Page 216 - Problem-Based Feline Medicine

208 PART 4 CAT WITH URINARY TRACT SIGNS

– Signs that suggest intravascular hemolysis and
WHAT?
hemoglobinuria include acute illness, fever,
pale mucous membranes, +/− jaundice, +/− Hematuria is the most common cause of discolored
splenomegaly, or acute lethargy and death in urine. This is most often associated with idiopathic
1–3-day-old kittens. lower urinary tract disease and less frequently with
– Hemoglobinuria and bilirubinuria may be both urolithiasis.
present with intravascular hemolysis.
● Myoglobinuria (red or brown urine) suggests acute
muscle damage. In cats this is most often associated DISEASES CAUSING DISCOLORED
with ischemic myopathy secondary to an aortic URINE
thrombosis, muscle injury from trauma or ischemia
(e.g. entrapment in window), or snake bite (espe-
cially Australian tiger snake). RED, PINK, ORANGE, BROWN
– Muscle damage with leakage of myoglobin is OR BLACK URINE
suggested by signs of muscle pain, biochemical
evidence of muscle damage (increased creatine Red, pink, orange, brown or black urine suggests the
kinase) and other historical and clinical signs of presence of hematuria (frank blood), hemoglobin, myo-
trauma, thrombosis or snakebite. globin or bilirubin. Red or pink urine is most com-
● Bilirubinuria (dark yellow urine) suggests marked monly associated with hematuria.
erythrocyte breakdown (hemolytic anemia), hepatic
Cats with discolored urine may or may not have signs
disease or bile duct obstruction.
of lower urinary tract disease (stranguria, pollakiuria,
– Bilirubinuria is most often associated with
dysuria, urination in inappropriate places).
hepatic disease including cholangiohepatitis
complex, hepatic lipidosis, neoplasia and feline Systemic illness may or may not be present.
infectious peritonitis.
Mucous membranes may be pale or yellow if associ-
– Occasionally it occurs when Hemobartonella-
ated with hyperbilirubinemia or anemia.
associated hemolysis is severe enough to cause
jaundice. Diagnosis is aided by examination of urine sediment
– Clinical signs are varied depending on the cause for red and white blood cells, and plasma or serum
of bilirubinuria. Serum and plasma are also jaun- color.
diced.
● Cats with hematuria from upper urinary tract dis-
ease or hemoglobinuria, myoglobinuria or biliru- IDIOPATHIC LOWER URINARY TRACT
binuria may be systemically ill. DISEASE CAUSING HEMATURIA***
● Mucus membranes may be pale or yellow if urine (IDIOPATHIC FELINE LOWER URINARY
discoloration is associated with hyperbilirubinemia TRACT DISEASE, IDIOPATHIC
or hemolytic anemia. CYSTITIS–URETHRITIS COMPLEX, FELINE
● Some cats with abnormal urine may have no other UROLOGIC SYNDROME, INTERSTITIAL
clinical signs. CYSTITIS)

Classical signs
WHERE?
● Stranguria, pollakiuria, inappropriate
Discolored urine is produced in the urinary tract. It may
urination and hematuria are present.
result from urinary tract disease (most common), a sys-
● Occurs most commonly in cats less than 10
temic bleeding disorder, or from excretion of pigments
years of age.
from the plasma.
Careful history and physical examination may help to See main reference on page 176 for details on idio-
determine if the discoloration is clinically significant. pathic lower urinary tract disease.