Page 502 - Problem-Based Feline Medicine

494 PART 7 SICK CAT WITH SPECIFIC SIGNS

Radiographic findings often reveal fractures and tho- Uremic stomatitis and uremic gastroenteritis may
racic abnormalities. Intra-abdominal bleeding may cause bleeding in acute and chronic renal failure, con-
cause loss of detail on abdominal radiographs, but ultra- tributing to anemia in the latter.
sound, abdominocentesis and diagnostic peritoneal
Hypertension may cause retinal hemorrhages and/or
lavage are superior for its detection.
retinal detachment.
● Thoracic injuries and resulting dyspnea are more
common and clinically important than abdominal Hemolytic-uremic syndrome is an uncommon compli-
injuries following blunt trauma in cats. Abdominal cation of renal transplantation.
hemorrhage may occur, but is rarely life threatening.
Hemostatic testing is usually normal in traumatized
Diagnosis
cats, although mild thrombocytopenia may occur sec-
ondary to massive bleeding. Trauma does not appear to Hemostatic testing is usually normal.
be an important trigger for DIC in cats. ● Mildly prolonged aPTT and mild thrombocytope-
nia (mechanisms not known) have been seen in
chronic renal failure.
Differential diagnosis
● Uremic thrombocytopathia has not been docu-
Differential diagnoses for hemoperitoneum include mented in cats, but probably occurs. Determining
anti-coagulant rodenticide poisoning, inherited coagu- BMBT prior to renal biopsy is recommended.
lopathy (e.g. hemophilia A and B), ruptured neoplasm ● Hemolytic-uremic syndrome results in thrombocy-
(e.g. hemangiosarcoma) and spontaneous bleeding from topenia.
a diseased liver (e.g. amyloidosis, peliosis hepatis).
Differential diagnoses for hemothorax include anti- Differential diagnosis
coagulant rodenticide poisoning, inherited coagulo-
If a cat with chronic renal failure is showing signs of
pathy (e.g. hemophilia A and B), and spontaneous
acute bleeding other than retinal hemorrhages, a con-
bleeding from the thymus.
current local or hemostatic disorder should be pursued.
Treatment
Treatment
See the appropriate chapters for treatment of specific
The use of H2-blockers and/or sulcralfate may
traumatic disorders.
reduce gastrointestinal bleeding.
Dental prophylaxis may reduce oral cavity bleeding.
RENAL FAILURE***
Amlodipine, enalapril or benazapril is recommended
Classical signs for treatment of hypertension (see The Blind Cat or
Cat With Retinal Disease, page 1171).
● Lethargy, inappetence, weight loss,
polyuria, polydipsia. No specific treatment is recommended for the hemosta-
● Pale mucous membranes (anemia). tic disorders. If BMBT is prolonged and requires cor-
rection prior to an invasive procedure, treatments useful
See main reference, page 235 (The Cat With Polyuria in humans and/or dogs include:
and Polydipsia). ● Whole blood or packed red cell transfusion, or
recombinant human erythropoietin therapy to
improve anemia, because uremic bleeding is worse
Clinical signs
at a lower hematocrit.
Cats with chronic renal failure show varying lethargy, ● Fresh-frozen plasma or cryoprecipitate trans-
inappetence, weight loss, polyuria, polydipsia, inter- fusion, or desmopressin to improve von Willebrand’s
mittent vomiting and anemia. factor level and/or function, because defects in von