Interesting Cases

Blood in the urine

Blood in a pet’s urine, termed cystitis, is a common illness in both dogs and cats. However, the causes in dogs and cats are quite different and can be discussed at a different time. In this case, Billy came in with a significant amount of blood in his urine that his “dad” had noted. Upon physical examination, he was in excellent health. We collected a urine sample and completed a series of tests or urinalysis.

A urinalysis is the testing done on all urine samples. The sample is tested for the presence of ketones, bilirubin, and glucose which my be elevated in liver disease or diabetes. Further testing is done for pH protein and blood. These help indicate whether an infection or inflammation exists. Next, the sample is spun for 10- 15 minutes. The sediment found on the bottom of the tube is stained and viewed under the microscope. A veterinary technician will look for red blood cells (RBC), white blood cells (WBC), crystals, casts, and bacteria. These cells, if found, are quantified by the number per high power field (#/HPF). All of these results are important as a baseline for which to compare in the event that the illness reoccurs or at the end of antibiotic therapy to assess of the condition is resolved.

In Billy’s case, his urinalysis showed a significant amount of red blood cells and bacteria. Since this is a common illness occurring from bacteria ascending into the urinary bladder from the penis, he was placed on two weeks of antibiotics.

Two weeks later Billy returned for a follow up urine sample. His urinalysis had not improved and the amount of blood in the urine was the same. Oddly, Billy was not showing any signs of discomfort, straining to urinate, or increased number of trips outdoors. Based on his poor response to the antibiotic, his age, and large amount of blood, we considered additional diagnostic tests.

The testing done on recurrent cystitis cases include: urine culture, abdominal X-rays, ultrasound, a dye study of the urinary tract, and bladder biopsy. We elected to perform an ultrasound. Ultrasound is a noninvasive way to visualize internal organ structures inside a pets’ bodies.

Billy was encouraged to lie on his back in a quiet room, have his abdomen shaved, and coupling gel placed on the clipped area to allow the ultrasound examination to occur. Both kidneys were visualized to evaluate their size, presence of stones, cysts, or degenerative changes. They were found to be of normal size, shape, and internal structures were normal limits. The bladder wall, local lymph nodes, and prostate were all found to be within normal limits. His urinary bladder, however, showed a discrete mass. A growth of tumor of the urinary bladder appears below as a white irregular object surrounded by a black background. The black background is urine which gives gives us great contrast to evaluate for stones or tumors in the urinary bladder.

Fortunately, this mass was still small enough and isolated in a part of the bladder that a we could resect it (surgically remove it)and still preserve enough bladder to function. Later that day, Billy had a tumor removed from his bladder. He recovered and returned home the next day.

The biopsy of his bladder mass indicated that it was a transitional cell carcinoma. This tumor arises from the epithelial cells of the urinary tact of dogs and cats. Patients are typically 8 years of age or older. Although, initially found in the urinary tract, if undiagnosed, it can fill the bladder and cause an obstruction (blockage) of urine flow. In some cases spread or metastasize other parts of the body.

In Billy’s case the diagnosis was made early and the surgical biopsy indicated a complete excision. Consultation with a veterinary oncologist suggested a course of chemotherapy due to a likely reoccurrence of this condition as Billy ages. Since no one chemotberaputic agent is highly effective against transition cell carcinomas, we selected one with the least potential adverse effects and to chart Billy’s urinary tract at 3 month intervals using ultrasound. Below is his two month post-op ultrasound showing no regrowth or reoccurance of his transitional cell carcinoma.

While writing this case, I had a similar patient (Mutzi) with blood in her urine for the third time in 5 months. Can you diagnose her condition? Visit next month for her case!

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