Upcoming Events:

Lunch and Learn offerings:
SAVE THE DATE: Tuesday, March 29th, 2016
VCA Alameda East Staff Meeting Room 
RSVP to 688.referrals@vca.com

Check out our Lunch and Learn offerings  here!
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Dear Doctors,

It looks like spring is coming early! We hope that you are enjoying this wonderful weather.

Don't forget to RSVP to our CPR Simplified CE on March 29th at 6:30pm here at VCA Alameda East Veterinary Hospital.  

Our Neurology team is still out and about visiting practices.  We hope to see you soon and please call if you would like us to stop by for an informal meeting so we can get to know our referring veterinarians.
Best regards,  
Angela Starkel  
Specialty Client Care Coordinator


Elise Contreras
Specialty Client Care Coordinator
What a bloody pain! Idiopathic Renal Hematuria in Dogs
Katherine Scott, DVM, DAVIM (SAIM)
When a dog presents with the chief complaint of gross hematuria, it is almost always due to a disease of the bladder. Urinary tract infection, urolithiasis, prostatic disease, trauma, and neoplasia are all relatively common causes that should be investigated. Less commonly, hematuria may be caused by disease of the penile urethra or prepuce/penis, vagina, or a systemic coagulopathy. Kidney disease can also be a cause of gross hematuria but is more challenging to diagnose. Known causes of renal hematuria include nephroliths, pyelonephritis, renal neoplasia, and idiopathic renal hematuria. Idiopathic renal hematuria is uncommon, but is an important differential for any dog in which routine testing has not identified a cause of gross hematuria.

Idiopathic renal hematuria (IRH), also called benign essential renal hematuria, is a condition that results in blood loss from the renal vessels into the renal pelvis and urine. It is chronic in nature, and by definition no identifiable cause can be found through standard testing. It is most commonly a disease found in young, large breed dogs, but has also been documented in cats. It is usually unilateral (possibly more common on the left), but is bilateral in about 20% of cases. Cases that start with unilateral disease may also develop bilateral disease at a later date.

Clinical signs may not be apparent, other than gross hematuria observed by the owner. However, some dogs will display signs of lower urinary tract disease (pollakiuria, stranguria), due to presence of blood clots in their lower urinary tract. Obstruction of either the ureters or urethra is possible, resulting in expected clinical signs based on obstruction location and severity. Approximately half of IRH cases reported in the literature will demonstrate hydronephrosis or hydroureter. Some dogs will present with clinical signs related to severe anemia, if the IRH is causing severe blood loss. Blood loss can be severe enough to require transfusion(s). If blood loss is chronic and/or severe, iron deficiency may also occur.

Diagnosis requires direct visualization of hematuria in the upper urinary tract. This traditionally was performed via laparotomy, during which urine could be collected bilaterally from the renal pelvis and examined for gross hematuria. More recently, the improved quality and availability of cystoscopy for both female and male dogs makes cystoscopy a less-invasive option for diagnosis of IRH. Cystoscopy allows for bilateral visualization of the ureterovesicular junction (UVJ), where the ureter connects and empties urine into the bladder. In dogs, the UVJ is a "C-shaped" structure located on the dorsal aspect of the bladder wall just proximal to the urethral sphincter (see figure 1). During cystoscopy, each UVJ is located and then observed until a jet of urine can be visualized. In dogs with IRH, the urine jet will appear grossly hematuric (see figure 2). The opposite UVJ is then observed for any evidence of hematuria. The rest of the bladder and urethra is also carefully examined for neoplasia, uroliths, or other abnormal lesions.
Figure 1. Left ureterovesicular junction
Figure 2. Left ureterovesicular junction demonstrating jet of hematuric urine 


Treatment for IRH has historically relied on ureteronephrectomy in cases of unilateral disease. Other treatments attempted include partial occlusion of the renal artery and medical management with Yunnan baiyao. Previously, cases of bilateral IRH might have been treated with benign neglect (when possible) or euthanasia in severe bilateral IRH, as bilateral ureteronephrectomy is not possible. New techniques using sclerotherapy for treatment of IRH are now available for dogs. Sclerotherapy is injection of a chemical irritant into a vein, resulting in swelling and scar tissue development within the vessel, essentially ligating the vessel. This technique has been used in people with IRH, and has been described in dogs using both silver nitrate and povidone iodine infusions. These therapies have been reported to result in either improvement or resolution of the hematuria, on either a short or longer-term basis. While additional studies are needed to clarify the long-term utility of this treatment option, it provides an exciting alternative that can be used in cases of bilateral disease. Sclerotherapy also allows for retention of both kidneys, which is a huge advantage in preserving long-term kidney function. These procedures can all be performed at AEVH.
Katherine Scott, DVM, DAVIM (SAIM)

Dr. Scott received a BS in zoology from the University of Oklahoma, and then obtained her DVM at Oklahoma State University in 2003. Following a one-year internship at Kansas State University, she went on to complete her small animal internal medicine residency at Texas A&M University. Dr. Scott became board certified by the American College of Veterinary Internal Medicine in Small Animal Internal Medicine, and continued to work in the small animal internal medicine section at Texas A&M University.
Dr. Scott brings her skill in numerous interventional radiology techniques to us here at VCA Alameda East. Her interests primarily include gastroenterology, infectious diseases, urology, and minimally invasive procedures. She is proficient in all endoscopic procedures. She is also a member of the American Association of Feline Practitioners.

Specialty Line: 720.975.2804 | Specialty Fax: 720.975.2854

9770 E. Alameda Avenue, Denver, CO 80247
(2 blocks west of Havana)