Veterinary Medicine - July 2008 - (Page 379)

Hematuria PEER-REVIEWED Figure 4—Upper urinary tract source: Diagnostic procedures and potential outcomes If you suspect upper urinary tract disease, perform a CBC, serum chemistry proﬁle, blood pressure measurement, urinalysis, and urine bacterial and fungal* culture (by cystocentesis). If no abnormalities are found, perform diagnostic imaging of the urogenital tract. (Additional diagnostic tests might include ultrasoundguided aspiration, biopsy, or culture; cystourethroscopy; or an abdominal exploratory.) If parasites are identiﬁed, treat the infection and pursue other diagnostic tests such as diagnostic imaging of the urogenital tract. If microbial growth is identiﬁed, treat the infection as a complicated infection and use the antimicrobial sensitivity results. If other abnormalities are identiﬁed, pursue additional testing as indicated. 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). *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. and include digital palpation of the perineal urethra as part of the urogenital examination. Vaginal examination can be enhanced by using a speculum or digital palpation. Rectal palpation allows the opportunity to palpate the prostate in male dogs, the pelvic urethra in most patients, and the posterior aspect of the bladder in some patients. Identifying pain or irregularities during palpation may indicate that organ or structure as a source of hematuria. Observe the patient during voiding to help verify hematuria and to con rm or detect abnormalities such as dysuria that could localize the source of hematuria. The stage of micturition at which blood appears can also help you localize the origin of hematuria. However, only general guidelines can be given since the stage of micturition when blood is observed often varies for any one source of hematuria. Blood seen at the beginning of urination or dripping independent of urination suggests a genital or urethral source. Blood produced at the end of urination often indicates a urinary bladder origin. Blood that persists throughout micturition is more suggestive of a kidney or ureteral origin, although a bladder origin cannot be ruled out. Urethral catheterization may be indicated in some cases, especially to assess patency in dogs or cats in which dysuria has been observed or reported. STEP 3: PERFORM OR RE-EVALUATE DIAGNOSTIC TESTS After localizing the source of hematuria based on historical and physical examination ndings, follow the most appropriate algorithm (Figures 3-7) to devise a diagnostic plan to identify the speci c cause of hematuria. CBC and serum chemistry proﬁle Performing a CBC and a serum chemistry pro le is never inappropriate in patients with hematuria. However, these tests are particularly indicated in patients with systemic signs of illness; VETERINARY MEDICINE July 2008 379

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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