Equine Hematuria Flashcards
what is the normal amount of RBC’s in urine?
5,000 RBC/ml which should not be seen by gross inspection, be less than 5 RBC/hpf on sediment examination, yield negative results on dipstick analysis
microscopic hematuria
10,000 to 2,500,000/ml RBCs in urine that cannot be seen gross inspection, is associated with > 10 RBC/hpf on sediment exam and causes a trace to 3+ rxn on dipstick analysis
macroscopic hematuria
2,500,000 - 5,000,000/ml RBC’s in urine that can be seen by gross inspection, and has an observable red cell pellet and clearing of supernatant after centrifugation
sources of blood in urine
urethra, urinary bladder, ureter, kidney
blood detected at the beginning of urination is localized to the __, end of urination to the __ and throughout urination to the __
blood detected at the beginning of urination is localized to the distal urethra, end of urination to the proximal urethra or bladder and throughout urination to the kidney, ureter, bladder
urethral hematuria causes
beginning of urination
neoplasia
urethral calculus
urethral rents
habronemiasis
what are the 4 most common tumors of the distal urethra and external genitalia
SCC, fibrosarcoma, sarcoid, papilloma
Squamous cell carcinomas are the __ tumor of the penis. Theres often depigmentation, ulceration, and foul odor or discharge. How do you treat them?
Squamous cell carcinomas are the most common tumor of the penis. Theres often depigmentation, ulceration, and foul odor or discharge. Tx with surgical removal, cryosurgery, hyperthermia, topical 5 fluoruracil or intralesional cisplatin.
urethral rents
Geldings or stallions present with hematuria at the end of urination as a result of a tear in the pelvic, dorsal urethral mucosa. When the bulbourethral muscles contract if forces blood through the tear into the urethral lumen. When the bulbourethral muscles contract it forces blood through the tear into the urethral lumen. Surgically treat with perineal urethrotomy or corpus spongiotomy.
urethral calculus
This usually occurs in stallions or geldings where the stone lodges at the ischial arch which leads to signs of colic and stranguria. This is diagnosed with ultrasound, confirmed with urethroscopy and treated by perineal urethrotomy or laser photofragmentation.
Habronemiasis
This causes a proliferative lesion on the distal aspect of the penis and is diagnosed by biopsy. Treatment is by ivermectin, local/systemic glucocorticoid or surgical excision.
vesical hematuria (blood in bladder)
Bleeding into the urinary bladder that causes hematuria at the end of urination or throughout urination. Vesical hematuria may be caused by calculus, neoplasia, bacterial cystitis, trauma, idiopathic hemorrhagic cystitis
Cystic calculi
These are located in the bladder and cause signs of dysuria. Cystic calculi can be diagnosed by rectal palpation and/or ultrasonography. Non-surgical removal by hydraulic fragmentation is the quickest and best option.
Neoplasia
Hematuria is often the presenting sign with neoplasia of the urinary bladder with squamous cell carcinomas being the most common tumor of the urinary bladder.
diagnosis and treatment of urinary bladder neoplasia
Diagnosis:
Rectal palpation, ultrasound exam, cystoscopy and biopsy, immunohistochemistry
Treatment: surgical resection, intravesicular installation of 5-fluoruracil, cox 2 selective NSAID’s
successful long tern outcomes have not been reported
bacterial cystitis
Occurs infrequently in the horse
This is often associated with inability to completely evacuate the bladder. Diagnosed by examination of urine sediment containing RBC, WBC, and bacteria. Treatment is by systemic administration of an antimicrobial based on urine c/s
Idiopathic hemorrhagic cystitis occurs in __ horses with signs of __ and __ . On ultrasound there will be a __ bladder wall and on histopath it might suggest __. Treat it with __ and theres a __ prognosis
Idiopathic hemorrhagic cystitis occurs in mature horses with signs of hematuria and pollakiuria. On ultrasound there will be a thickened bladder wall and on histopath it might suggest TCC. Treat it with potentiated sulfonamides and theres a favorable prognosis.
Ureteral Hematuria
bleeding from the ureters may cause hematuria observed throughout urination
Ureterolith likely originate in the __ and are passed into the __. Affected horse usually remains asymptomatic until obstruction of both ureters causes __ and __. This is diagnosed by __ and __. Ureteroliths may be surgically (ureterotomy) or non surgical removal (endoscopic basket stone extraction)
Ureterolith likely originate in the kidney and are passed into the ureter. Affected horse usually remains asymptomatic until obstruction of both ureters causes post renal azotemia and hydronephrosis. This is diagnosed by rectal palpation and ultrasonography. Ureteroliths may be surgically (ureterotomy) or non surgical removal (endoscopic basket stone extraction)
T/F: renal hematuria occurs frequently
F it occurs infrequently
causes of renal hematuria
calculus, neoplasia, tubular/papillary necrosis, idiopathic
Nephrolithiasis
This usually occurs in stallions or geldings and remains asymptomatic until azotemia and bilateral hydronephrosis occurs. Its diagnosed by rectal palpation and ultrasound. If its unilateral nephrolithiasis removal may be attempted.
most common primary tumor of the kidney
adenocarcinoma
treatment of choice for renal neoplasia
nephrectomy but they’re often very large and adherent to surrounding organs at the time of diagnosis
Tubular or papillary necrosis
This is caused by admin of aminoglycosides or non steroidal anti inflammatory drugs that usually causes microscopic hematuria
Idiopathic renal hematuria is __ and only has presenting signs of __ and __. Diagnosis is supported by __ and treatments include blood transfusions, steroids, yunnan baiyo, nephrectomy. The majority __ or are __
Idiopathic renal hematuria is rare and only has presenting signs of severe hematuria and severe anemia. Diagnosis is supported by cystoscopy and treatments include blood transfusions, steroids, yunnan baiyo, nephrectomy. The majority die or are euthanized.
