The Veterinary Journal the Veterinary Journal 175 (2008) 240–248
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Available online at www.sciencedirect.com The Veterinary Journal The Veterinary Journal 175 (2008) 240–248 www.elsevier.com/locate/tvjl Clinical and ultrasonographic findings, diagnosis and treatment of pyelonephritis in 17 cows U. Braun a,*, K. Nuss a, D. Wehbrink a, S. Rauch a, A. Pospischil b a Department of Farm Animals, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland b Institute of Veterinary Pathology, University of Zurich, Winterthurerstrasse 260, CH-8057 Zurich, Switzerland Accepted 22 December 2006 Abstract The goal of the present study was to describe the clinical, haematological and ultrasonographic findings and treatment of 17 cattle with pyelonephritis. Fifteen cattle had an abnormal general condition, which varied in severity; five animals had signs of colic. The urine was brownish-red in 11 animals and cloudy in 13. Clumps of purulent material were seen in the urine of nine animals and clots of blood in two. The specific gravity was lower than normal in 13 animals and ranged from 1.005 to 1.020. A urine test strip revealed protein in 16 animals, blood in 16 and leukocytes in 12. Bacteriological examination of urine yielded Corynebacterium renale in 11 animals, Arcano- bacter pyogenes in two and Escherichia coli in one. Rectal examination revealed abnormalities of the urinary tract in 11 animals; there was dilatation of the left ureter and/or enlargement of the left kidney in eight cases, and dilatation of the right ureter and/or enlargement of the right kidney in three others. The most frequent abnormal haematological finding was an increase in the serum concentrations of total protein, fibrinogen, urea and creatinine, a decreased haematocrit and a positive glutaraldehyde test. In 13 animals, ultrasonography via the rectum and right flank using a 5.0 MHz transducer revealed dilatation of the right or left ureter, cystic lesions in one or both kidneys and dilatation of the renal sinus. Eight animals were euthanased or slaughtered at the owners’ request or because of a poor prognosis. Nine (53%) animals were suc- cessfully treated; five received antibiotics and four underwent unilateral nephrectomy and antibiotic therapy. The treated animals were clinically healthy when discharged from the clinic 10–21 days after admission. A follow-up via telephone 8–24 months later revealed that none had experienced complications and all were in full production. In cattle with severe unilateral pyelonephritis, unilateral nephrec- tomy is the treatment of choice. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Cattle; Pyelonephritis; Clinical findings; Ultrasonography; Treatment 1. Introduction teaching hospital were diagnosed with pyelonephritis (Divers et al., 1982). Pyelonephritis is a specific bacterial infection of the In the majority of cattle, pyelonephritis is caused by urinary tract in cattle. It has a protracted course and is Corynebacterium renale, a facultative pathogen that is a characterised by fever, episodes of colic and pyuria common inhabitant of the lower urogenital tract of healthy and/or haematuria (Gru¨nder, 2002). Of bovine kidneys cattle. Escherichia coli, Arcanobacter pyogenes, Corynebac- examined, the incidence of pyelonephritis in two abattoir terium cystitidis, Corynebacterium pilosum, Staphylococcus surveys was 0.87% (Rosenbaum et al., 2005) and 3.5% spp., Streptococcus spp., Enterococcus spp., Klebsiella spp. (Monaghan and Hannan, 1983). In a retrospective study, and Pseudomonas spp. are less commonly isolated from 2/800 bovine patients (0.25%) admitted to a veterinary the urine of affected cattle (Fetcher, 1985; Rosenbaum et al., 2005). Pyelonephritis is seen almost exclusively in * Corresponding author. Tel.: +41 1 6358241; fax: +41 1 6358904. cows, and in approximately 75% of cases occurs after abor- E-mail address: [email protected] (U. Braun). tion, dystocia or puerperal infection. Catheterisation of the 1090-0233/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.tvjl.2006.12.018 U. Braun et al. / The Veterinary Journal 175 (2008) 240–248 241 bladder for urine collection can result in pyelonephritis Eleven animals had been ill 1–8 days and six others for (Radostits et al., 2000), and natural breeding has been >14 days before referral. The owners of nine animals saw hypothesized to be another cause (Radostits et al., 2000). signs of colic, such as treading, lying down and kicking The clinical signs of pyelonephritis have been described in at the abdomen. Tentative diagnoses made by the referring one study of 15 cattle (Rebhun et al., 1989) and in various veterinarians were urinary tract disease in 12 animals with case reports (Johnson et al., 1984; Wallace et al., 1990; Tyler brown or bloody urine, indigestion in one case, omphalitis et al., 1991; Hayashi et al., 1994; Hirsbrunner et al., 1996; in the bull calf, bronchopneumonia in one case, caecal dila- Gufler, 1999; Rademacher, 2005). Diagnosis is based on tation in one case and ileus of the small intestines in one the results of clinical examination and urinalysis as well as case; the latter two animals had signs of colic and had ultrasonographic findings (Gru¨nder, 2002; Radostits et al., not passed any faeces. 2000). Descriptions of the ultrasonographic findings of cows with pyelonephritis have been limited to case reports, in 2.2. Physical examination which the findings varied greatly (Tyler et al., 1991; Hayashi et al., 1994; Hirsbrunner et al., 1996; Gufler, 1999; Radem- All cattle underwent a thorough physical examination acher, 2005). Hayashi et al. (1994) reported dilatation of (Rosenberger, 1979), which included general behaviour the renal pelvis and renal or urethral concretion. In one and condition, auscultation of the heart, lungs, cow with pyelonephritis, endoscopy of the bladder revealed rumen zand intestine, measurement of heart rate, respira- that the flow of urine, which contained blood and pus, from tory rate and rectal temperature, swinging auscultation the affected kidney was only about one-third of that of the and percussion auscultation of both sides of the abdomen, normal kidney (Hirsbrunner et al., 1996). Endoscopy was rectal examination and examination of the faeces. Testing diagnostically useful and warrants further investigation. for foreign bodies in the reticulum consisted of pinching Treatment of pyelonephritis necessitates the administra- of the withers, upward pressure on the xiphoid area and tion of antibiotics for 10 days to several weeks (Rebhun percussion of the reticulum. et al., 1989; Radostits et al., 2000; Gru¨nder, 2002; Van Metre and Divers, 2002) and procaine penicillin is the antibiotic of 2.3. Haematological and biochemical analyses choice. Treatment of pyelonephritis that is caused by Gram- negative bacteria depends on the results of urine culture and The haematocrit, total leucocyte count and concentra- sensitivity; ampicillin, amoxicillin, sulfonamides, gentamy- tions of total protein and fibrinogen were determined in cin, and nitrofurans are commonly used. Nephrectomy is EDTA blood. The concentrations of urea and creatinine advocated in cows with unilateral pyelonephritis that fails were determined in serum using a Cobas Integra 700 ana- to respond to treatment (Horney and Archibald, 1961; Poun- lyser (Roche Diagnostics) and Roche reagents under condi- den et al., 1962; Tulleners et al., 1981; Johnson et al., 1984; tions defined by the International Federation of Clinical Hayashi et al., 1994; Hirsbrunner et al., 1996). It is crucial Chemists at 37 °C. Blood gas analysis was undertaken on to determine that the remaining kidney is healthy before sur- a jugular venous blood sample and included measurement gery. The goal of the present study was to describe the clin- of pH, pCO2, bicarbonate and base excess. The reference ical, haematological and ultrasonographic findings and ranges for the variables were determined in the Veterinary treatment in 17 cows with pyelonephritis. Medical Laboratory, University of Zurich, using blood sam- ples from 10 healthy Swiss Braunvieh cows. Additionally, a 2. Materials and methods glutaraldehyde test (Glutaltest, Gra¨ub) was performed. 2.1. History 2.4. Urinalysis From 1987 to 2005, 17 cattle (13 cows, three heifers, one Urine samples were evaluated for colour, transparency, bull calf) with pyelonephritis were examined. They com- odour and the presence of abnormal substances. The urine prised 11 Braunvieh, three Holstein Friesians, two Sim- was also assessed using a strip test (Combur9-Test, mentals and one Aberdeen Angus and were aged six Roche), and the specific gravity was measured using a months to 12 years (mean [SD] 5.5 [3.48] years). refractometer. Smears of the urine sediment were stained Two cows had calved within 2 weeks and two others with Gram stain and examined microscopically, and a within 8 weeks of referral. Eight cows had calved >8 weeks urine sample was cultured bacteriologically on blood agar, before referral, three had never calved and the date of par- Brolac agar and MacConkey agar for 24 h at 37 °C. If turition was unknown in two others. Of nine cows in which Gram-negative bacteria were found an antibiogram was parturition was observed, one had dystocia. Two cows had performed. undergone repeated treatment for a retained placenta, and one other had been treated for a vaginal injury. Two cows 2.5. Ultrasonography of the urinary tract that had calved >6 months before referral had been bred naturally or artificially several times. The bull calf and In 13 of the animals, transrectal ultrasonography of the one of the heifers had been treated for purulent omphalitis. left kidney, left ureter and bladder was carried out using a 242 U. Braun et al. / The Veterinary Journal 175 (2008) 240–248 5.0 MHz linear transducer (Hitachi Medical Systems; treated. The same variables were compared between ani- Braun, 1993). The right kidney and right ureter were exam- mals with unilateral and bilateral pyelonephritis. ined via transcutaneous ultrasonography from the right flank (Braun, 1991). 3. Results 2.6. Treatment and outcome 3.1. Clinical findings Eight animals were either slaughtered or euthanased An abnormal general condition, which varied in sever- without treatment at the owners’ request (Nos.