Urinary Path 3

Acquired renal cysts involve —- obstruction, leading to retention and dilation. They are often associated with ————— and secondary to (acute/chronic) renal injury.

Tubular

Chronic tubulointerstitial fibrosis/scarring

Chronic

True or False: Acquired renal cysts are solitary only.

False! Acquired renal cysts may be SOLITARY OR MULTIPLE.

Congenital or inherited renal cysts come from developmental or hereditary abnormalities of the renal —-.

They have (single/multiple) cyst(s) that may involve the —- and —- of the kidney.

Tubules

Multiple

Cortex

Medulla

What are the TWO major inherited renal cyst types?

1. Autosomal dominant PKD

2. Congenital/juvenile PKD

Autosomal dominant PKD is usually seen in (young/adults), while congenital/juvenile PKD is seen in (young/adults).

Adults

Young

What gene is associated with autosomal dominant PKD?

PKD1 (polycystin-1)

What dog and cat is most likely to get autosomal dominant PKD?

Dog: Bull Terriers

Cat: Persian

What TWO animals are most likely to get congenital/juvenile PKD?

1. Cairn/Westie Terriers

2. Perendale sheep

What is the pathogenesis of polycystic kidney disease (PKD)?

Abnormal tubular epithelial/ciliary signaling -> epithelial proliferation + fluid accumulation -> cyst expansion -> compression and loss of functional renal parenchyma

What does PKD look like grossly?

Multiple, fluid-filled cysts in cortex and medulla of various sizes compressing parenchyma

In what species is PKD a congenital disease and cysts are present at birth, where severe disease may cause perinatal death?

Perendale sheep

Normal interaction is required between what TWO embryonic structures to form normal, functional kidneys?

Ureteric bud and metanephric blastema

The ureter, renal pelvis, major and minor calyces, and collecting ducts/collecting tubules are all formed from what embryonic structure?

Ureteric bud (metanephric diverticulum)

The nephrons, glomeruli, PCT, Loop of Henle, and DCT are all formed by what embryonic structure?

Metanephric blastema (metanephric mass)

What is the complete absence of recognizable renal tissue?

Can it be unilateral, bilateral, or both?

Renal agenesis

Both

True or False: In renal agenesis, bilateral cases may be incidental because of compensatory hypertrophy of the opposite kidney. Unilateral agenesis is incompatible with life.

False! UNILATERAL cases may be incidental because of compensatory hypertrophy of the opposite kidney. BILATERAL agenesis is incompatible with life.

Familial forms of renal agenesis can be seen in what THREE dog breeds?

1. Beagles

2. Shetland Sheepdogs

3. Doberman Pinschers

What TWO things can be the pathogenesis of renal agenesis?

1. Failure of ureteric bud formation/outgrowth

2. Failure of induction or development of metanephric blastema

What is incomplete development of the kidney, characterized by a quantitative defect with reduced nephron number?

Renal hypoplasia

What do kidneys with hypoplasia look like grossly?

Can it be unilateral, bilateral, or both?

Small and smooth without acquired scarring

Both

What are the THREE criteria for diagnosing renal hypoplasia?

1. Marked reduction in renal size/mass

2. Reduced number of calyces/lobules/nephrons

3. No evidence of pre-existing renal disease

In a unilateral case of renal hypoplasia, what do you expect the contralateral kidney to look like? Why?

Much larger- compensatory due to hypoplastic kidney

What is the fusion anomaly of opposite renal poles during nephrogenesis and is often an incidental finding with little or no functional impairment?

Horseshoe kidneys

When does clinical significance of horseshoe kidneys increase?

Ureteral drainage altered or obstruction

What is the disorganized differentiation and organization of renal parenchyma?

Renal dysplasia

In renal dysplasia, there is often persistence of what THREE embryonic structures within the kidney?

1. Primitive ducts/tubules

2. Fetal glomeruli

3. Primitive mesenchyme; cartilage may be present

What does renal dysplasia look like grossly?

Small, irregular, pale, fibrotic, or cystic; malformed with accessory vessels (sounds like gina)

True or False: In renal dysplasia, ureteral or other urinary tract anomalies may coexist and functional impairment varies from incidental to progressive renal failure.

True!

What FOUR causes of renal dysplasia exist?

1. Abnormal interaction of ureteric bud & metanephric blastema

2. Hereditary/developmental

3. Hypovitaminosis A in pigs

4. Teratogenic viral infections during active nephrogenesis

What cause of renal dysplasia interferes with normal development of the lower urinary tract and ureteric bud insertion?

Hypovitaminosis A in pigs

Name THREE viral infections which can cause renal dysplasia and when they occur.

1. Feline panleukopenia (fetal)

2. Canine herpesvirus (neonatal)

3. BVDV (fetal)

What is the diagnostic hallmark of renal dysplasia?

Persistent embryonal structures

Neoplastic diseases of the kidney are uncommon in domestic animals and account for ——-% of all neoplasms in dogs and cats.

0.6-2.5%

True or False: Primary renal tumors are more common than secondary neoplasms.

False! Secondary tumors (metastatic) are more common than primary.

Primary renal tumors are usually (unilateral/bilateral)

Unilateral

What THREE classifications can primary renal neoplasms have?

Epithelial, mesenchymal, or embryonal

What is the most common primary renal tumor in adult dogs, cattle, and horses?

Renal carcinoma

What is an embryonal tumor that is most common in young pigs and chickens, called Wilms' tumor in humans?

Nephroblastoma

True or False: Other renal tumors include adenoma, hemangioma/hermangiosarcoma, fibroma/fibrosarcoma, and lymphoma.

True!

Renal carcinomas are most reported in what species?

Is it usually unilateral or bilateral?

Dogs

Unilateral

What does renal carcinoma look like grossly?

Solitary to multinodular cortical/medullary mass with hemorrhage and necrosis

True or False: Renal carcinoma is usually locally invasive and often mets to lungs, regional lymph nodes, liver, and adrenal gland.

True!

Name at least THREE of the clinical signs seen with renal carcinoma.

1. Hematuria

2. Weight loss

3. Abdominal enlargement

4. Paraneoplastic polycythemia

What is the most common primary renal neoplasms in pigs and chickens?

Are they typically young or old?

Nephroblastoma

Young

What are the TWO major pathogenesis behind nephroblastoma?

1. Malignant transformation during nephrogenesis

2. Persistence and later neoplastic rests in postnatal kidney

What are the FOUR characteristic histological features of nephroblastoma?

1. Undifferentiated blastemal cells

2. Abortive glomeruloid and tubular structures

3. Loose spindle stroma

4. Mesenchymal components (bone/cartilage/fat/skeletal m)

Where is ectopic nephroblastoma located?

What kind of dogs is it typically seen in?

What happens?

Thoracolumbar junction

German Shepherds and males

Embryonal rests trapped between dura mater and spinal cord

Renal involvement of —- is common in dogs, cats, cows, and pigs. It may be nodular or diffuse and is usually bilateral.

Lymphoma

What are the THREE causes of intrinsic acute renal failure?

1. Acute glomerulonephritis

2. Acute interstitial nephritis (allergic rxn)

3. Acute tubular necrosis (nephrotoxin; long hypoperfusion)

Glomerular, tubulointerstitial/tubular, vascular, and congenital/hereditary diseases can all contribute to (acute/chronic) renal failure.

Chronic

Describe the FOUR stages of chronic renal failure progression in order.

1. Reduced renal reserve (50% GFR)- compensatory hypertrophy/hyperfiltration; no azotemia

2. Renal insufficiency (25-50% GFR)- reduced concentration; PU/PD

3. Renal failure (20-25% GFR)- persistent azotemia/uremia

4. End-stage kidney (

True or False: In general, ongoing nephron loss leads to fibrosis and progressive decline in function.

True!

Grossly, acute disease tends to —- kidneys, whereas chronic disease is associated with —— and —-.

Enlarge

Scarring

Contraction

True or False: Both acute and chronic kidney injury are reversible.

False! Only ACUTE kidney injury is reversible.

Compare how a kidney would look in acute vs chronic renal injury.

Acute: enlarged and pale with smooth surface

Chronic: small, firm, irregular with fibrosis

What condition is usually associated with chronic renal failure and less commonly with acute severe uremia?

What does it look like grossly?

Ulcerative necrotic stomatitis

Ulcers and necrotic plaques on tongue/oral mucosa

What species is ulcerative necrotic stomatitis most seen in?

Dogs

What are the TWO major pathogeneses behind ulcerative necrotic stomatitis?

1. Uremia -> fibrinoid necrosis of oral arterioles -> ischemic infarction

2. Bacterial urease converts to ammonia -> chemical irritation and epithelial necrosis

What is common in dogs and cats, shows fibrinoid necrosis of arterioles on histopath, and can lead to intestinal intussusception?

What is more common in cattle?

Uremic gastritis

Colitis

What stain is used to visualize uremic gastritis histologically?

Von-Kossa stain

What is the most common extra-renal lesion associated with uremia?

Sub-pleural mineralization

What is the pathogenesis of sub-pleural mineralization?

Renal failure -> phosphate retained + decreased calcitriol -> relative hypocalcemia and secondary hyperparathyroidism -> increased calcium-phosphorus product -> metastatic mineralization

True or False: Sub-pleural mineralization is deposited in the pleura and may also occur in gastric mucosa, endocardium, and vessels.

True!

What THREE portions of the heart are most susceptible to uremic endocarditis?

1. Left atrium

2. Pulmonary trunk

3. Aortic trunk

True or False: Uremic endocarditis is more common in acute than chronic renal failure.

True!

What is bone loss and replacement by fibrous tissue, especially in the jaw bones?

Fibrous osteodystrophy (Big Head Disease/Rubber Jaw)

What condition causes big head disease/rubber jaw/fibrous osteodystrophy?

Chronic hyperparathyroidism

What are THREE common causes of chronic hyperparathyroidism?

1. Renal failure

2. High P diet

3. Vitamin D deficiency

(Also parathyroid tumors)

True or False: Causes of chronic hyperparathyroidism work by creating a hypocalcemic environment, which increases PTH, causing excessive bone resorption and fibroblast proliferation/fibrous tissue in bone.

True!

Match the lesion to the mechanism. Some may be used more than once:

Pulmonary edema

Fibrinous pericarditis

Ulcerative/hemorrhagic gastritis

Ulcerative/necrotic stomatitis

Atrial and aortic thrombosis

Hypoplastic anemia

Soft tissue mineralization

Fibrous osteodystrophy

Parathyroid hyperplasia

Increased vascular permeability

Endothelial/subendothelial damage

Increase RBC fragility and lack of EPO in kidney

Altered Ca/P metabolism

Ammonia secretion/vascular necrosis

Pulmonary edema: increased vascular permeability

Fibrinous pericarditis: increased vascular permeability

Ulcerative/hemorrhagic gastritis: ammonia secretion/vascular necrosis

Ulcerative/necrotic stomatitis: ammonia secretion/vascular necrosis IN SALIVA

Atrial and aortic thrombosis: endothelial/subendothelial damage

Hypoplastic anemia: increased RBC fragility and lack of EPO in kidney

Soft tissue mineralization: altered Ca/P metabolism (stomach, lungs, pleura, kidney)

Fibrous osteodystrophy: altered Ca/P metabolism

Parathyroid hyperplasia: altered Ca/P metabolism

I genuinely am so sorry for these pathology quizlets

Oh my god why