Veterinary Medicine - July 2008 - (Page 391)

Hematuria PEER-REVIEWED in people, is transient and is thought to be primarily related to bladder mucosal damage that occurs as a result of repetitive or vigorous movement of the bladder during exercise. In some cases, the source of exercise-induced hematuria may be nontraumatic and occur as a result of increased glomerular excretion of RBCs into the urine.10,11 Although uncommon, leakage of RBCs through the glomerulus can occur because of chronic congestive mechanisms resulting from disorders such as heart failure8,12 or as a consequence of ischemic and congestive mechanisms associated with exerciseinduced hematuria.11 Renal hematuria can fall in an idiopathic category. Primary (idiopathic) renal hematuria is thought to result from benign vascular abnormalities that are not readily recognizable through typical diagnostic procedures.13-15 8. Note the blood-tinged urine emerging from the ureter opening (arrow) into the bladder as visualized on cystoscopy. SUMMARY Handling patients with hematuria begins with con rming RBCs in the urine since a variety of pigmented substances can discolor the urine. Hematuria can be confused with hemoglobinuria, myoglobinuria, bilirubinuria, and pseudohematuria. Once RBCs have been con rmed, historical and physical examination ndings can often localize the source of hematuria to the upper urinary tract, lower urinary tract, or genital tract. Coagulopathies must be differentiated from disease of the urogenital tract as the source of urine RBCs. After localizing the source of hematuria, you can follow a series of algorithmic steps delineating a logical diagnostic plan to identify categories of disorders that can lead to a speci c cause of hematuria. REFERENCES 1. DiBartola SP. Renal disease: clinical approach and laboratory evaluation. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier, 2005;1716-1730. 2. Chew DJ, DiBartola SP. Urinalysis interpretation. In: Interpretation of canine and feline urinalysis. Wilmington, Del: The Gloyd Group Inc, 1998;15-33. 3. Davies C, Shell L. Discolored urine. In: Common small animal diagnoses: an algorithmic approach. Philadelphia, Pa: Saunders, 2002;200-201. 4. Bartges JW. Discolored urine. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier, 2005;112-114. 5. Chew DJ, DiBartola SP. Sample handling, preparation, and analysis. In: Interpretation of canine and feline urinalysis. Wilmington, Del: The Gloyd Group Inc, 1998;9-11. 6. McCarthy TC. Lower urinary tract endoscopy, in Proceedings. Western Vet Conf 2002. 7. Chew DJ, McLoughlin MA, Cannizzo K. Uroendoscopy in dogs and cats, in Proceedings. Western Vet Conf 2003. 8. Kaufman GM. Hematuria-dysuria. In: Ettinger SJ, ed. Textbook of veterinary internal medicine. 3rd ed. Philadelphia, Pa: WB Saunders Co, 1989;160-164. 9. Grauer GF. Clinical manifestations of urinary disorders. In: Nelson RW, Couto CG, eds. Manual of small animal internal medicine. St. Louis, Mo: Elsevier Mosby, 2005;368377. 10. Gambrell RC, Blount BW. Exercise–induced hematuria. Am Fam Physician 1996;53(3):905–911. 11. Arbarbanel J, Benet AE, Lask D, et al. Sports hematuria. J Urol 1990;143(5):887-890. 12. Lorenz MD. Discolored urine. In: Lorenz MD, Cornelius LM, eds. Small animal medical diagnosis. Philadelphia, Pa: JB Lippincott Co, 1987;331-342. 13. DiBartola SP. Renal disease: clinical approach and laboratory evaluation. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 6th ed. St. Louis, Mo: Elsevier, 2005;1716-1730. 14. Forrester SD. Diagnostic approach to hematuria in dogs and cats. Vet Clin North Am Small Anim Pract 2004;34(4):849866. 15. Berent AC. Endourology and interventional radiology of the urinary tract, in Proceedings. Am Coll Vet Intern Med Forum 2007. EXTRAS See for information on performing a cystotomy in cats and on urinary tract ultrasonography in dogs. VETERINARY MEDICINE July 2008 391 http://prnpharmacal.com/bloodstop http://prnpharmacal.com/bloodstop

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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