Hematuria and transitional cell papilloma of the renal pelvis treated via unilateral nephrectomy in an alpaca

CASE DESCRIPTION: An 11-year-old 72-kg (158-lb) sexually intact female alpaca was examined for diagnosis and treatment of hematuria of 4 months' duration. CLINICAL FINDINGS: Pigmenturia was detected by the owner when the alpaca was 8 months pregnant. Radiographic, ultrasonographic, vaginal speculum, and cystoscopic evaluation of the urinary tract revealed normal vaginal and urethral epithelia and increased bladder vessel tortuosity, with pulses of hemorrhage from the left ureter. Regenerative anemia and mild leukopenia were detected and serum urea nitrogen and creatinine concentrations were within reference ranges. TREATMENT AND OUTCOME: Chronic hematuria resolved after unilateral nephrectomy of the left kidney, and no dysfunction was detected in the remaining kidney. Histologic evaluation of the kidney revealed a transitional cell tumor in the renal pelvis. CLINICAL RELEVANCE: Although anemia is common in South American camelids, hematuria is an uncommon sign of this condition. Chronic urinary tract infection, toxin ingestion, and neoplasia causing hematuria or hemoglobinuria should be considered in South American camelids with pigmenturia. Thorough and systematic evaluation of the urinary tract should be performed to locate the site of hemorrhage to treat hematuria appropriately.     

Idiopathic hematuria of unilateral renal origin in a dog

Idiopathic hematuria of unilateral renal origin was diagnosed in a 3-month-old male Weimaraner. The hematuria had been visible grossly for 6 weeks. Extensive clinicopathologic, radiographic, and histologic evaluations localized the source of the hematuria to the right kidney, but could not identify a cause. Nephrectomy of the right kidney resolved the problem. This case report supports a previous article comparing canine idiopathic hematuria of renal origin with benign essential hematuria of human beings.     

Persistent Hematuria as a Result of Chronic Renal Hypertension Secondary to Nephritis in a Stallion

A 13-year-old Lusitano stallion was referred to our institution with a history of severe hematuria for 8.5 months. The origin of the hematuria was determined to be the left kidney. The diagnostic workup failed to identify obstructive, infectious, or neoplastic conditions. The history and ultrasonographic examination suggested a chronic condition. The stallion was subjected to left nephrectomy because of the persistent hematuria and anemia. A histopathological examination detected lesions, which were compatible with chronic nephritis and vascular renal hypertension. It is hypothesized that changes in the normal parenchymal architecture produced a vascular aberration that led to renal hypertension, with subsequent blood extravasation and hematuria. The horse recovered completely after nephrectomy.     

Leiomyoma of a kidney in a dog: a rare diagnosis

A five-year-old, neutered male, Bernese Mountain Dog was referred because of a two-week history of hematuria and a one-week history of polydipsia and polyuria. Palpation of the dorsomedial mesogastrium revealed a mass on the left side, which was seen via radiography and ultrasonography to be attached to the left kidney. The left kidney and the attached mass were excised surgically, and the dog had an uneventful recovery. Histological examination of the mass revealed a dense proliferation of non-polymorphic spindle cells, which stained positive for smooth muscle actin via immunohistochemistry. Leiomyoma of the kidney was diagnosed. Postoperatively, there was mild azotaemia, which did not affect the general condition of the dog and was still present 15 months after surgery. Leiomyoma of the kidney is a benign tumor, and hematuria may be the only clinical sign.     

Paraneoplastic leukocytosis in a dog with a renal carcinoma

A 7-year-old male German Shepherd dog in poor body condition had a 3-month history of intermittent hematuria. Nonregenerative anemia, mild leukocytosis, marked hypoalbuminemia, and hematuria were observed. Subsequently, marked neutrophilia and moderate monocytosis were noted; anemia, hypoalbuminemia, and hematuria persisted; and the dog developed disseminated intravascular coagulation. Ultrasonographic examination of the abdomen revealed the presence of an enlarged and irregularly shaped right kidney with a large area of cavitation, and a nephrectomy was performed 30 days after initial examination. Cytologic examination of fine-needle aspirates and imprints of the right kidney revealed a neoplastic cell population suggestive of renal carcinoma. The histopathologic diagnosis was chromophobic cystic-papillary renal carcinoma. The tumor cells expressed granulocytic/macrophage-colony-stimulating factor (GM-CSF), detected by immunohistochemical staining, and elaboration of GM-CSF by the tumor may have mediated the leukocytosis in this dog. Following excision of the tumor, neutrophil and monocyte counts were only mildly increased. The dog died 135 days after initial presentation, and a necropsy was not permitted. Paraneoplastic neutrophilic leukocytosis is an uncommon finding and may be caused by elaboration of CSF by neoplastic cells.     

Massive hematuria of nontraumatic renal origin in dogs

Massive hematuria of renal origin was diagnosed in 4 dogs. In all dogs, blood and blood clots were clearly visible in the urine. Serum urea nitrogen and urine concentrating ability were normal. All dogs were anemic, and results of coagulation and platelet function tests were within normal limits. Excretory urography indicated hydroureter and hydronephrosis in all dogs, with filling defects in the bladder attributable to large blood clots in 2 dogs. Cystotomy and catheterization of the ureters enabled identification of one kidney as the source of bleeding in 3 dogs. Unilateral nephrectomy and ureterectomy resolved their hematuria. The results of histologic examination were normal in 2 dogs. The 3rd dog had evidence of pyelitis. Cystoscopy of the 4th dog did not reveal hematuria from either ureter. The dog was not operated on and it continued to have intermittent hematuria.     

Efficacy and safety of ultrasound-guided percutaneous biopsy of the right kidney in cattle

The purpose of the present study was to develop a technique for biopsy of the kidneys of cattle and to evaluate its usefulness and safety based on 25 consecutive biopsies. Using a handheld 14G spinal biopsy needle, the right kidney was biopsied under ultrasound control by one operator. To assess the immediate effects of renal biopsy, twenty cattle were necropsied shortly after the procedure and examined. The remaining five animals were biopsied and examined daily for nine days and then necropsied. One pass was made for biopsy of the right kidney. No immediate or delayed macroscopic hematuria was observed post-biopsy. Six animals had a thin subcapsular hematoma (less than 2 cm in diameter). We conclude that percutaneous ultrasound-guided biopsy of the right kidney is safe, fast, cost-effective and practical as long as it is performed properly.     

Obstructive renal cyst in a dog: ultrasonography-guided treatment using puncture aspiration and injection with 95% ethanol

A 12-year-old, intact male, mixed-breed dog was evaluated after surgical removal of a mast cell tumor from the shoulder. Results of laboratory tests were within the reference ranges, but examination of urinary sediment identified epithelial cells of the upper urinary tract and microscopic hematuria. Abdominal ultrasound examination performed after a 12-hour fast identified a simple cyst in the left kidney. The cyst was approximately 26 mm in diameter, was anechoic, and had a thin, slightly hyperechoic wall with distal acoustic enhancement accompanied by dilatation of the caudal papillary duct and renal pelvis (Fig 1). Excretory urography with iopamidol^a contrast (800 mg/kg IV) confirmed the presence of dilatation of the left renal pelvis and collecting system (Fig 2).     

ULTRASOUND LOCALIZATION AND GUIDANCE FOR RENAL BIOPSY IN THE HORSE

Real-time ultrasonography was used to assist percutaneous renal biopsies in seven normal horses. Ultrasound (US) guidance and blind biopsy following US localization were compared. Ten biopsies (seven right kidney and three left kidney) were performed. A transverse approach to the lateral border of the right kidney through the 17th intercostal space was favored, with the needle angle being approximately perpendicular to the body wall. Both biopsy techniques were effective, but blind biopsy following US localization was favored as it was easily performed by one operator without the need for specialized biopsy equipment. The spleen had a variable location and its penetration with the biopsy needle was necessary to obtain two left kidney biopsies. Macroscopic and microscopic hematuria was observed postbiopsy in one and four horses, respectively, out of six horses examined. Perirenal hemorrhage was a prominent finding on necropsy in five of six horses euthanized.     

ULTRASOUND-GUIDED BIOPSY OF THE CANINE LIVER, KIDNEY, AND PROSTATE

Sixty-nine hepatic, 25 renal, and 16 prostatic biopsies were performed under ultrasound guidance using a biopsy guide. The majority (98 of 110) were tissue-core biopsies. Multiple attempts at obtaining a sample were required; however, in the kidney, the number of attempts was restricted to two. Adequate samples were obtained in 94% (65/69) hepatic, 88% (22/25) renal, and 94% (5/6) prostatic biopsies. Postbiopsy scanning did not demonstrate parenchymal hemorrhage. In three renal and one prostatic biopsy, gross hematuria, noted immediately following biopsy, resolved in 2–3 days. Animals with prostatic disease frequently had hematuria, making evaluation for this complication difficult. One animal died acutely 2 days following prostatic biopsy due to an unrelated problem, a ruptured aortic àneurysm. Complications were not encountered with the liver biopsy procedure. Animals biopsied under sedation tolerated the procedure well. The authors preferred to anesthetize uncooperative animals and those needing kidney biopsy to minimize the likelihood of complications. Problems encountered during the procedure, overlying bowel gas obscuring the target organ or poor visualization of the biopsy needle, were corrected by changing patient or transducer position or the procedure was postponed. The usefulness of the biopsy procedure is illustrated in four case reports.     

Medical and surgical management of multiple organ infarctions secondary to bacterial endocarditis in a dog

A 6-year-old male Doberman Pinscher developed multiple organ infarctions secondary to vegetative endocarditis. Clinical signs included fever, nystagmus, head-tilt, inappetence, dehydration, hematuria, and dysuria. The dog was azotemic and anemic and had a high WBC count and high liver enzyme activities. Disseminated intravascular coagulation was diagnosed on the basis of thrombocytopenia and prolonged activated clotting times. Vegetative mitral valvular lesions were evident on M-mode echocardiography. The dog underwent diuresis with physiologic saline solution and was treated parenterally with antibacterial and anticoagulant agents. Surgery was performed to remove an infarcted kidney and an infarcted spleen and to relieve urethral obstruction caused by a large blood clot. Gram-positive cocci were noticed in the biopsy specimens. Mortality associated with organ infarctions secondary to bacterial endocarditis is high, and combined medical and surgical therapy is rarely reported. This dog survived and was alive 38 months after surgery.     

Removal of an ectopic left kidney through a ventral midline celiotomy in a calf

A 4-month-old Holstein heifer was examined because of poor growth, weight loss, dysuria, hematuria, pyuria, and a palpable mass in the right caudal quadrant of the abdomen. Clinicopathologic abnormalities included hyperfibrinogenemia, hyperproteinemia, anemia, and leukocytosis, and were consistent with chronic inflammation. Results of ultrasonographic evaluation of the umbilical cord remnants were suggestive of urachal abscess formation. Transabdominal ultrasonography of the kidneys was attempted; the right kidney appeared normal, but the left kidney could not be imaged. The calf was anesthetized and a ventral midline celiotomy was performed. The left kidney was larger than normal, was multilobulated, and contained multiple abscess. It had also broken through the peritoneum and was located in the peritoneal cavity. Unilateral nephrectomy and resection of umbilical cord remnants were performed. The calf recovered without complications and was healthy 5 years later. In this calf, ventral midline celiotomy provided sufficient surgical exposure for removal of the ectopic left kidney and resection of umbilical cord remnants.     

Congenital cystic disease of the liver and kidney in a pygmy goat.

A 1-month-old pygmy goat was presented with abdominal distension and hematuria. Anemia, leukocytosis, and increased bilirubin and blood urea nitrogen levels suggested renal and hepatic disease. Radiographs revealed bilateral renomegaly, and ultrasound confirmed bilateral hydronephrosis. Necropsy findings determined that the renomegaly was due in part to edema and marked cystic tubular distension. Similarly, intrahepatic bile ducts were ectatic. The character and distribution of the gross and histologic lesions were consistent with a polycystic disorder, presumably congenital, affecting the liver and the kidney.     

Clinicopathologic analysis of herpesvirus-induced urinary tract infection in specific-pathogen-free cats given methylprednisolone

The clinicopathologic manifestations of bovid herpesvirus-4 (BHV-4; FCAHV strain)-induced infection of the lower portion of the urinary tract were characterized in 12 adult neutered male and 6 female specific-pathogen-free cats, and were compared with those in 12 neutered male control cats. Six neutered male and 6 female cats were given immunosuppressive doses of methylprednisolone acetate prior to inoculation of their urinary bladders with BHV-4. Six neutered male control cats were given immunosuppressive doses of methylprednisolone acetate prior to inoculation of their urinary bladders with uninfected tissue culture control inoculum. Six additional neutered male control cats were exposed only to uninfected tissue culture control inoculum. All cats were observed for 90 days following inoculation. Dysuria and gross hematuria were observed in only 1 BHV-4-exposed cat. Radiographic abnormalities of the lower portion of the urinary tract were not observed. Microscopic hematuria, crystalluria, and lipiduria were identified with similar frequency in BHV-4-exposed and control cats. Results of urine culturing for bacteria, mycoplasma, ureaplasma, and viruses were negative. Viruses were not isolated from blood leukocytes collected from exposed or control cats. Three to 6 weeks after inoculation, high concentrations of BHV-4 serum antibodies were detected in all exposed cats by an indirect fluorescent antibody test. Light microscopic examination of the urinary tract revealed multifocal lymphoid cystitis in 2 BHV-4-exposed cats. Except for suppurative bronchitis in 1 BHV-4-exposed cat given glucocorticoids, morphologic differences in urinary and extraurinary tissues were not observed. In urinary bladder tissue collected 90 days after inoculation, BHV-4 was reisolated from urinary bladder explants of all but 1 exposed cat. Virus was also isolated from a kidney explant of 1 exposed male cat, and spleen cell co-cultures of 1 exposed female cat given glucocorticoids.(ABSTRACT TRUNCATED AT 250 WORDS)     

ULTRASOUND-GUIDED TISSUE-CORE BIOPSY OF LIVER, SPLEEN AND KIDNEY IN NORMAL DOGS

Six normal dogs were subjected to ultrasound-guided biopsy of the liver, spleen and kidney to examine the accuracy of the technique (i.e. the presence of targeted tissue) and the histologic quality of the biopsies. Five consecutive tissue-core biopsies of each organ were taken on one or more occasions. The accuracy of the technique was 77% for hepatic, 90% for splenic, 53.5% for left kidney and 40% for right kidney biopsies. The histologic quality of the liver and kidney samples was sufficient, although for some samples the diagnostic value was limited by their size and in renal samples either cortical or medullary tissue was sometimes lacking. In contrast, the quality of the splenic sections was not good. The effect of reused and resterilized needles on the quality of the specimens was evaluated by histologic inspection of the samples and by the amount of biopsies lacking tissue. All tissue samples, including those taken with reused or resterilized needles had sharp-cut edges. Twenty-two of the total number of 120 biopsies (18%) contained no tissue. Absence of tissue in the samples was observed in biopsies taken with all needle types. The animals were observed for possible complications of the repeated needle biopsy. Apart from one case of hematuria, no complications were encountered.     

Randomized controlled trial of the efficacy of short-term amitriptyline administration for treatment of acute,nonobstructive, idiopathic lower urinary tract disease in cats

OBJECTIVE: To determine whether short-term amitriptyline administration would be efficacious in the treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. DESIGN: Randomized controlled trial. ANIMALS: 31 untreated male and female cats with acute, nonobstructive, idiopathic lower urinary tract disease. PROCEDURES: Cats were treated with amitriptyline (5 mg/d; n = 16) or a placebo (15) for 7 days and monitored for pollakiuria, hematuria, and adverse events. Cats were reexamined 1 month after treatment, and owners were interviewed by telephone 6, 12, and 24 months after treatment. RESULTS: 2 amitriptyline-treated cats were excluded from analyses because of acquired urinary tract infection. Clinical signs resolved by day 8 in 8 amitriptyline-treated and 10 control cats. There were no apparent differences in likelihood or rate of recovery from pollakiuria or hematuria between groups. Overall, clinical signs recurred significantly faster and more frequently in amitriptyline-treated than control cats. However, after excluding recurrences within 21 days of treatment, risk of recurrence was similar in both groups. Increasing age was significantly associated with increased likelihood and rate of recovery from hematuria and with decreased risk of recurrence of signs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that short-term amitriptyline treatment has no benefit in terms of resolution of pollakiuria and hematuria in cats with idiopathic lower urinary tract disease and may be associated with an increased risk of recurrence.     

Evaluation of laparoscopy for obtaining renal biopsy specimens from dogs and cats

Laparoscopic direction of renal biopsy was evaluated in 37 dogs and 1 cat suspected of having renal disease. Specimens adequate for morphologic diagnosis were obtained in 37 cases (97%). Eleven of the 38 animals were necropsied and the biopsy diagnosis was confirmed in 10 of the cases (91%). Excessive pericapsular hemorrhage and severe hematuria developed in 1 dog. Three dogs (8%) had macroscopic hematuria for 24 hours after biopsy.     

Granulosa cell tumor in 8 African pygmy hedgehogs (Atelerix albiventris)

A retrospective study involving eight African pygmy hedgehogs histopathologically diagnosed with granulosa cell tumors was conducted. The age at onset was 2.2–4.5 years, with a median age of 3.6 years. The most common clinical signs were hematuria and abdominal distension, which were observed in >50% cases. Exploratory laparotomy was performed in all cases, and ovariohysterectomy or excision of the abdominal mass was performed. Patients with only hematuria survived for >250 days after surgery, whereas those with initial ascites showed recurrence of ascites or tumor growth and survived for approximately 130 days after surgery. Intraperitoneal injection of carboplatin was performed in three recurrent cases. In one of these three cases, the tumor mass disappeared. Hence, carboplatin can be considered a potential antineoplastic drug for the treatment of granulosa cell tumors.     

Urethral Defects in Geldings With Hematuria and Stallions With Hemospermia

A urethral defect, presumed to communicate with the corpus spongiosum penis, caused hematuria in seven geldings and hemospermia in three stallions. Hematuria in geldings occurred at the end of urination. Hematuria was not observed in stallions with hemospermia. A linear urethral defect was identified, by endoscopic examination, on the convex surface the urethra at the level of the ischial arch of each horse. Cause of the defect was not determined. Two stallions were successfully treated for hemospermia, one by temporary subischial urethrostomy combined with sexual rest for 10 weeks, and the other by sexual rest alone for 6 months. The third stallion had hemospermia 6 weeks after urethrostomy. The geldings were successfully treated for hematuria, six by temporary subischial urethrostomy, and one by a subischial incision that extended into the corpus spongiosum penis but did not enter the lumen of the urethra. Efficacy of subischial urethrostomy for treatment of hemospermia was difficult to assess because of the small number of surgically treated stallions. In geldings, surgery eliminated hematuria, presumably by reducing vascular pressure in the corpus spongiosum penis during urination, thus allowing the urethral defect to heal.