Veterinary Medicine - July 2008 - (Page 378)

Hematuria PEER-REVIEWED Figure 3—Lower urinary tract source: Diagnostic procedures and potential outcomes If you suspect lower urinary tract disease, obtain a sample by cystocentesis and perform a complete urinalysis and urine bacterial and fungal* culture. If no microbial growth occurs with or without urinalysis abnormalities (e.g. RBCs, WBCs, crystals, protein, Capillaria species ova), either treat for a Capillaria species infection or perform diagnostic imaging of the urogenital tract. (Additional diagnostic tests might include ultrasound-guided aspiration, biopsy, or culture; cystourethroscopy; or an abdominal exploratory.) If microbial growth occurs (e.g. bacteria, fungus, Mycoplasma species) with or without urinalysis abnormalities and it is a ﬁrst-time infection, treat as appropriate. Abnormalities that might be found include a mass or neoplastic changes, evidence of trauma, calculi, cysts or anatomical defects, and inﬂammatory, toxic, embolic, or congestive changes. If no abnormalities are found, go to the unknown source algorithm (Figure 7). If microbial growth occurs (e.g. bacteria, fungus, Mycoplasma species) with or without urinalysis abnormalities and it is a reinfection or recurrence, treat according to antimicrobial sensitivity testing results and pursue additional diagnostic tests such as a CBC, a serum chemistry proﬁle, and diagnostic imaging of the urogenital tract. *Fungal culture is primarily indicated when systemic evidence of fungal infection is present, urinalysis reveals fungal organisms, the patient is immunocompromised, or the patient has a history of antibiotic-resistant or repeated episodes of urinary tract infection. tract may also connect hematuria to a coagulopathy. Suspect a coagulopathy if the physical examination reveals bleeding from another organ system, including petechiation or ecchymoses of the skin. Perform a fundic examination not only to determine evidence of infectious or neoplastic disease but also to look for retinal hemorrhage that could indicate a coagulopathy. Although systemic hypertension is not generally considered a primary cause of hematuria, its presence is often associated with renal disease and could exacerbate bleeding and alter treatment. Historical and physical ndings that may indicate systemic hypertension include polydipsia and polyuria; cardiac murmur; tachycar- dia; epistaxis; neurologic signs such as disorientation, ataxia, or seizures; and ocular abnormalities such as choroidopathy, retinopathy, and hemorrhage. When blood is observed grossly in a voided sample but is not as readily apparent in urine obtained by cystocentesis or catheterization, suspect a genital or urethral source of hematuria. However, hematuria from a genital tract or urethral source can sometimes be observed in both voided and nonvoided samples since the collection technique can result in iatrogenic RBC contamination or because material from the genital tract or urethra may re ux into the bladder, especially in patients with prostatic disease. Examine the urogenital area and observe voiding During the physical examination, be sure to inspect the genitalia and urethral ori ce as well as to abdominally palpate the bladder, kidneys, and prostate. Although sometimes involved in disorders resulting in hematuria, the uterus is generally not palpable in intact female dogs unless it is enlarged or associated with a mass. If the bladder is markedly distended with urine when palpated, palpate it again after the animal has voided to increase the chances of palpating abnormalities in the bladder wall or lumen. Extrude the penis from the prepuce for inspection in male patients, 378 July 2008 VETERINARY MEDICINE

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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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