Pathology
of the
Urinary
System
EM Cabana, BSAH, DVSM, MVSt (VPath), PhD
Professor – Veterinary Pathology
Reading Assignment
Pathologic Basis of Veterinary Disease
5th ed 2012
• Urinary System: p589-649 (60 pages)
Calyx
Cortex
Pelvis
Medulla Renal
Artery
Renal
Vein
Renal
Pyramid
Ureter
Bowman’s
Glomerulus capsule Proximal Distal
Tubule Tubule
Afferent
arteriole
Efferent
arteriole
Medulla
Loop of
Henle Collecting Duct
Glomerulus Loop of
Henle
Proximal
tubule
Bowman’s capsule
Arterial Branching
Interlobular
artery
Arcuate artery
Interlobar artery
Renal artery
Glomerulus
Afferent Efferent
arteriole arteriole
Bowman’s
capsule
Peritubular
capillaries
Proximal
tubule
Podocyte
Red blood cell
Lumen
Basement
membrane
Endothelial cell
Mesangial cell
Podocyte
Capillary
Juxtaglomerular Macula densa
Cells cells
Renal Regulation of GFR
Renal auto regulation:
If GFR Drops
Increase renal
blood flow Filtrate flows thru nephron slowly
Dilation of afferent
arterioles Macula Densa
Renal Regulation of GFR
regulation of Blood Pressure:
If Blood pressure Drops,
GFR Drops
Blood pressure, renal
perfusion & GFR returns
to normal
JG cells secrete Renin
Sytemic Angiotensin II and
vasoconstriction Aldosterone formed
Renal Failure
Pre-renal causes:
• Diseases that reduces renal perfusion
Renal causes:
• Diseases of the kidneys
Post-renal causes:
• Obstructive lesions in the ureters,
urinary bladder and urethra
Uremia
An endotoxaemic state caused by renal
failure; “End-Stage Kidney”
Azotaemia – elevation of nitrogenous
products of protein catabolism (urea and
creatinine)
Other toxic substances include:
• High molecular weight Alcohols
• Guanidine and Phenolic acids
• Electrolytes particularly Sodium and Potassium
Death is due to cardiotoxicity of elevated
potassium, and metabolic acidosis
Extra-renal lesions of Uremia
Pulmonary edema
Fibrinous pericarditis
Ulcerative stomatitis and gastritis
Atrial and aortic plaques
Hypoplastic anemia
Soft tissue mineralisation
Hyperplastic parathyroids
Uremia: Stomatitis
Uremia: Stomatitis, Dog
Uremia: Atrial plaques
Uremia: Ulcerative gastritis
Uremia: Mineralization of pleura
Uremia: Parathyroid hyperplasia
Nephrotic Syndrome
The nephrotic syndrome is characterized by
massive proteinuria.
Effects include:
• Hypoproteinemia or hypoalbunemia
• Hyperlipidemia with elevated cholesterols,
triglicerides and other lipids,
• Edema – due to hypoosmolar state caused
by the loss of plasma proteins, and from
abnormal salt and water retention
Nephrotic Syndrome
Nephrotic Syndrome
Pathology of the
Kidneys
Horseshoe kidney: Cat
Horseshoe kidney: Horse
Renal Dysplasia: Porcine
Polycystic kidney: Dog
Polycystic kidney: Porcine
Solitary cyst
Congenital Hypoplasia: Ovine
Congenital Hypoplasia: Cattle
Infarction of the Kidney
Infarction of the Kidney
Kidney Hemorrhages: PDNS
Kidney Hemorrhages: CSF
Amyloidosis: Canine
Amyloidosis: Canine
Amyloidosis: Canine
Congo red stain
Renal carcinoma
Renal carcinoma: Equine
Tumor Metastasis
Diseases of the
Glomerulus
Glomerulonephritis
Mainly immune-mediated:
• Formation of autoantibodies against
basement membrane
• Deposition of immune complexes
(immune complex glomerulonephritis)
Autoantibodies: IgA nephropathy
Autoantibodies: IgA nephropathy
IgG nephropathy: Goodpasture’s
Syndrome, Human
Glomerulonephritis
Types:
Proliferative – observed in cattle,
sheep, horse and pigs
Membranous – observed in dogs,
cats and pigs
Membrano-proliferative – observed
in and dogs, horses and pigs
Proliferative glomerulonephritis
Membranous glomerulonephritis
Membranous glomerulonephritis: TEM
Membranous glomerulonephritis: FAT
Membrano-proliferative glomerulonephritis
MPGN Type 1
MPGN Type 2
Glomerulonephritis
Specific Causes:
Immune mediated disease (SLE, IHA)
Bacterial septicemias
Blood Parasites
• Canine Heartworm Disease
• Trypanosomiasis
Viral disorders
• Feline infectious Peritonitis
• Feline Leukemia virus
• Hog Cholera
• Bovine Viral Diarrhea
Course and Consequence of
Glomerulonephritis
Widespread glomerular disease
Reduced GFR Filtration failure
& proteinuria
Acute renal failure Nephrotic syndrome
& proteinuria
Renal Failure and
Nephrotic syndrome
Glomerulonephritis
Effects:
Leads to nephrotic syndrome, then
anuria, and finally, Uraemia
In chronic cases, leads to
glomerulosclerosis
Glomerulosclerosis
Glomerulosclerosis
Pathology of the
Tubules and Interstitium
Tubulo-interstitial Diseases
Nephrosis (Tubular necrosis)
Causes include:
• Circulatory disturbances
• Prolonged ischaemia/anoxia
• Toxicities
• Antibiotic overdose
• Macrolide
• Sulfa drugs
Nephrosis
Course and Consequence of Nephrosis
Abrupt onset of tubular necrosis
Renal “shutdown”
Necrosis Tubulorrhexis
may cease impede
If irreversible
Leads to regeneration
Uraemia
Epithelial
regeneration
Sclerosis
Tubulo-interstitial Diseases
Interstitial nephritis
• Usually haematogenous
• Most common form
• Interrupts tubular function leading to:
• Defect in electrolyte balance
• Defect in urine concentration
Interstitial nephritis
Course and Consequence of
Interstitial Nephritis
Inflammation of kidney interstitium
Progressive loss of nephrons
with replacement fibrosis
Reduction of renal mass
leads to polyuric renal failure (isosthenuria)
Sclerosis and Uremia
Interstitial nephritis
Interstitial nephritis
Tubulo-interstitial Diseases
Embolic Suppurative nephritis
• Usually haematogenous, following
bacterial septicaemia
Pyelonephritis
• Ascending urinary tract infection following
an established lower urinary tract disease
Embolic Suppurative Nephritis
Pyelonephritis: Lamb
Pyelonephritis: Dog
Pyelonephritis: Dog
Diseases of the
Lower Urinary Tract
Lower Urinary Tract Disease
Ureteritis – inflammation of the ureters
Cystitis – inflamation of the urinary
bladder
Urethritis – inflammation of the urethra
Urolithiasis – urinary stone formation
Neoplasms
Pathology of Bacterial Infection of
Lower Urinary Tract
Lower urinary tract is normally sterile due
to:
• Regular flushing action by urine
• Antibacterial property of urine itself
• Secretory IgA and mucus with are anti-
adhesive for bacteria
Bacterial infection occur when there is:
• Urine stasis
• Trauma
• Altered urine constituents and character
Ureteritis: Pig
Cystitis: Pig
Cystitis: Dog
Cystitis: Dog
Hemorrhagic Cystitis
Urethritis: Cattle
Urethritis: Horse
Bladder Rupture: Cattle
Growth Disturbances
Non-neoplastic changes:
• Squamous metaplasia
• Glandular metaplasia
Neoplasms:
• Transitional Cell Papilloma
• Transitional Cell Carcinoma – 90% of
bladder tumors in domestic animals
• Other tumors:
• Adenocarcinoma
• Squamous cell carcinoma
• Undifferentiated Carcinoma
Normal Bladder Mucosa
Squamous Metaplasia
Glandular Metaplasia
Transitional Papilloma
Transitional Papilloma
Transitional Papilloma
Transitional Papilloma (inverted)
Bladder Carcinoma: Dog
Transitional Cell Carcinoma
Transitional Cell Carcinoma
Transitional Cell Carcinoma
Lower Urinary Tract Diseases
Urolithiasis – stone formation;
(urinary calculi, urolith, urinary stone)
Causes include:
• Oversaturation of urine with solutes
• Predisposing factors:
• Vitamin A deficiency
• Phosphate, oxalate in plants and silicates
• Amino acid transport defect
• Infection of the urinary bladder
Uric acid metabolism
Fructose
metabolism
Purines
from meat
(Uricase)
In the dalmatian, a
defect of the uric
acid transporter
SLC2A9 alters
hepatic and renal
transport of uric
acid, leading to
abnormally high
serum and urine
concentrations
of uric acid
Urolith Impaction Sites
Male animals:
• Ischial arch
• Sigmoid flexure in ruminants
• Vermiform appendage of ram
• Proximal end of os penis in dogs
• Penile urethra in cats
Female animals:
• Renal pelvis
• Urinary bladder
Uroliths
Seven types found in domestic
animals:
1. Struvite (NH4, Mg, and PO4) - in dogs
and ruminants
2. Oxalate – dogs and sheep
3. Cysteine – exclusive in male dogs, and
in cats
Uroliths
4. Xanthine – in sheep, cattle, and rare in
dogs. Related to molybdenum deficiency
5. Calcium Carbonate – horses
6. Silica – horses, ruminants, pigs, rare in
dogs and cats
7. Urate – in dogs, particularly Dalmatian
breed
Urolith: Struvite
Urolith: Oxalate
Urolith: Cysteine
Urolith: Urate
Consequence of Urolithiasis
Partial obstruction:
• Urinary retention
• Secondary bacterial infection
• Atrophy of kidney
• Hydronephrosis
Complete obstruction:
• Urinary retention
• Post renal failure
• Bladder wall rupture
Hydronephrosis: Dog
Feline Urologic Syndrome
A disorder in cats brought about by the
accumulation of mineral crystals within
the urinary tract
Syndrome includes:
• Cystitis
• urolithiasis
• urethral blockage
• Uremia
Also known as Feline Lower Urinary Tract
Disease (FLUTD)
Causes of FUS
Diet - foods containing extremes in
magnesium or producing extremes in
urine pH
Reduced Frequency of Urination:
• Decreased water intake
• Reduced physical activity
• Litter box that is dirty or not
accessible
Signs of FUS
Early signs:
• Change in urinary habits
• Difficulty in urinating
• Frequent attempts to urinate with passage
of only small amounts of urine.
• Blood in the urine -- a pink tinge to the
urine
• Excessive licking at the penis or female
genitalia.
Signs of FUS
Late signs:
• Loss of appetite, depression, vomiting.
• Urine-like odor to the breath.
• Abdominal pain due to bladder
distention
• Coma and death
End of Lecture in
Pathology of the Urinary System
