Page 218 - Problem-Based Feline Medicine

210 PART 4 CAT WITH URINARY TRACT SIGNS

Clinical signs
TRAUMA CAUSING HEMATURIA*
Bacterial urinary tract occurs in approximately
1–2% of cats less than 10 years of age that have Classical signs
lower urinary tract disease, 40–50% of cats greater
● Hematuria.
than 10 years of age that have lower urinary tract dis-
● History of trauma may be present.
ease, and in approximately 20% of cats with renal
● Evidence for other trauma-induced injury
failure.
(such as broken bones, diaphragmatic
Bacterial urinary tract infection is more common than hernia, dyspnea, etc.).
other infectious agents and usually involves the lower
urinary tract.
Clinical signs
Less common infectious agents causing hematuria
include feline infectious peritonitis (FIP). Evidence for trauma such as broken bones, dyspnea,
pneumothorax, shredded nails, lacerations, etc., are
Urinary bladder is most common site of urinary tract often present.
infection. Clinical signs include hematuria, stran-
guria, pollakiuria and/or inappropriate urination; History of traumatic episode, such as being hit by a
however, some cats may be asymptomatic. car or attacked by a dog is often present.
If the upper urinary tract is involved, fever, renal pain Shock may be present.
and/or uremic signs may be present. Hematuria is present if the urinary tract is injured due

Bacterial urinary tract infection may occur secondary to trauma (hemorrhage may be from upper urinary
to diseases that alter normal host defense mechanisms tract, lower urinary tract or both).
such as renal failure, diabetes mellitus, urolithiasis or
neoplasia; therefore, additional clinical signs may Diagnosis
relate to the underlying disease.
Hematuria (numerous RBCs) is found on urinalysis.
● Hemorrhage may be from the lower urinary
tract, the upper urinary tract or both.
Diagnosis ● It is important to determine if the urinary tract is
intact. This may require an excretory urogram to
Urinalysis may reveal pyuria (> 5 WBC/hpf), bac-
evaluate the upper urinary tract and/or contrast ure-
teriuria, hematuria (> 5 RBC/hpf), and/or protein-
throcystography to evaluate the lower urinary tract.
uria; however, a bacterial urinary tract infection
– Unexplained azotemia or uroabdomen (abdominal
may be present with an inactive urinary sediment
fluid with composition of urine, i.e. creatinine con-
on microscopic examination, especially in cats with
centration > plasma) is an indication for contrast
concurrent disease(s).
radiography and possibly surgical intervention.
An aerobic culture and sensitivity should be performed
Evidence for other organ systems being traumatized
on a urine sample collected by cystocentesis.
aids diagnosis.
● This allows identification of the organism as well as
selection of the appropriate antimicrobial for treat-
ment.
NEOPLASIA CAUSING HEMATURIA*
● Nitrite and leukocyte test pads present on some dip-
sticks are not reliable and should not be used.
Classical signs
● Urine may be stained with Wright’s stain or
Gram stain to aid in identification of bacteria and ● Hematuria, pollakiuria, stranguria and/or
to assist in selecting an appropriate antibiotic until inappropriate urination may be present.
culture results are returned.