URINARY SYSTEM PATHOLOGY

TABLE OF CONTENTS

Unit 1 – Normal Structure and Function………………………………. page 2

Unit 2 – Vocabulary and Renal Failure……………………………….. page 4
Unit 3 - Circulatory Disturbances………………………………………. page 6
Unit 3 – Glomerular Disease……………………………………………. page 7
Unit 3 – Tubular Diseases……………………………………………….. page 9
Unit 4 – Bladder…....……………………………………………..…….. page 11

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 Unit 1 – Normal Structure and Function
Grossly, kidneys are divided into three parts – cortex, medulla, and pelvis (see diagram below):

And there are some species differences –

Cattle have kidneys that are composed of multiple  Horse kidneys have mucus glands in the pelvis, and so 
lobes.  there is often a lot of mucus in this area. 

The urine collected in the pelvis moves on down the ureter and into the bladder, where it remains
until there is a conscious decision to relax the sphincter and urinate.

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The cortex is where all the action happens - this is the focus of all the filtering and absorptive
functions.

The nephron is the functional unit of the kidney, consisting of renal corpuscle (glomerulus and
associated blood vessels), proximal convoluted tubule, loop of Henle, distal tubules, and
collecting ducts.

Blood comes into the kidney and arterioles branch and go directly to the glomerulus where they
are intertwined with the glomerular apparatus. The blood and the glomerular cells are very
closely attached, and the blood filtrate gets pushed through the membrane into the urinary space.
Only water and the smallest molecules can make it through unless there is something wrong with
the glomerulus, in which case much bigger molecules go through.

From the urinary space of the glomerulus, the filtrate goes on into the proximal tubule and loop
of Henle. The lining cells here are very active, and have a brush border that greatly increases the
surface area. The proximal tubular cells and loop of Henle cells are active in re-absorbing all the
good ions back into the body, including Na+, K+, and Cl- as well as water. The amount of each
of these that is reabsorbed is regulated by antidiuretic hormone and keeps the general osmolarity
of the body in balance.

From here the filtrate moves on into the distal tubules and collecting ducts, which serve to
further concentrate the filtrate, and it becomes urine.

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 Unit 2 – Renal Failure and Associated Vocabulary
Renal function is essential for life. When the kidneys fail, that is very bad, because ionic balance
is all screwed up and also excretory wastes are not disposed.

Kidneys can fail because the glomeruli stop working or the tubules stop working. But a problem
in one usually leads to problems in the other.

The body functions fine until more than 75% of renal function is lost (this means 75% of
nephrons aren’t working). At that point, it becomes “end stage kidney disease” and this can be
started by glomerular, tubular, or interstitial problems.

END STAGE KIDNEYS are small,

pitted and fibrotic. This term is used
because of the inability to differentiate
antecedent cause, which may have been
glomerular, tubular, vascular or
interstitial. Renal failure with azotemia
and uremia would be expected.

RETENTION OF EXCRETORY WASTES

 Azotemia is defined as the presence of excessive urea or creatinine in the blood without
clinical manifestation of renal disease. Azotemia may be due to several causes:

 Uremia is the presence of urinary constituents in the blood AND the toxic condition
produced by those constituents. Thus uremic animals would be azotemic AND have
clinical signs or systemic lesions caused by the retained waste products. Nausea and
depression are common.

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ABNORMAL URINE EXCRETION
 Anuria is the absence of urine
excretion.
 Oligouria is reduction in the
amount of urine excreted. There
are many causes, including
dehydration.
 Polyuria is the passage of
abnormally large amounts of
urine.
 Pollakiuria is increased frequency of urination (the amount may be normal).

 Dysuria is painful or difficult

urination.
 Stranguria is the slow and
painful discharge of urine due to
spasm of the urethra or bladder.

EXCRETION OF ABNORMAL SUBSTANCES

 Proteinuria is the presence of excess protein in the urine.
 Glucosuria is the presence of glucose in the urine.
 Crystalluria is the presence of crystals in the urine.
 Pyuria is neutrophils in the urine
 Hemoglobinuria is the presence of hemoglobin in the urine.
 Myoglobinuria is the presence of myoglobin in the urine, due to muscle damage.
 Hematuria is the presence of red blood cells in the urine.

RED URINE
Urine may be red due to: hemoglobin, myoglobin, or red blood cells. In addition, certain foods
(e.g. beets), drugs and even chronic lead or mercury poisoning may result in red urine.

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 Unit 3 - Circulatory disturbances
There are two big problems that happen in the kidney relative to circulatory disorders.

The first big circulatory problem in the kidney is infarction. The arteries of the kidney are
called “end arteries”, which means there is no collateral circulation. Consequently, if there is a
thrombotic or embolic problem in the animal, these arteries are likely to get infarcted, because
with end arteries, there is no peripheral circulation. Infarcts are red at first, then they become
white, then they get replaced with fibrous tissue which shrinks the area and causes an
indentation.

The second circulatory problem that happens in the kidney is that it is very susceptible to
hypoxia! So anytime there is very severe anemia or hypovolemic shock, the kidneys might just
shut down entirely. The proximal tubule cells will die if not constantly exposed to enough
oxygen, and they never recover. Necrosis of proximal tubules is called NEPHROSIS and will be
covered more later.

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 Unit 4- Glomerular diseases

When there is glomerular disease, the filtration function is altered. So, instead of just very small
ions and water passing through the glomerulus into the tubules, bigger molecules that are
supposed to stay in the blood (!) get passed through into the urine. THIS IS BAD!

An additional problem is that when the glomerulus is altered, the blood flow to the tubules
changes. All the blood to the kidney goes through the glomerulus first, so if there is a problem in
the glomerulus, the tubules don’t get enough blood, and they eventually die too!

Main causes of damage to the glomerulus:

Amyloid is an unusual protein ("beta pleated sheet") formed by cleavage from larger proteins
and then deposited in extracellular areas of tissues, especially glomerulus! It totally screws up
the filtration (there isn’t any) and all the protein in the blood just spills out into the urine.
Amyloid is something that just happens, there are no good reasons. It is usually seen in old
animals.

Normal glomerulus  Glomerulus filled with amyloid – no filtration!

Immune complex glomerular disease: If

there is chronic antigen circulating and many
antibodies produced, these form complexes
that get deposited in the glomerular
membranes. The result is similar to amyloid,
filtration is screwed up, basically, there isn’t
any, and protein goes right through into the
urine.

Acute infectious inflammation due to bacteria, usually part of a bacterial septicemia, can settle
in the glomerulus.

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 Unfortunately, there are not really any gross lesions with glomerular
changes, so we can’t do a gross morphologic diagnosis.

PROTEINURIA is the hallmark of glomerular disease. When the glomerulus is messed up, there
is no filtering, and protein goes directly through the open door of the glomerulus and into the
urine.

As a result there is often hypoproteinemia and edema in many parts of the body.

THROMBOSIS
Thrombosis is a common sequela of severe glomerular amyloidosis and proteinuria in dogs.
This is attributed to the loss of proteins that inhibit coagulation (i.e., anti-thrombin III) in the
urine. Since they are depleted, inhibition of coagulation is less, and thrombosis may result.

This dog had glomerular amyloidosis

and was leaking protein into the urine.
A common problem with this disease
situation is that the animal is very pro-
thrombotic and pulmonary thrombosis
happens. Which is more or less instant
death (whole body hypoxia).

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 Unit 5- Tubular disease
The tubules are a very important part of the nephron and essential for maintaining the body’s
ionic balance and also ensuring that bad waste products get disposed. When tubules become
necrotic, the term is NEPHROSIS. Nephrosis is really awful and life-threatening.

Unfortunately, there are not really any gross lesions with glomerular
changes, so we can’t do a gross morphologic diagnosis.

What are the causes of nephrosis???

ISCHEMIA is a big one. A sudden severe drop in blood pressure (like SHOCK), or massive
hemorrhage, can cause the acute tubular necrosis (nephrosis) and the kidneys will never
recover.

HEMOLYSIS will also cause nephrosis. Free hemoglobin in the blood is toxic to the tubules.

CRYSTALS that settle out in the tubules will damage them mechanically and uh oh, dead
tubules.

TOXINS – There are MANY toxins that affect the tubules of the kidney. Certain plants, heavy
metals, excess copper, mycotoxins. Also, too much gentamycin or kanamycin will cause
nephrosis.

BACTERIA – Leptospira grows inside the tubules and kills the tubular cells (nephrosis).

A characteristic of NEPHROSIS is finding CASTS of protein or cells in the urine:

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PYELONEPHRITIS
Pyelonephritis happens when bacteria come up
from the bladder. There is always cystitis
(bladder inflammation) associated with
pyelonephritis. The organisms have such a
good time in the bladder that they decide to go
on a little trip up the ureter, and the pelvis of
the kidney and the collecting ducts there
become inflamed.

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 Unit 6 – Bladder
UROLITHIASIS
Urinary calculi (uroliths) may be found in the renal pelvis (nephroliths), ureter (ureterolith), urinary
bladder (urocystolith), or urethra (urethrolith). They are most commonly found in the bladder so they
are covered this chapter.

Stones are composed of various minerals and

knowing which mineral is present can help you
determine the cause and prevent future
occurrences. In males they often lodge in the
urethra. Ouch.

Urinary tract obstruction is common in male cats and is called

feline urologic syndrome (FUS) or BLOCKED CAT.
The
blockage is due to small stones, almost like sand.

Inflammation of the bladder is called CYSTITIS. It is most commonly caused by bacteria that are
present around the anus, specifically coliforms. If these bacteria get the chance to move into the
environment of the urethra and the bladder, they do that.

Some predisposing factors for cystitis include:

 Being a female – females have a shorter urethra so the bacteria don’t have to travel as far!
 Urine stagnation – animal is not urinating voluntarily and so urine builds up in the bladder.
There is not the flushing action that cleans the urethra regularly.
 Mucosa trauma – usually due to catheterization
 Glucose in the urine – this occurs in diabetes, the bacteria do very well with extra glucose!

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