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Special Topics in Equine Clinical Practice > Hematuria > Flashcards

Hematuria Flashcards

1
Q

what are the 4 possible anatomic origins of hematuria?

A
  1. urethra
  2. bladder
  3. ureter
  4. kidneys
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2
Q

what is the normal concentration of blood in the urine?

A

5,000 RBC/mL or 5 RBC/hpf
(not grossly seen and yields negative dipstick results)

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3
Q

What defines ‘microscopic’ hematuria?

A
  • increased RBCs (10,000-2,500,000/mL)
  • > 10 RBC/hpf
  • cannot be grossly seen
  • causes trace-3+ reaction on dipstick
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4
Q

what defines ‘macroscopic’ hematuria?

A
  • increased RBCs (2,500,000-5,000,000/mL)
  • can be grossly seen
  • observable red cell pellet and clearing of supernatant after centrifugation
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5
Q

What is the most likely source of bleeding if the blood occurs in urine at the BEGINNING of urination?

A

distal urethra

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6
Q

What are the 2 most likely sources of bleeding if the blood occurs in urine at the END of urination?

A

proximal urethra or bladder

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7
Q

What is the 3 possible sources of bleeding if the blood occurs in urine at the THROUGHOUT urination?

A

kidneys
ureters
bladder

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8
Q

what are the 4 causes of urethral hematuria?

A
  1. neoplasia (SCC*, fibrosarcoma, sarcoid, or papilloma)
  2. urethral calculi
  3. urethral rents/tears
  4. habronemiasis
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9
Q

what is the most common tumor of the equine penis that results in depigmentation, ulceration, and foul odor or discharge from the penis?

A

squamous cell carcinoma

diagnosed by biopsy
tx by surgical removal (complete excision)

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10
Q

Urethral rents occuring in geldings or stallions most often cause hematuria at the (beginning/ end/ throughout) urination.

bonus: why

A

end of urination
this is because the bulbourethral muscles contract at the end of urination and it forces blood through the tear into the urethral lumen

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11
Q

what is the treatment for urethral rents?

A

surgical – perineal urethrotomy
but this is very frustrating, so most commonly just give them time to heal, but they do not always.

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12
Q

What is the typical signalment and presentation of a horse with urethral calculi?

A

stallions or geldings
often displaying colic and stranguria

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13
Q

how do you diagnose and treat urethral calculi?

A

Dg: u/s (often they lodge at the ischial arch), can confirm with urethroscopy

tx: PU or laser fragmentation (but this doesnt work well)

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14
Q

How do you diagnose and treat habronemiasis (a proliferative lesion on the distal aspect of the penis close in proximity to the external urethral orifice).

A

Dg: biopsy

Tx: ivermectin, local/systemic glucocorticioid (if small lesion) or surgical excision (if large lesion)

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15
Q

what are 5 causes of vesical (bladder) hematuria that causing bleeding at the END or THROUGHOUT urination?

A
  1. calculi
  2. neoplasia
  3. bacterial cytstitis
  4. trauma
  5. idiopathic hemorrhagic cystitis
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16
Q

Horses affected with cystic calculi often display what signs?

A
  • hematuria (often after exercise)
  • stanguria
  • pollakiuria
  • pyuria
  • urinary incontinence
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17
Q

how do you diagnose cystic calulus in horses?

A

rectal palpation and/or
u/s

can confirm with cystoscopy and assess the damage to the bladder mucosa.

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18
Q

how do you treat cystic calculi?

A

non-surgical removal – hydraulic fragmentation

or surgical removal by laparocystotomy or PU

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19
Q

what is the most common type of tumor of the urinary bladder?

A

SCC

others include: TCC, lymphosarcoma, leiomyosarcoma

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20
Q

how do you diagnose bladder neoplasia?

A

rectal palpation
u/s
cystoscopy and biopsy

21
Q

what is the tx for bladder neoplasia?

A

the goal is to prolong survival and improve comfort

surgical resection (if you can get to it) or intravesicular installation of 5-flouracil or COX-2 selective NSAIDs

but prognosis is poor for long term survival

22
Q

Bacterial cystitis is associated with inability to …

A

completely evacuate the bladder (secondary to EHV-1, cauda equina syndrome, etc.)

this can lead to sabulous cystitis (build up of sediment)

23
Q

how do you diagnose bacterial cystiits?

A

urine sediment (contains RBC, WBC, and bacteria) and clinical signs present.

24
Q

how do you treat bacterial cystitis in horses?

A

systemic antibiotics (TMS or based on culture/susc)

if sabulous cystitis present – repeated lavage with dilute acetic acid. but they usually never resolve 100%

25
Q

What causes exercise-associated hematuria?

A

strenuous exercise causes abdominal contents to compress the bladder against the pelvis.

26
Q

how do you diagnose exercise-associated hematuria?

A

it is a diagnosis of exclusion

27
Q

how do you diagnose idiopathic hemorrhagic cystitis in horses?

A

u/s will show a thickened bladder wall. but definitive diagnosis is based on cystoscopy and biopsy (suppurative, proliferative cystitis)
the histopath may suggest neoplastic process (ex. TCC), so reevaluate in 2-4 weeks to ensure it does not progress to neoplasia.

28
Q

how do you treat idiopathic hemorrhagic cystitis?

A

potentiated sulfonamides (even though the urine culture usually does not grow anything)

prgnosis is good.

29
Q

What is the most common cause of ureteral hematuria (causing bleeding throughout urination)?

A

ureteroliths (likely originating in the kdiney and passing into the ureters)

30
Q

T/F: horses with ureteroliths typically remain asymptomatic until the obstruction of BOTH ureters causes post-renal azotemia and hydronephrosis

A

true

clinical signs seen are often assoc with the azotemia (dull, inappetant, weight loss) rather than an obstruction (colic, stranguria)

31
Q

how do you diagnose ureteroliths?

A

rectal palpation (sometimes) – feel calculi, feel ureteral dilation, or feel nephromegaly (L)

u/s – transrectal and transabdominal to locate and ID # of calculi, see dilation or ureter and renal pelvis, and hydronephrosis.

32
Q

how do you treat ureteroliths?

A

surgical removal if unilateral (ureterotomy, ureterctomy + nephrectomy)

or non-surgical removal (endoscopic basket stone extraction) or electrohydraulic lithotripsy.

33
Q

What are the 4 causes of renal hematuria (causing bleeding throughout urination)?

A
  1. calculi
  2. neoplasia
  3. tubular/papillary necrosis
  4. idiopathic
34
Q

T/F: horses with nephroliths experience severe symptoms such as stranguria and colic very early in the obstructive process.

A

false – they typically remain asymptomatic until azotemia and bilateral hydronephrosis occurs.
the signs they show are assoc with the azotemia (dull, inappetant, weight loss)

35
Q

how do you diagnose nephroliths?

A

rectal palpation – nephromegaly

u/s – locate and ID # of calculi, see dilation of renal pelvis, nephromegaly, and hydronephrosis

36
Q

how do you treat nephroliths in horses?

A

surgery –these are NOT minor surgeries tho

37
Q

what are some primary kidney tumors?

A
  1. adenocarcinoma
  2. nephroblastoma
  3. TCC
  4. SCC
38
Q

what are some secondary kidney tumors?

A
  1. lymphosarcoma
  2. hemangiosarcoma
  3. melanoma
  4. adenocarcinoma
39
Q

Renal tumors are rare in horses, but how would a horse present if they had one?

A
  • dull
  • inappetant
  • weight loss
  • recurrent colic
  • hematuria
  • mass that is palpable on rectal exam
40
Q

how do you diagnose renal neoplasia in horses?

A

rectal exam - feel the irregular kidney

u/s – see mass and abnormal renal architecture

biopsy, abdominocentesis, urine cytology (see neoplastic cells)

41
Q

how do you treat renal neoplasia in horses?

A

nephrectomy

difficult and impossible in most cases because tumors are usually large/adherent to surrounding organs.

42
Q

what drugs most commonly cause tubular and papillary necrosis in horses?

A

tubular necrosis – aminoglycosides

papilary necrosis – NSAIDs

43
Q

T/F: tubular or papillary necrosis causes macroscopic hematuria

A

false – microscopic.

its diagnosed using dipstick analysis and sediment exam. (increased protein, blood, and WBCs without bacteria)

44
Q

what is the tx for tubular or papillary necrosis caused by drug administration?

A

suportive while the kidneys heal themselves.

45
Q

What horse breeds have increased prevalence of idiopathc renal hematuria?

A

arabians

46
Q

what are presenting signs of horses with idiopathic renal hematuria?

A

severe hematuria (gross blood clots)
severe anemia

47
Q

how do you diagnose idiopathic renal hematuria in horses?

A

cystoscopy – see blood or blood clots at the ureteral openings.

anemia

48
Q

how do you treat idiopathic renal hematuria?

A

blood transfusion
corticosteroids (bc its thought it might be immune-mediated)
Yunnan Baiyao
Nephrectomy

majority die/euthanized within 3 months after onset.

Special Topics in Equine Clinical Practice (18 decks)

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