EQUINE VETERINARY EDUCATION / AE / MAY 2019


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TABLE 1: Conditions associated with haematuria in the horse, and clues and means of identification are listed Condition


Clues as to cause of haematuria based on signalment and history


Urethral rent Cystolith


Exercise-induced haematuria


Habronemiasis of urethral process Urethrolithiasis


Nephrolithiasis Renal neoplasia Occurs in geldings; terminal haematuria


Haematuria after exercise; stilted hindlimb gait; pollakiuria; dribbling of urine; dysuria; prolonged periods of penile protrusion


History of horse emptying its bladder immediately before exercise


Terminal haematuria; granulomatous lesion on the urethral process


Dysuria; stranguria; pollakiuria Dysuria; stranguria; pollakiuria


Haematuria is often intermittent. Other signs are nonspecific, but weight-loss, signs of colic, and ventral oedema are commonly observed


Haemorrhagic cystitis


Idiopathic renal haematuria


Cantharidin toxicosis


NSAID-induced ulcerative cystitis Cystic neoplasia


Usually a male horse; pollakiuria; dysuria; no cystolith can be palpated


Usually an Arabian or Arabian-cross; blood clots in stall; often severe anaemia


Concomitant signs of abdominal pain and/or endotoxaemia; alfalfa hay diet


Administration of a NSAID Dysuria; stranguria; pollakiuria


Aids to diagnosis


Urethroscopy; assumed to be the cause of haematuria if no other cause can be found Palpation per rectum or cystoscopy


Cystoscopy; urinalysis Cytological or histological examination of lesion


Transcutaneous palpation of urethra; urethroscopy; inability to pass a urinary catheter into the bladder


Ultrasonographic and/or radiologic examinations; serum biochemical analyses; urinalysis


Palpating a renal mass or enlarged kidney per rectum; ultrasonographic examination; renal biopsy for histological examination; cytology of peritoneal fluid


Cystoscopic examination; histological examination of bladder mucosa; bacterial culture of urine


Cystoscopy (see blood emanating from a ureter); renal ultrasonographic exam


Finding beetles in the hay or high performance liquid chromatography testing of urine or refluxed gastric contents


Cystoscopy; positive response to discontinuing administration of the NSAID


Palpation of bladder per rectum; cystoscopy; urinalysis; histological exam of biopsy of a cystic mass along with immunohistochemical examination of tissue for COX-2 receptor expression


Cystic hematoma


Foal; stranguria; pigmenturia; signs of abdominal pain Transabdominal ultrasonographic examination of the bladder


Renal medullary necrosis History of administration of a NSAID (e.g. phenylbutazone); dehydration


Renal vascular anomalies Usually a young horse


Haemolytic uraemic-like syndrome Verminous nephritis


Polypoid cystitis Pyelonephritis Leptospirosis


Osteochondroma of the os pubis


Oliguria; progressively severe azotaemia; marked oedema of the abdomen and groin


Migrating Halicephalobus larvae may also cause encephalitis or osteomyelitis


No clinical signs other than haematuria


There is often evidence of disease of the bladder or urethra


Usually young horses; sometimes multiple horses affected; signs of acute kidney disease (e.g. anorexia, lethargy, fever) Haematuria after exercise


ultrasonographic renal changes of each disease are similar (Schumacher 2007). Blood in the urine of a neonate is likely to emanate from


a cystic blood clot resulting from retrograde bleeding into the bladder caused by periparturient trauma to the umbilicus (Arnold et al. 2005). A homogeneous or heterogeneous echogenic mass is seen within the lumen of the bladder during ultrasonographic examination of the urinary tract of an affected foal. Reports of horses with haematuria caused by a congenital or acquired renal vascular anomaly are rare


Ultrasonographic exam of kidneys


Endoscopy combined with renal ultrasonography (esp. Doppler ultrasound) Contrast-enhanced cross-sectional imaging Clinical signs; high serumal creatinine and BUN


Urinalysis; ultrasonographic examination of kidneys


Cystoscopy; histological examination of biopsied tissue; bacterial culture of urine or biopsied tissue


Endoscopy, urinalysis, urine culture, renal biopsy for histopathological examination and culture


Complete blood count; urinalysis; bacterial culture of urine; fluorescent antibody test on urine; serology


Palpation of os pubis per rectum; ultrasonography


(Johnston et al. 1987; Latimer et al. 1991; Schott et al. 1996; Larsdotter et al. 2009; Nogradi et al. 2013). The renal vascular anomaly of the horses described in these few reports was discovered during transcutaneous ultrasonographic examination of the kidneys. Colour-flow Doppler ultra- sonographic examination was particularly useful in diagnosing the vascular anomaly of some affected horses (Schott et al. 1996; Larsdotter et al. 2009; Nogradi et al. 2013). Radiographic examination of the abdomen of a foal with


haematuria, performed after administering contrast medium into the aorta at the level of the renal artery, confirmed the


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