are more common. Crystals are only PARITALLY responsible for calculogenesus
What are the 5 most common urine crystals?Struvite, bilirubin, calcium carbonate, amorphous, calcium oxalate dihydrate crystals
Struvite crystals: how common? What are they usually related w/?MOST common Type In cats & dogs (rectangle-y looking ones). Usually known as "infxn calculi" bc Urinary tract infxn w/ urease-positive bacteria can promote Struvite crystalluria (& urolithiasis) by raising urine pH & increasing free ammonia
*"Infectious calculi" are aka for what crystal?Struvite

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