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EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2019) 31 (5) 260-263 doi: 10.1111/eve.12908
Case Report Idiopathic renal haematuria in an Egyptian Arabian stallion
L. M. Martin†* , B. C. Jochems†‡, J. C. Lattimer†, P. J. Johnson† and D. D. Whelchel†§ †Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; ‡Texas A & M University College of Veterinary Medicine & Biomedical Sciences, College Station, Texas; and §Georgia Equine Veterinary Services, Canton, Georgia, USA *Corresponding author email:
martinlyn@missouri.edu
Keywords: horse; kidney; pyelectasia; urinary bladder; pigmenturia; cystoscopy
Summary A 17-year-old Egyptian Arabian stallion was presented for haematuria and blood clots in the urine of 4 days’ duration. During micturition, haematuria was noted mid-stream with passage of blood clots occurring at the end of urination. Physical examination findings were unremarkable aside from pale mucous membranes. Cystoscopic examination revealed intermittent passage of frank blood (with clots) from the left ureteral orifice compared to grossly normal-appearing urine issuing from the right ureteral orifice. Transcutaneous ultrasonographic evaluation of the right kidney yielded normal findings while the left kidney exhibited pyelectasia, a decreased cortico-medullary ratio, and markedly increased echogenicity of the renal pelvis. Diagnosis of idiopathic renal haematuria was confirmed at necropsy.
Introduction
Idiopathic renal haematuria is a rare condition reported most commonly in Arabian horses (Schott 2010). No sex or age predilection has been reported. The condition is associated with sudden and often severe, frank haemorrhage originating from one or both kidneys with blood clots voided in the urine. Generally, there are no other clinical signs of disease (Schott and Hines 1994; Schott 2010, 2015). Case reports of equine idiopathic renal haematuria have been rarely described in the literature (Schott and Hines 1994; Vits et al. 2008). In the present
report, we describe the endoscopic and ultrasonographic findings associated with idiopathic renal haematuria, which was later confirmed and characterised at necropsy.
Case history
A 17-year-old 401 kg (885 lb) Egyptian Arabian stallion was presented to the University of Missouri Veterinary Health Center for evaluation of haematuria and blood clots in the urine of 4 days’ duration. During micturition, haematuria was noted mid-stream with passage of blood clots occurring at the end of urination. No evident pain was associated with micturition and the urine voided appeared to be appropriate in terms of volume and frequency. The stallion exhibited an appropriate attitude and mentation with normal appetite, water consumption and defaecation. The owner had treated the present problem for 3 days using trimethoprim-sulphonamide1 (25 mg/kg bwt per os q. 24 h) prior to evaluation, with no improvement. A milder episode of haematuria reportedly occurred 2 years earlier but had resolved after 3 days of treatment with trimethoprim-sulphonamide (unknown dose).
© 2018 EVJ Ltd Clinical findings
On presentation, the rectal temperature was not obtained due to the fractious nature of the stallion. The heart rate was 36 beats/min and the respiratory rate was 12 breaths/min. Physical examination findings were unremarkable other than pale mucous membranes observed in the oral cavity, nasal cavity and third eyelid. During the examination, the stallion voided urine with similar characteristics previously described. External inspection and palpation of the prepuce and the penis did not reveal any abnormalities. Haematological evaluation revealed mild normochromic, normocytic anaemia characterised by decreased haematocrit (25%; rr 32–53%), decreased red blood cell count (4.98 9 1012/L; rr 6.80–12.90 9 1012/L) and decreased haemoglobin (88 g/L, rr 110–190 g/L). There was hyperfibrinogenaemia (5 g/L; rr 1– 4 g/L) and lymphopoenia (1.262 9 109/L, rr 1.5–7.7 9 109/L). Abnormalities identified on plasma biochemistry included hyperglycaemia (8.27 mmol/L, rr 4.61–6.27 mmol/L), hypoalbuminaemia (29 g/L, rr 35–44 g/L), hyperglobulinaemia (43 g/L, rr 24–41 g/L) and hypophosphataemia (<0.32 mmol/L, rr 0.58–1.16 mmol/L). Analysis of urine, collected during sterile cystoscopic examination, revealed 3+ haeme, 2+ protein, and >40 red blood cells/high powered field. Urinary bacteriological culture yielded 30 CFU/mL of Sphingomonas spp., which was attributed to contamination from the endoscope. Cystoscopic examination (Fujinon EV-45OLP5/30
1.2 mm 9 3 m endoscope)2 revealed that frank blood and clotted blood were being passed intermittently from the left ureteral orifice compared to grossly normal-appearing urine from the right ureteral orifice (Fig 1; Supplementary Item 1). No other abnormalities were observed via cystoscopy. As cystoscopy indicated haemorrhage originating from the
upper urinary tract, specifically the left kidney, transcutaneous ultrasonographic evaluation of both kidneys in the longitudinal and transverse planes was performed. Aside from suspicion of a mild decrease in the cortico-medullary ratio, images of the right kidney were considered to be unremarkable (Fig 2). Renal artery, vein and parenchymal blood flow associated with the right kidney were considered to be within normal limits. The size (16.6 9 7.56 cm, normal is 15 9 10–11 cm [Kidd et al. 2014]) and overall echogenicity of the right renal parenchyma were also considered to be normal. Ultrasonographic examination (Philips CX50; C5-1 MHz
probe)3 of the left kidney revealed markedly increased echogenicity of the renal pelvis (Fig 3). The renal pelvis was somewhat irregular in shape and markedly increased in size. Acoustic shadowing distal to the renal pelvis was not observed. The renal medulla was decreased in thickness. The
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