Urinary System

Urinary Bladder - Calculus/Crystal

Narrative
Comment:
Calculi may be seen as spontaneous or as chemically induced lesions. Calculi may be single or multiple (Figure 1). Gross examination of the bladder is important since some small calculi may be washed out of the bladder when processed for histopathology. Calculi result from the precipitation of normal constituents or chemical compounds/metabolites associated with changes in urinary pH or other conditions. Frequently in the rodent, calculi contain some form of calcium or mineral complex. Calculi often result in necrosis, ulceration, inflammation, and hyperplasia of the urothelium (Figure 2 and Figure 3). They are often the cause of bladder obstruction. In addition, bladder neoplasia may result from the presence of calculi. The presence of crystals and the subsequent appearance of calculi are often associated. Strain differences in the presence of crystals have been reported. Crystals, like calculi, tend to be washed out during histologic processing.
Recommendations:
Calculi and crystals should be diagnosed but should not be graded. Calculi are usually associated with secondary lesions, such as hemorrhage and inflammation. The pathologist should use his or her judgment in deciding whether or not these secondary lesions are prominent enough to warrant a separate diagnosis. Since calculi may induce neoplasia, a separate diagnosis of hyperplasia is warranted.
References:

Arnold LL, Cano M, St John MK, Healy CE, Cohen SM. 2001. Effect of sulfosulfuron on the urine and urothelium of male rats. Toxicol Pathol 29:344-352.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/11444256

Clayson DB, Fishbein L, Cohen SM. 1995. Effects of stones and other physical factors on the induction of rodent bladder cancer. Food Chem Toxicol 33:771-784.

Abstract: http://www.sciencedirect.com/science/article/pii/0278691595000443

Cohen SM. 1999. Calcium phosphate-containing urinary precipitate in rat urinary bladder carcinogenesis. In: Species Differences in Thyroid, Kidney and Urinary Bladder Carcinogenesis (Capen CC, Dybing E, Rice JM, Wilbourn JD, eds). IARC Scientific Publication No. 147. International Agency for Scientific Cancer, Lyon, France, 175-189.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10627184

Cohen SM, Arnold LL, Cano M, Ito N, Garland EM, Shaw RA. 2000. Calcium phosphate-containing precipitate and the carcinogenicity of sodium salts in rats. Carcinogenesis 21:783-792.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10753216

Cohen SM, Ohnishi T, Clark NM, He J, Arnold LL. 2007. Investigations of rodent urinary bladder carcinogens: Collection, processing, and evaluation of urine and bladders. Toxicol Pathol 35: 337-347.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/17455081

Fukushima S, Murai T. 1999. Calculi, precipitates and microcrystalluria associated with irritation and cell proliferation as a mechanism of urinary bladder carcinogenesis in rats and mice. In: Species Differences in Thyroid, Kidney and Urinary Bladder Carcinogenesis (Capen CC, Dybing E, Rice JM, Wilbourn JD, eds). IARC Scientific Publication No. 147. International Agency for Scientific Cancer, Lyon, France, 159-174.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10627184

Kahn SR. 1998. Calcium oxalate urolithiasis, rat. In: Monographs on Pathology of Laboratory Animals: Urinary System, 2nd ed (Jones TC, Hard GC, Mohr U, eds). Springer, Berlin, 431-438.

Abstract: http://www.ilsi.org/publications/urinarysystem.pdf

Tannehill-Gregg SH, Dominick MA, Reisinger AJ, Moehlenkamp JD, Waites CR, Stock DA, Sanderson TP, Cohen SM, Arnold LL, Schilling BE. 2009. Strain-related differences in urine composition of male rats of potential relevance to urolithiasis. Toxicol Pathol 37:293-305.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/19380840

Wojcinski ZW, Renlund RC, Barsoum NJ, Smith GS. 1992. Struvite urolithiasis in a B6C3F1 mouse. Lab Anim 26: 81-287.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/1447906

Yarlagadda SG, Perazella MA. 2008. Drug-induced crystal nephropathy: An update. Expert Opin Drug Safety 7:147-158.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/18324877
  • Image of calculus in the urinary bladder from a male F344/N rat in a chronic study

    A calculus (asterisk) fills the entire bladder lumen from a male F344/N rat in a chronic study.

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A calculus (asterisk) fills the entire bladder lumen from a male F344/N rat in a chronic study.
A calculus (asterisk) fills the entire bladder lumen from a male F344/N rat in a chronic study.
Hyperplasia of the urothelium (arrow) due to the presence of the calculus, from a male F344/N rat in a chronic study.
Hyperplasia of the urothelium (arrow) due to the presence of the calculus, from a male F344/N rat in a chronic study.
A small basophilic calculus (arrow) associated with chronic inflammation and urothelial hyperplasia, from a female Harlan Sprague-Dawley rat in a chronic study.
A small basophilic calculus (arrow) associated with chronic inflammation and urothelial hyperplasia, from a female Harlan Sprague-Dawley rat in a chronic study.

Authors

John Curtis Seely, DVM, DACVP
Senior Pathologist
Experimental Pathology Laboratories, Inc.
Research Triangle Park, NC

Abraham Nyska,  DVM, Diplomate ECVP, Fellow IATP
Expert in Toxicologic Pathology
Visiting Full Professor of Pathology
Sackler School of Medicine, Tel Aviv University
Timrat Israel

Reviewers

Samuel M Cohen, PHD, MD
Professor
Havlik-Wall Professor of Oncology
Director of Pathology Residency Program
Nebraska Medical Center
Omaha, NE

David E. Malarkey DVM, PhD, DACVP, FIATP
Head, National Toxicology Program Pathology Group
Cellular and Molecular Pathology Branch
Division of the National Toxicology Program
National Institute of Environmental Health Sciences
Research Triangle Park, NC