Pigmenturia Flashcards

Pigmenturia

• Pigmenturia = abnormal amounts of:
  • RBC's
  • Pigments (hemoglobin, bilirubin, other)
• Hematuria = abnormal amount of RBC's

Classification

• Macroscopic
  • Visible discoloration
  • Presenting complaint
    • “Bloody” urine
    • Dark urine
• Microscopic
  • No visible discoloration
  • ">5 rbc’s per hpf"
  • Positive “blood” on dipstick

Urinalysis Blood

• Differentiating intact RBC’s from free pigments

Macroscopic Pigmenturia: Primary differential diagnoses

• Macroscopic hematuria
  • Upper urinary tract (usually do NOT see stranguria, pollakiuria, dysuria)
    • Renal neoplasia - renal carcinoma, transitional cell carcinoma, lymphoma
    • Trauma
    • Large solitary renal cyst
    • Acute bacterial pyelonephritis
    • Calculi - renal
    • Renal infarction
    • Recurring macroscopic hematuria of Welsh corgi dogs
    • Idiopathic renal hematuria
  • Lower urinary tract (often also see stranguria, pollakiuria, dysuria)
    • Infection
    • Inflammation
    • Feline idiopathic cystitis (FIC)
    • Granulomatous urethritis
    • Calculi - bladder or urethra
    • Neoplasia
      • Bladder - transitional cell carcinoma, squamous cell carcinoma, polyps
      • Prostate - adenocarcinoma, squamous cell carcinoma
      • Urethra - squamous cell carcinoma
    • Vagina, penis, or prepuce - transmissible venereal tumor, squamous cell carcinoma
    • Trauma
    • Benign prostatic hyperplasia, prostatic cyst, paraprostatic cyst
    • Pro-estrus, estrus, subinvolution of placental sites
  • Other conditions associated with macroscopic hematuria
    • Systemic coagulopathy (should see evidence of bleeding at other sites)
    • Parasites - Dioctophyma renale, Capillaria plica, Dirofilaria immitis
• Hemoglobinuria
  • Immune-mediated hemolytic anemia
  • Disseminated intravascular coagulation
  • Transfusion reaction
  • Heat stroke
  • Splenic torsion
  • Caudal vena cava syndrome of dirofilariasis
  • Coral snake (Elapid) envenomation
• Myoglobinuria (extremely rare in dogs and cats)
  • Severe crush injury
  • Prolonged seizures

Blood

• Intact rbcs
  • Systemic disorder
  • Lower urinary tract
    • Bladder
    • Urethra
    • Prostate
    • Vagina
    • Prepuce
    • Penis
  • Upper urinary tract
    • Kidneys
    • Ureters – RARE!!!
  • Coagulopathy

Pigmenturia

• Other pigment
  • Systemic disorder
    • Hemolysis (hemoglobin / bilirubin)
    • Severe muscle trauma (myoglobin)*
    • Hepatic disease (bilirubin)
    • Drugs*
    • Food dyes / colorings*
      • *NOT COMMON

History

• Dysuria/Stranguria
• Pollakiuria
• Urine stream
• When seen
• Reproductive status
• Drugs

Hematuria

• Hematuria with dysuria/stranguria
  • Cystitis (infectious or inflammatory)
  • Urolithiasis
  • Prostatitis
  • Benign prostatic hyperplasia
  • Neoplasia
  • Trauma
• Hematuria without dysuria
  • Renal neoplasia
  • Polycystic kidneys
  • Trauma
  • Nephroliths
  • Pyelonephritis
  • Idiopathic renal bleeding*
  • Glomeulonephritis
  • Heat stroke
  • Coagulopathy

Localization

• Blood throughout urination (total hematuria)
• Blood at the end of urination (terminal hematuria)
• Independent of, or at the beginning of urination

Physical Exam

• Kidneys
  • Size/Shape
  • Evidence of pain
• Bladder
  • Size/Wall thickness
  • Crepitus
  • Pain
• Rectal exam
  • Prostate
  • Urethra
• Vaginal exam
• Prepuce/Penis
• Observe urination

Clinical Case 1

• 3 yo, F-s, mixed breed dog
• Presenting complaint → “bloody urine”
• 3 days duration
• Increased frequency of urination
• Straining, passing small amounts of urine
• Otherwise normal

Clinical Case 1 - Diagnostics

• Urinalysis
  • Verify blood vs pigment
  • Free catch vs. Cystocentesis
    • Iatrogenic hemorrhage
    • +/- localization
  • Bacteria
  • Casts
  • Parasite eggs (rare)
  • +/- urine culture
• Bloodwork
  • +/- CBC with platelet count
  • +/- Assess coagulation status
    • PT/PTT
    • ACT
    • Concerned about systemic disease / coagulopathy
• Radiographs (survey)
  • Uroliths
  • Kidney size and shape
  • Prostate size and shape
  • Lymph nodes
• Abdominal Ultrasound
  • Kidneys
  • Bladder
  • Prostate
    • FNA
    • Cysts, masses abscesses, stones
• Contrast Radiography
  • Double contrast cystogram
  • Retrograde urethrogram
  • Excretory urogram
• Other Diagnostics
  • Cystoscopy
  • Laparotomy
  • Biopsy

Hemoglobinuria

• Immune mediated hemolytic anemia
• DIC
• Heat stroke
• Caval syndrome
  • D. immitis
• Other causes of hemolysis