Veterinary Medicine - July 2008 - (Page 387)

Hematuria PEER-REVIEWED Figure 7—Unknown source: Diagnostic procedures and potential outcomes Perform a CBC, serum chemistry proﬁle, urinalysis, and urine bacterial and fungal* culture (by cystocentesis). If the urinalysis results are normal with or without other abnormalities, perform a urinalysis on a voided sample. If any of the test results are abnormal, treat for microbial growth, if appropriate, and pursue additional tests as indicated. Also perform diagnostic imaging of the urogenital tract. If the results of the urinalysis on the voided sample are abnormal, go to the genital tract source algorithm (Figure 5). If the results of the urinalysis on the voided sample are normal, perform diagnostic imaging of the urogenital tract. If the diagnostic imaging results are abnormal, consider additional diagnostic tests such as ultrasound-guided aspiration, biopsy, or culture; cystourethroscopy; or an abdominal exploratory. If the diagnostic imaging results are normal, rule out a coagulopathy by performing a coagulation proﬁle. Abnormalities that may be identiﬁed on the additional diagnostic testing include a mass or neoplastic changes, evidence of trauma, cysts or anatomical defects, calculi, and inﬂammatory, toxic, embolic, or congestive changes. If no deﬁnitive abnormalities are seen on additional diagnostic testing, the hematuria is either exercised-induced (with appropriate history) or idiopathic. If the results of the coagulation proﬁle are normal, consider additional diagnostic tests such as ultrasound-guided aspiration, biopsy, or culture; cystourethroscopy; or an abdominal exploratory. If the results of the coagulation proﬁle are abnormal, pursue diagnostic procedures appropriate for coagulopathies. *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. STEP 4: PINPOINT THE CAUSE BASED ON DIAGNOSTIC TEST RESULTS Table 1 summarizes possible causes of hematuria based on potential outcomes of the diagnostic algorithms for suspected urogenital sources. Exercise-induced hematuria may represent a rare subcategory of trauma that is diagnosed by excluding other causes of hematuria and noting a history of vigorous exercise that occurred within minutes to a few days before blood became apparent in the urine.8,9 Exercise-induced hematuria, as described VETERINARY MEDICINE July 2008 387

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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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