3146. A 14-year-old female Labrador Retriever passes blood with urine for over one year. Hepatitis. Chronic haematuria

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Dogs are considered senior when they are as follows: Small and Medium-sized breeds: Over 7 years Large and Giant-sized breeds: Over 5 years.

 

AN OLD FEMALE LABRADOR RETRIEVER PEES BLOOD IN THE URINE MANY TIMES 

Hematuria is the presence of red blood cells in the urine. 
 

DIAGNOSIS
History and physical examination. 
Signs of dysuria (difficulty in urination) and/or pollakiuria (abnormally frequent urination) point to a lower urinary tract location

Use laboratory aids to diagnosis. Blood and urine tests. X-rays and ultrasound, IVP, CT scan and MRI.
Voided urine is usually sent for testing. Ideally, urine is collected by cystocentesis (from the bladder directly). 

• Urinalysis is the examination of urine for various cells and chemicals. Red blood cells are found in haematuri. White blood cells a urinary tract infection. Casts, which are groups of cells molded together in the shape of the kidneys' tiny filtering tubes signal kidney disease. Excessive protein in the urine also signals kidney disease.
• Blood tests may reveal kidney disease if the blood contains high levels of urea and creatinine. 
• Kidney imaging studies include ultrasound, computerized tomography (CT) scan, or intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. Imaging studies may reveal a tumor, a kidney or bladder stone, an enlarged prostate (in the male dog, or other blockage to the normal flow of urine.
• A cystoscope can be used to take pictures of the inside of the bladder. It has a tiny camera at the end of a thin tube, which is inserted through the urethra. A cystoscope may provide a better view of a tumor or bladder stone than can be seen in an IVP.

DIFFERENTIAL DIAGNOSIS

1. Infections 
    Upper Urinary Tract Infections .  
     Lower Urinary Tract Infections  
    Uterine/vaginal disease e.g. pyometra in unspayed female dogs. 

2. Urolithiasis. Urinary stones in the kidneys, ureter, urethra and bladder. Bladder stones is most common. 
3. Neoplasia - Tumours or cancer of the kidneys, bladder or uterus

4. Others 
4.1 Trauma e.g. hit by a vehicle or fall into the drain. 
4.2  Coagulopathy. The blood has clotting problems/.
4.3  Hereditary in some breeds.
4.4  Drugs
4.5  Oestrus in old dogs
4.6  Idiopathic renal haematuria - cause is unknown. 
4.7 Renal disease such as Renal telangiectasia.  

Some dogs, including Welsh corgis, have a genetic predisposition to this spontaneous widening of blood vessels in the kidney, which can lead to blood in their urine.

TREATMENT depends on the cause.  Infections. Antibiotics.

PREVENTION

1.  As large breeds usually pee outdoors, the owner must be vigilant to monitor by checking whether her urine has blood. Early detection and treatment enables your dog to live to a ripe old age.

2. Yearly urine and blood test for your senior dog.

3 Prevention of urinary stone formation by feeding certain food to optimise the urine pH.  or example, struvite bladder stones develop when the urine is alkaline. A therapeutic diet from Hills or Royal Canin acidifies the urine to prevent such stones being developed. 

Taking your dog for regular veterinary checkups is the best way to prevent blood in their urine and other urinary problems. Your vet can tell you if your dog is predisposed to urinary issues. If they are, the vet can routinely test your dog's urine to make sure they're in tip-top health.

  

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AN OLD FEMALE LABRADOR RETRIEVER PASSES BLOOD IN THE URINE AGAIN.

Dr Sing Kong Yuen, BVMS (Glasgow)

On this Thursday 10 Sep 2020, the owner of a 14 year-old female Labrador Retriever came to Toa Payoh Vets to buy Zentonil and was surprised to see me. Her dog was inside her car.

“What do you buy Zentonil today? I asked. “It is for my dog’s liver disease!”

4 days ago, on 6 Sep 2020, the owner consulted Dr Daniel Sing as her  the 14-year-old Labrador Retriever was not eating and losing weight. The dog has multiple subcutaneous "fatty" lumps over the past 3 years or  more and another vet advised to leave them alone. The dog pees blood in the urine, but recovered when the other vet prescribed antibiotics for 3 occasions.  Dr Daniel had a blood and urine test done.

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Shyan to create a table of the blood and urien  test results and show me first.

BLOOD TEST on 6 Sep 2020

1. Liver disorders.

SGPT/ ALT   788 U/L  (less than 59)

SGOT/ AST   259 U/L  (less than 81)

2.  Bacteraemia.

Total white cell count in the blood was  29.0 x 10*9/L. The normal reference range is (6-17)

Neutrophils  96.1%   (60-70%)    Absolute  27.9 x 10*9/L (3-11.5)

3.  No kidney disease. Urea and creatinine within normal units. 

URINE TEST on 6 Sep 2020

pH = 7 (5-8)

SG  1.020  (1.005-1.030)

Protein 4+ (Negative)

Ketones 2+ (Negative)

Blood  4+ (Negative)

White blood cells over 900 (/uL)

Red blood cells over 1800 (/uL)

Bacteria +

No casts or crystals.

DIAGNOSIS

1. Hepatitis

2. Urinary tract infection

Bacteraemia. No vomiting or polydipsia and polyuria.

Fever due to bacteraemia. Infections could be from the liver and urinary tract infections.

ADVICES

 

1. Chronic haematuria. Blood in the urine stopped when the vet prescribed antibiotics. This happened on 3 occasions.  What to do?

My advice will be to check for urinary tract infections due to urinary stones or neoplasia. 

“Did the other vet do an X-ray for urinary stones?” I asked. “No,” she replied. The dog was 14 years old and old age could lead to urinary neoplasia or urinary incontinence and infections. 

“My dog has many large lumps in her body,” the owner said that the other vet consulted told her to leave the lumps alone unless they cause the dog to be unwell. No biopsy was recommended to check for cancer.

“The dog is inside my car,” the owner had parked her car some distance away. I walked with her to see the dog. The dog was active and slightly thin. She was OK as she was on antibiotics prescribed by Dr Daniel for 10 days.

I advised

1. Completion of the course of antibiotics. 

2.  A therapeutic diet (Hills L/D) to help the liver to recover.

I have not recommended a therapeutic diet to prevention urinary stone formation by feeding certain food to optimise the urine pH.  For example, struvite bladder stones develop when the urine is alkaline. A therapeutic diet from Hills or Royal Canin acidifies the urine to prevent such stones being developed. 

3. X-ray of the abdomen for liver tumours, urinary stones and neoplasia of the kidneys, bladder and urethra.

4. Spaying the dog may prevent a possible womb infection bacteria going into the bladder to infect the bladder. In my experience, spaying may help to prevent urinary tract infections in the old female dogs as they may have open pyometra.  

5. Multiple large subcutaneous tumours.

The owner did not want any treatment as advised by the other vet earlier. Are they lipomas?  Or mast cell tumours or others? A biopsy will be preferred. 

3. Old dogs need more regular check ups, at least once yearly if you want them to live to a ripe old age. 

 

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