Veterinary Medicine - July 2008 - (Page 376)

Hematuria PEER-REVIEWED Figure 2—Evaluating historical and physical examination ﬁndings to localize the source of hematuria Indicative of lower urinary tract disease • Pollakiuria • Dysuria or stranguria • Blood observed at the beginning or end of urination • Blood dripping from the vulva or penis independent of urination • Blood apparent grossly in a voided urine sample but not in a nonvoided sample • Abnormalities of the bladder or urethra suspected by observation or palpation • History of exposure to toxins or drugs such as cyclophosphamide • History of trauma or vigorous exercise before observing the hematuria Indicative of upper urinary tract disease • Polydipsia and polyuria • Signs of systemic disease such as weight loss, fever, or ocular abnormalities or other clinical signs related to hypertension • Persistent blood throughout micturition • Abnormalities of the kidney or ureters suspected by observation or palpation • History of exposure to nephrotoxic drugs • History of trauma or vigorous exercise before observing the hematuria Indicative of genital tract disease • Tenesmus or dysuria • Blood observed at the beginning of urination • Blood dripping from the vulva or penis independent of urination • Blood apparent grossly in a voided urine sample but not in a nonvoided sample • Abnormalities of the genital tract suspected by observation or palpation • Historical or physical evidence of recent estrous cycle or breeding or trauma • Signs of systemic disease such as fever or lethargy Indicative of a coagulopathy • Petechiae or ecchymoses • Concurrent bleeding from other organ systems • Bleeding into body cavities • History of exposure to drugs or toxins affecting coagulation Hematuria from an unknown source • Hematuria is the sole clinical sign • Presence of apparently unrelated historical and clinical ﬁndings laboratories are good resources for investigating the possible presence of toxins, dyes, medications, and porphyrins. In addition, PennGen, the Section of Medical Genetics associated with the University of Pennsylvania School of Veterinary Medicine, may be able to provide guidance in detecting inherited disorders of heme synthesis in young patients. problem and localizing the source of hematuria (Figure 2). Obtain the patient’s reproductive history and, in intact females, estrous cycle information as part of a complete history. Ask the owner about the possibility of trauma to the pet, including whether the pet has a history of recent vigorous exercise prior to the observation of discolored urine. STEP 2: RE-EVALUATE HISTORICAL AND PHYSICAL EXAMINATION FINDINGS A thorough history and physical examination often play important roles in identifying hematuria as a potential Note clinical signs, history, and variations in hematuria based on the collection method Identifying signs of systemic disease, urination frequency, and dysuria can help establish whether the hematuria more likely originates from the upper urinary tract, lower urinary tract, or genital tract. Classic signs of lower urinary tract disease include pollakiuria and dysuria. Signs of systemic disease such as weight loss or fever support upper urinary tract or, in some cases, genital tract disease. Dif cult defecation in male dogs may indicate prostatic disease. A patient’s medication history or its potential exposure to toxins may signal hematuria related to a coagulopathy or originating from the upper urinary tract. Determining whether the owner has seen evidence of bleeding unrelated to the urinary 376 July 2008 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - July 2008

Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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