Renal Failure Overview

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Questions and Answers

Match the type of renal failure with its characteristic:

Acute renal failure = Oliguria or anuria Chronic renal failure = Polyuria (Usually irreversible) Prerenal azotemia = Renal hypoperfusion (heart failure, shock, or hemorrhage) Postrenal azotemia = Urinary obstruction

Match the term with the correct definition:

Azotemia = Elevated BUN without clinical manifestations of renal disease Uremia = Clinical syndrome with extra-renal lesions Acute glomerular injury = Type of acute renal failure Chronic renal disease = End result of many chronic renal diseases

Match the condition with its manifestation:

Acute renal failure = Acute glomerular or Tubulo-interstitial injury Chronic renal failure = End-stage kidney disease Prerenal azotemia = Renal injury due to hypoperfusion Renal azotemia = Problem intrinsic to the kidney

Match the type of azotemia with its cause:

Prerenal azotemia = Renal hypoperfusion Renal azotemia = Intrinsic renal injury Postrenal azotemia = Obstruction of urinary outflow Acute renal failure = Rapid decline in kidney function Signup and view all the answers

Match the following terms with their associations:

BUN = Blood urea nitrogen Acute renal failure = Rapid onset condition Chronic renal failure = Long-term kidney dysfunction Azotemia = Accumulation of nitrogenous waste products in the blood Signup and view all the answers

Match the types of glomerulonephritis (GN) with their characteristics:

Membranous = Primarily involves immune complex deposition Proliferative = Characterized by cellular proliferation in glomeruli Membranoproliferative = Features both membranous and proliferative changes Nephrotic syndrome = Marked by significant proteinuria and edema Signup and view all the answers

Match the typical clinical findings with their descriptions:

Proteinuria = Hallmark sign of glomerulonephritis Hypoalbuminemia = Low albumin levels in the blood Hypercholesterolemia = Elevated cholesterol levels in the blood Generalized edema = Swelling due to fluid accumulation in tissues Signup and view all the answers

Match the gross findings of glomerulonephritis with their stages:

Early stage = Pale, edematous large kidney with bulging cut surface Later stage = Shrunken kidney with granular pitted surface Bilateral distribution = Involvement of both kidneys Kidney damage = Results from inflammation due to immune response Signup and view all the answers

Match the immune mechanisms with their descriptions in glomerulonephritis:

Antibody binding = Antibodies binding to exogenous antigens in the glomerulus Immune complexes deposition = Circulating immune complexes deposit in glomeruli Basement membrane antibodies = Formation of antibodies against glomerular basement membrane Complement components = C3a and C5a attract neutrophils to the site of damage Signup and view all the answers

Match the components involved in glomerular injury with their roles:

Neutrophils = Attracted to the site of injury by complement components Chemokines = Mediate inflammatory response leading to damage Oxidants = Released by neutrophils, contributing to cellular injury Antigen-antibody complexes = Formed during the immune response in glomerulonephritis Signup and view all the answers

Match the following clinical findings with their associated symptoms:

Polyuria = Excessive urine production Uremic encephalopathy = Neurologic abnormalities Gastrointestinal ulcers = Vomiting Hypertension = High blood pressure Signup and view all the answers

Match the causes of hypocalcemia with their mechanisms:

Retention of phosphate = Decreased serum calcium Metabolic acidosis = Increased parathyroid hormone Decreased renal 1-α-hydroxylase activity = Vitamin D deficiency Parathyroid gland hyperplasia = Bone resorption Signup and view all the answers

Match the findings in kidneys with their descriptions:

Small, firm kidneys = Irregular surface and usually bilateral Difficult capsule removal = Adhesions to the cortex Thinned cortex = Sign of chronic damage Necrosis = Associated with uremic conditions Signup and view all the answers

Match the gastrointestinal findings with their characteristics:

Uremic gastritis = Ulcerations in the stomach Marked mineralization = Associated with high free calcium Foul-smelling odor = Presence of ammonium Oral ulcers = Especially on the ventral surface of the tongue Signup and view all the answers

Match the types of edema with their causes:

Pulmonary edema = Fluid accumulation in the lungs Ascites = Fluid accumulation in the abdominal cavity Edema due to hypoproteinemia = Decreased protein levels Uremic edema = Due to renal failure Signup and view all the answers

Match the types of azotemia with their corresponding causes:

BUN elevation = Renal insufficiency Creatinine elevation = Impaired kidney function Prerenal azotemia = Dehydration or hypotension Postrenal azotemia = Obstruction of urinary tract Signup and view all the answers

Match the following types of hemorrhages with their characteristics:

Petechial hemorrhages = Occur beneath the capsule Renal hemorrhages = Present in classical swine fever Pulmonary hemorrhages = Common in African swine fever Liver hemorrhages = Associated with Porcine salmonellosis Signup and view all the answers

Match the metabolic abnormalities with their implications:

Metabolic acidosis = Loss of bicarbonate Hypocalcemia = Decreased serum calcium Hypoproteinemia = Edema and ascites Azotemia = BUN and creatinine increase Signup and view all the answers

Match the symptoms of renal failure with their effects:

Polyuria = Frequent urination Neurologic abnormalities = Cognitive impairments Gastrointestinal signs = Nausea and discomfort Pulmonary hypertension = Difficulty breathing Signup and view all the answers

Match the following conditions with their related symptoms:

Renal infarction = Local ischemic necrosis Analgesic nephropathy = Caused by NSAIDs Hydronephrosis = Accumulation of fluid in the kidney Renal medullary necrosis = Associated with papillary necrosis Signup and view all the answers

Match the diseases with their associated findings:

Fibrous osteodystrophy = Bone resorption due to increased PTH Uremic gastritis = Inflammation and ulceration of the stomach Soft tissue mineralization = High free calcium levels Metabolic acidosis = Decreased serum bicarbonate Signup and view all the answers

Match the following causes with the resulting renal condition:

Urinary obstruction = Hydronephrosis Incomplete obstruction = Progressive atrophy of renal parenchyma Dilation of renal pelvis = Early symptom of hydronephrosis Bilateral obstruction = Early death from uremia Signup and view all the answers

Match the following statements with the associated renal condition:

Trapped renal tissue = Renal hemorrhages Wedge-shaped infarct = Common in renal infarction after 2-3 days Fibrous tissue replacement = Occurs post-infarction Dehemoglobinization = Takes place 24 hours after infarction Signup and view all the answers

Match the following drugs with their effects on the kidneys:

Aspirin = Inhibits cyclooxygenase Flunixin = Causes loss of vasodilatory effect Ibuprofen = Contributes to papillary necrosis Phenylbutazone = Associated with analgesic nephropathy Signup and view all the answers

Match the following renal conditions to their descriptions:

Hydronephrosis = Thin-walled sac in advanced cases Renal infarction = Progressive replacement by fibrous tissue Analgesic nephropathy = Results in papillary necrosis Renal medullary necrosis = Loss of vasodilatory effect on arterioles Signup and view all the answers

Match the following conditions with their potential causes:

Prostatic enlargement = May cause hydronephrosis Calculi = Common cause of urinary obstruction Cystitis = Can lead to hydronephrosis Compression of the ureters = Results in renal inflammation Signup and view all the answers

Match the following renal injury markers with their progression timelines:

Swollen and congested tissue = Occurs first in renal infarction Wedge-shaped area changes to white = Occurs after 2-3 days Fibrous scarring = Forms during healing process Fluid accumulation in the renal pelvis = Early sign of hydronephrosis Signup and view all the answers

Match the following mechanisms with their corresponding renal effects:

Inhibition of prostaglandin E2 = Decreased blood flow to juxtamedullary nephrons Infarcted area turning white = Indicates necrosis progression Dilation of renal pelvis = Results from urinary obstruction Renal parenchyma atrophy = Can lead to irreversible damage Signup and view all the answers

Match the following terms with their corresponding descriptions:

Amyloidosis = Abnormal protein deposition interfering with normal tissue function Hydronephrosis = Swelling of a kidney due to a buildup of urine Nephritis = Inflammation of the renal parenchyma Congo red staining = Technique to visualize amyloid with 'apple green' birefringence Signup and view all the answers

Match the types of nephritis with their classification criteria:

Ascending nephritis = Infection route through the uriniferous tubules Descending nephritis = Infection route via hematogenous spread Suppurative nephritis = Type associated with pus formation Non-suppurative nephritis = Type without pus formation Signup and view all the answers

Match the classifications of glomerulonephritis with their descriptions:

Membranous glomerulonephritis = Characterized by thickening of capillaries in the basement membrane Proliferative glomerulonephritis = Increased cellularity due to cell proliferation Membranoproliferative glomerulonephritis = Combination of membranous and proliferative features Acute glomerulonephritis = Rapid onset type of glomerulonephritis Signup and view all the answers

Match the gross findings of amyloid deposition with their descriptions:

Enlarged organs = Abnormally increased organ size Firm texture = Consistency like muscle tissue Pale gray to yellowish-orange appearance = Color change observed in affected organs Finely stippled appearance = Characteristic appearance of kidneys with amyloid Signup and view all the answers

Match the characteristics of urinary stasis with its consequences:

Predisposition to infection = Urinary stasis increases infection risk Pyelonephritis = Kidney infection resulting from urinary obstruction Irreversible renal damage = Result of prolonged urinary obstruction Compensation by contralateral kidney = Normal kidney functioning to compensate for obstruction Signup and view all the answers

Match the microscopic findings with their descriptions:

Acellular eosinophilic material = Homogenous extracellular material in affected areas Expanded glomerular tufts = Increase in size due to amorphous material Lightly eosinophilic material = Indicates presence of amyloid deposits Congo red positive staining = Confirms amyloid presence under microscopy Signup and view all the answers

Match the types of amyloid with their characteristics:

Primary amyloidosis = Associated with plasma cell disorders Secondary amyloidosis = Develops secondary to chronic inflammatory diseases Localized amyloidosis = Found in specific organs without systemic involvement Hereditary amyloidosis = Genetic mutation leading to amyloid production Signup and view all the answers

Match the terms related to abnormal renal findings with their corresponding descriptions:

Waxy organs = Characteristics of organs affected by amyloidosis Pale gray spots = Indicate pathology in kidney structure Staining with iodine = Procedure resulting in red-brown appearance of glomeruli Acetic acid exposure = Further modifies the color change in glomeruli Signup and view all the answers

Match the terms related to urinary obstruction with their effects:

Complete obstruction = Results in irreversible renal damage after 3 weeks Contralateral compensation = Normal kidney function aiding in renal health Urinary stasis = Increases likelihood of pyelonephritis Hydronephrosis = Caused by urine build-up in the kidneys Signup and view all the answers

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Study Notes

Renal Failure

Acute Renal Failure (ARF) is characterized by a sudden decline in renal function within 24 hours.
Chronic Renal Failure (CRF) is a progressive loss of renal function over several months to years.
Azotemia describes an elevated blood urea nitrogen (BUN) and creatinine levels without clinical signs of renal disease.
Uremia is a clinical syndrome with extra-renal lesions caused by high BUN and creatinine levels.
Prerenal Azotemia is caused by renal hypoperfusion (heart failure, shock, or hemorrhage).
Renal Azotemia is a problem caused by direct renal injury.
Postrenal Azotemia is caused by urinary obstruction.

Clinical Pathology of CRF

Anemia: Due to loss of erythropoietin production.
Hypoproteinemia: Edema and ascites occur because of unfiltered protein escaping into the urine.
Metabolic Acidosis: Loss of bicarbonate through the urine.
Hypocalcemia: Three mechanisms:
- Retention of phosphate decreases calcium levels.
- Metabolic acidosis decreases calcium levels.
- Decreased renal 1-α-hydroxylase activity leads to Vitamin D deficiency and lowered calcium absorption.
Hypocalcemia stimulates parathyroid gland hyperplasia, leading to increased parathyroid hormone (PTH) production. This results in bone resorption, fibrous osteodystrophy, and pathologic fractures.

Clinical Findings of CRF

Polyuria: Excessive urination.
Neurologic Abnormalities: Uremic encephalopathy caused by metabolic acidosis and hypocalcemia.
Gastrointestinal Signs: Ulcers caused by:
- Bacteria converting urea to ammonia.
- Damage to endothelial cells.
- Vomiting.
Hypertension: Elevated blood pressure.
Pulmonary Edema: Fluid buildup in the lungs.

Gross Findings of CRF

Kidneys:
- Small, firm, with an irregular surface, usually bilateral.
- Capsule difficult to remove due to adhesions.
- Thinned cortex.
Gastrointestinal Tract:
- Stomach: "Uremic gastritis" characterized by ulcerations, marked mineralization, and red-black blood.
- Oral Cavity: Foul-smelling odor due to ammonia, ulcers (especially on the ventral surface of the tongue).
Widespread Soft Tissue Mineralization: High free calcium levels in the blood lead to mineralization of tissues.
Lungs: "Pumice stone" appearance beneath the parietal pleura, "ladder-like" renal hemorrhages.
Petechial Hemorrhages: Small, pinpoint hemorrhages beneath the capsule, often seen in:
- Classical swine fever (hog cholera).
- African swine fever.
- Porcine salmonellosis.
- Porcine erysipelas (hemorrhages larger and more irregular).
- Porcine circovirus-2.

Renal Infarction

Local Ischemic Necrosis: Occurs due to occlusion of the renal artery or its branches.
Cats: Often indicates hypertrophic cardiomyopathy and distal aortic thromboembolism.

Gross Findings of Renal Infarction

Wedge of Tissue: Swollen and congested.
Dehemoglobinization: Occurs 24 hours after the infarction, turning the tissue pale.
White Infarcted Area: Develops 2-3 days after infarction.
Fibrous Tissue Replacement: Healed infarct tissue with pale gray-white scars, wedge-shaped, and depressed.

Renal Medullary Necrosis

Analgesic Nephropathy: Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, phenylbutazone, flunixin, and ibuprofen inhibit cyclooxygenase.
Loss of Vasodilatory Effect: Inhibits prostaglandin E2 (PGE2) production, leading to decreased blood flow to the juxtamedullary nephrons.
Papillary Necrosis: Damage to the renal papillae (renal crest necrosis).

Hydronephrosis

Accumulation of Fluids: Dilatation of the renal pelvis and progressive atrophy of the renal parenchyma.
Cause: Urinary obstruction (incomplete).
Common Causes:
- Calculi.
- Prostatic enlargement in dogs.
- Cystitis.
- Compression of the ureters.
Bilateral Obstruction: Leads to early death from uremia.
Early Stage: Progressive dilation of the pelvis and calyces.
Advanced Cases: The kidney transforms into a thin-walled sac.
Sequelae:
- Return of renal function if obstruction is removed within a week.
- Irreversible renal damage after three weeks of complete obstruction.
- Unilateral hydronephrosis can be compensated for by the contralateral kidney if normal.
- Urinary stasis increases the risk of infection (pyelonephritis).

Amyloidosis

Abnormal Protein Deposition: Amyloid, an amorphous hyaline substance, is deposited in tissues.
Interferes with Function: Causes pressure atrophy of adjacent cells and hinders normal tissue function.

Gross Findings of Amyloidosis

Enlarged: Kidneys are typically enlarged.
Firm: Firm texture, similar to muscle.
Color: Pale gray to yellowish orange.
Waxy Appearance: Organs have a waxy appearance.
Stippled Appearance: The kidney has a finely stippled appearance with fine yellow spots representing glomeruli.
Iodine Staining: Glomeruli stain red-brown with iodine solution and turn purple when exposed to acetic acid/vinegar.

Microscopic Findings of Amyloidosis

Glomerular Tufts: Expanded by varying amounts of amorphous, finely fibrillar to waxy, lightly eosinophilic material (amyloid).
Acellular Material: Amyloid appears as acellular, pale eosinophilic, homogenous, extracellular material.
Congo Red Staining: Amyloid stains "apple green" birefringence with Congo red dye.

Nephritis

Inflammation of Renal Parenchyma: Inflammation of the kidney tissue.

Classification of Nephritis

Route of Infection:
- Ascending (uriniferous): Infection ascends from the lower urinary tract.
- Descending (hematogenous): Infection spreads from the bloodstream.
Histologic Distribution:
- Suppurative: Contains pus.
- Non-suppurative: Does not contain pus..
- Tubulo-interstitial: Affects the tubules and interstitial tissue.
- Glomerulonephritis: Affects the glomeruli.
- Proliferative: Characterized by increased cellularity due to cell proliferation.
- Membranous: Thickening of the capillary basement membrane.
- Membranoproliferative (mesangiocapillary): Combined features of membranous and proliferative changes.

Glomerulonephritis (GN)

Immune-mediated: Most cases are caused by:
- Antibodies binding antigens in the glomerulus.
- Deposition of circulating immune complexes in the glomeruli.
- Formation of antibodies against the glomerular basement membrane.
Antigen-antibody Complexes: Complexes activate complement components (C3a, C5a), attracting neutrophils and releasing chemokines and oxidants. This damages cellular constituents.

Typical Clinical Findings of GN

Proteinuria: Hallmark sign of glomerulonephritis.
Nephrotic Syndrome: Characterized by proteinuria, hypoalbuminemia, generalized edema, and hypercholesterolemia.

Gross Findings of GN

Bilateral Distribution: Usually affects both kidneys.
Early Stages: Kidneys are pale, edematous, and large with a bulge on the cut surface.
Later Stages: Kidneys are shrunken with a granular pitted surface.

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