Section: Veterinary Care In-depth
Diagnosis In-depth
The following tests may be needed to diagnose the cause of hematuria:
Urinalysis to evaluate for white blood cells, red blood cells, crystals and bacteria.
Bacterial culture of urine to identify urinary tract infection and determine the best antibiotic to use to treat the infection.
A complete blood count to evaluate for systemic infection, anemia, or low platelet count (thromobocytopenia).
Serum biochemistry tests to evaluate kidney and liver function and to identify electrolyte and acid base disturbances.
A panel of clotting tests to assess whether the pet's blood can clot normally.
Vaginal cytology in intact female cats that may have vaginitis.
Abdominal X-rays to evaluate bladder and kidney size and identify stones dense enough to be visible on plain X-rays.
Abdominal ultrasound to evaluate the urinary tract for stones, tumors, obstruction to flow or evidence of infection in the kidneys themselves (pyelonephritis). Ultrasound often is recommended when other diagnostic procedures have been inconclusive. Completion of an ultrasound examination may necessitate referral to a specialty hospital.
A contrast dye study to evaluate the urinary tract for stones, tumors or obstruction. A contrast study of the upper urinary tract (kidneys and ureters) is called an excretory urogram or intravenous pyelogram. This study can identify obstruction of the upper urinary tract and signs of kidney infection (dilated kidney pelvis). A contrast study of the lower urinary tract (bladder and urethra) is called a cystourethrogram. This study can help identify bladder tumors or congenital abnormalities such as an outpouching of the bladder wall (urachal diverticulum). These tests may be recommended if other diagnostic tests were inconclusive.
Cystoscopy in female cats allows evaluation of the vagina, urethra, and bladder by introducing a rigid scope urethra and bladder. This technique allows the veterinarian to visualize congenital abnormalities of the urogential tract, tumors, stones and other abnormalities. It also allows for small biopsy samples to be obtained through the scope without the need for major abdominal surgery. Cystoscopy usually is done after other diagnostic procedures have been inconclusive. It necessitates general anesthesia and referral to a specialist.
Treatment In-depth
Treatment of hematuria depends on the underlying cause. Treatments for the common causes of hematuria are as follows:
Antibiotics are used to treat bacterial urinary tract infection. Ideally, the antibiotic should be chosen based on bacterial sensitivity testing to identify the antibiotic most effective for the particular type of bacteria causing the infection. However your veterinarian may make an educated guess about which antibiotic to use based on knowledge of the types of bacteria that commonly cause urinary tract infection and the ability of several antibiotics to be secreted into urine by the kidney tubules. Treatment generally is recommended for 2 to 3 weeks.
Fluid therapy may be recommended for pets that are dehydrated. It also may be recommended to increase urine output (establish a diuresis).
Dietary changes may be recommended if stones are present in the urinary tract or if kidney failure is present.
Vitamin K is the treatment of choice for hematuria secondary to warfarin (rat poison) ingestion.
Surgical intervention may be necessary for the removal of stones or tumors in the urinary tract or to correct congenital abnormalities. Surgery also may be necessary to determine wheter bleeding is coming from the left or right kidney in rare cases of "benign renal hematuria."
Chemotherapy may benefit in some animals with cancer of the urinary tract.
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