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EQUINE VETERINARY EDUCATION / AE / MAY 2019
a)
b)
Fig 3: Longitudinal (a) and transverse (b) ultrasonographic images of the left kidney in the same horse as Figure 2. The white arrows demarcate the margins of the haemorrhage and clotted blood within the distended renal pelvis. C5-1 MHz transducer; depth of field 26 cm (a and b).
1987; Schott 2010). Initial intermittent episodes of renal haemorrhage often resolve spontaneously but are reported to recur over time with worsening degrees of blood loss during subsequent episodes, eventually leading to severe haemorrhage (Schott 2010). Reportedly, most horses diagnosed with idiopathic renal haematuria are subjected to euthanasia within 2 years of diagnosis (Schott 2015). Diagnosis of idiopathic renal haematuria is achieved by
consideration of the clinical presentation, endoscopic demonstration of blood in ureteral urine and exclusion of other causes of renal haematuria. Differentials for haematuria in horses include urethral rents, bacterial cystitis, pyelonephritis, glomerulonephritis, urolithiasis, verminous nephritis, renal and vesicular neoplasia, vascular malformations, haemorrhagic diathesis, renal trauma, nonsteroidal anti-inflammatory drug toxicosis and blister beetle (cantharidin) toxicosis (Schumacher et al. 2002; Schumacher 2007; Vits et al. 2008). In candidate idiopathic renal haematuria cases, endoscopic examination of the bladder is essential for the identification of haemorrhage originating from the upper urinary tract and may reveal unilateral or bilateral disease (unilateral is more commonly reported). Ureteropyeloscopic evaluation of the associated anatomy of the equine renal pelvis has been previously described (Pasquel et al. 2013). Renal ultrasonography should be performed to rule out other causes of upper urinary tract haemorrhage including nephrolithiasis, neoplasia or renal vascular anomalies (Schott 2010).
Currently, there is no consistently effective cure for
idiopathic renal haematuria in horses, and supportive care (blood transfusion) for acute blood loss remains the mainstay of treatment (Schumacher et al. 2002). Drugs intended to promote haemostasis (such as aminocaproic acid and formalin) may be administered, but the efficacy of this approach for idiopathic renal haematuria in horses is unproven
Fig 5: Pictured is the left kidney transected in the sagittal plane. The renal pelvis is filled with residual blood following removal of blood clots. The cortex is pale and thinned.
a)
b)
Fig 4: Pictured are the left (a) and right kidneys (b) at post- mortem examination. The left kidney was approximately twice the weight of the right kidney.
© 2018 EVJ Ltd
Fig 6: Pictured is the trigone area of the urinary bladder. The left ureteral orifice (white arrowhead) is hyperaemic, inflamed, and there is clear evidence of recent haemorrhage. In contrast, the right ureteral orifice (black arrowhead) is apparently normal.
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