Discoloured urine

Question 1

What are complications of urinary tract disease?

Answer 1

• AKI
• ARF
• CRF

Question 2

What could cause urine to appear brown/red/black?

Answer 2

haematuria, haemaglobinuria or myoglobinuria

Question 3

What can cause myoglobinuria?

Answer 3

Myopathy
◦ Exertional rhabdomyolysis
◦ Postanaesthetic myopathy
◦ Atypical Myopathy
◦ Immune mediate myopathies
◦ Nutritional Myopathies
◦ Toxic myopathies

Question 4

How is myoglobinuria managed?

Answer 4

• IV Fluids (NGT fluids?)
• Analgesia
• Acepromazine?
• Others depending on cause

Question 5

What can cause haemoglobinuria?

Answer 5

Intravascular haemolysis
◦ Equine infectious anaemia
◦ Immune mediated
◦ neonatal isoerythrolysis
◦ Toxic
‣ Red maple leaf
‣ Copper
‣ Wild onion

Question 6

How can haemoglobinuria managed?

Answer 6

• Primary disease
• +/- IV Fluids if concern over kidneys

Question 7

What can cause haematuria? How are they each managed?

Answer 7

• exercise induced
  
  • Benign neglect, Primary disease
• UTI
  
  • Sterile catheterisation or mid stream free catch,
  • Antimicrobials (culture and sensitivity),
  • TMPS if fails to grow on culture
• pyelonephritis
  
  • Sterile culture (can do individual ureter sampling via cystoscopy)
  • Antimicrobials based on culture and sensitivity
  • Removal of calculi if present
• idiopathic renal haematuria
  
  • Supportive, +/- blood transfusion
• idiopathic haemorrhagic cystitis
  
  • NSAIDs and TMPS?
• urethral rents
  
  • Benign neglect?, Causing anaemia and/or unresolving –> surgery
• neoplasia
  
  • Unilateral renal –> nephrectomy,
  • Bladder –> sx removal and topical chemotherapy
• urolithiasis

Question 8

When would you use urine culture as a diagnostic method?

Answer 8

• UTI/cystitis
• pyelonephritis
• idiopathic renal haematuria
• idiopathic haemorrhagic cystitis

Question 9

What clinical signs are associated with nephroliths? How are they diagnosed? How are they managed?

Answer 9

Clinical signs:
* Often none (unilateral),
* Recurrent colic?
* Passed into bladder
* Intermittent/persistent haematuria
* Bilateral –> usually in CRF, signs of obstructive disease

Diagnosis:
* Incidental at post mortem
* Plasma biochemistry: CRF if bilateral, often normal if unilateral
* Urinalysis –> Pigmenturia

Management:
* Surgery +/- lithotripsy

Question 10

What clinical signs are associated with uteroliths? How are they diagnosed? How are they managed?

Answer 10

Clinical signs:
* Originally nephroliths?
* Often none (unilateral),
* Recurrent colic?
* Passed into bladder
* Intermittent/persistent haematuria
* Bilateral –> usually in CRF, signs of obstructive disease

Diagnosis:
* As above
* Rectal Examination
* Transrectal ultrasound

Management
* Surgery +/- lithotripsy

Question 11

What clinical signs are associated with cystic calculi? How are they diagnosed? How are they managed?

Answer 11

Clinical signs
* Dysuria/stranguria/pollakiuria
* Haematuria (often post exercise)

Diagnosis:
* Rectal palpation
* Cystoscopy
* Ultrasonography (rectal)

Management:
* As above
* Mare- manual removal (<10cm), standing procedure

Question 12

What clinical signs are associated with urethral calculi? How are they diagnosed? How are they managed?

Answer 12

Clinical signs
* Acute obstruction
* Colic
* Posturing/attempting to urinate
* Anuria
* Blood at urethral orifice

Diagnosis:
* Urethroscopy
* Pass urinary catheter
* Abdominocentesis if bladder ruptured (peritoneal creatinine to serum x2)

Management:
* Upper urethra –> perineal urethrotomy
* Lower urethra –> transendoscopic retrieval
* Surgery if not possible