Volume 17 | Issue 3 Article 7

1955 A Discussion of Hemoglobinuria and Hematuria R. L. Nelson Iowa State College

Follow this and additional works at: https://lib.dr.iastate.edu/iowastate_veterinarian Part of the Large or Food Animal and Equine Medicine Commons, and the Veterinary Pathology and Pathobiology Commons

Recommended Citation Nelson, R. L. (1955) "A Discussion of Hemoglobinuria and Hematuria," Iowa State University Veterinarian: Vol. 17 : Iss. 3 , Article 7. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol17/iss3/7

This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. A Discussion of Hemoglobinuria and Helllaturia

R. L. Nelson

EMOGLOBINURIA MAY BE DE­ give rise to these symptoms. Some cases EI FINED as the symptom of a patho­ are of unknown causes. logical state in which the animal passes Etiology of Hematuria and hemoglobin in the urine. In this condition the urine will be pink to brownish-red in Hemoglobinuria color depending upon the amount of hem­ Bacteria and Viruses oglobin passed. ''Leptospira pomona of bovine *Corynebacterium renale Hematuria is a symptom of that patho­ *Clostridium hemolyticum logical condition in which the animal pass­ *Bacillus anthracis es whole blood in the urine. The erythro­ *Staphylococcus sp. cytes do not hemolyze and the urine will *Streptococcus sp. Proteus ammon,ae appear pink to brownish-red in color de­ Mycobacterium tuberculosis pending upon the amount of blood passed. Erysipelothrix rhusiopathiae Neither hematuria or hemoglobinuria is Torter suis Pasturella multocida a lesion but they are signs that lesions are Clostridium perfringens present. Certain etiological factors are re­ Physical Influences sponsible for both hematuria and hemo­ *Renal calculi globinuria and it should be remembered Trauma that both of these conditions may occur si­ Sulfonamide crystals Oxalate crystals multaneously. Dystocia In general, it can be said that hemoglob­ Infarction inuria is due to a condition in the body Embolism which is pre-renal whereas hematuria is Temperature Influences caused by a renal or post renal lesion. Severe burns The accompanying list of etiological fac­ Cold tors gives an indication of the complexity Physiological *Myogenous toxins (Azoturia) of the problem of making a diagnosis on "Heterologous blood transfusions the basis of discovery of blood or blood *Post parturient hemoglobinuria hemoglobin in the urine. The factors listed Deficiency of blood platelets Right A-V insufficiency are presented as the more important Local anaphylaxis causes of hematuria and hemoglobinuria. Cystic ulcers It does not, of course, include all of the Neoplasms of the bladder Prostatic cysts possible etiological agents which could Chemical Agents The author is a member of the present junior *Lead class. This paper was prepared under the direc­ Arsenic tion of Dr. F. K. Ramsey. Copper

Issue 3, 1~54-55 159 Mercury vary in the different areas of the country. Bismuth The types of viral and bacterial diseases Sulfur Phosphorus occurring frequently in the area, the type Dietary Deficiencies of vegetation and common nutritional de­ Avitaminosis ficiencies are all factors which will influ­ Phosphorus ence the order of importan-ce of the etiolo­ Miscellaneous Trichlorethylene extracted soybean-oil-meal gical factors. For instance, the practitioner Snake venom in the western and southwestern states Warfarin would want to consider the poisonous Parasites plants as a common cause of the Symp­ Protozoa toms. Certain areas may have many cases *Babesia sp. Toxoplasma gondii?? of bloody urine or blood pigmented urine Eimeriatruncata? ? due to a particular species of parasite. Helminths The most important factors causing the Dirofilaria immitis Stephanurus dentatus symptoms of hemoglobinurea and hema­ Dictophyma renale turia in the midwestern states can be listed Broad fish tapeworm? as follows: (1) Leptospirosis pomona of Hookworms? Ascarids? bovine (2) Pyelonephritis (3) Anthrax Strongylus vulgaris (4) Bacillary hemoglobinuria (5) Uri­ Capillaria plica nary calculi (6) Streptococcus infections Plants (7) Staphylococcus infections (8) Lead Sweet clover Brachen fern poisoning (9) Post parturient hemoglob­ Rape inuria (10) idiopathic hemoglobinuria. Mustard If the diagnosis does not indicate that Poisonous mushrooms Fir tree sprouts and sawdust the condition of hemoglobinuria or hema­ Ergotized rye turia is caused by one of the above factors, Agave lecheguilla Lupine then the other etiological factors should Black locust be considered more closely. The disease Castor bean diagnosis will largely be made on the ba­ Heliotrope Quercus sis of the following: (1) The history of Turnip the condition or disease (2) Clinical symp­ Beet pulp toms (3) Palpation (4) Urine examina­ Bryonia tion (5) Serological methods. Drugs Since there may be a question in the Cantharides Sulfonamides practitioner's mind as to whether the an­ Carbolic acid imal has hematuria or hemoglobinuria it Potassium chlorate would be well to mention a few Qf the dif­ Phenacetin Antifebrin ferences in the two symptoms. Either one Creolin may be present or both may occur at the Napthaline Turpentine same time. (1) Presence of blood clots in Phenol hematuria (2) Presence of whole erythro­ Insulin cytes in hematuria '(3) Opacity of urine Phenophthalein Purine in hematuria while in hemoglobinuria Pseudo-hematuria there is a transparency which allows the Phenothiazine reading of print through varying depths of Prontosil urine (4) Settling of the erythrocytes with *Idiopathic hemoglobinuria a relatively clear supernatent plasma in ? (Doubtful importance) "(Important influences) hematuria, A more stable solution char­ acterizes the hemoglobinuria sample. Since there are so many etiological agents, the practitioner should keep sev­ Hematuria eral of the more common causes foremost in his mind when attempting to make a When the symptom of hematuria is ob­ diagnosis. The order of importance will served then there are several important

160 Iowa State College Veterinarian etiological agents which should be con­ I. Indications of urethral and vestibular lesions A. Constant dripping of blood between pe­ sidered first. Some of the more common riods of micturition (may be confused conditions which exhibit the symptoms with hemorrhage from the genital tract) are: (1) Injuries of the kidney due to B. Blood seen in the urine only at the be­ ginning of urination traumatism (2) Nephritis (inflammation) C. History of recent catherizat:on (3) Nephrosis (degenerative lesions in II. Indications of bladder damage renal tubules) (4) Ureteritis (5) Pyelitis A. _ Most blood seen at the end of urination (6) Cystitis (7) Urethritis (8) Prostatitis B. Presence of large blood cots C. Not a large amount of albumin present (9) Generalized acute infections (toxins in relation to the amount of blood. Bac­ increase the permeability) (10) Acciden­ terial count may be high tal hematuria. D. Cellular content of the urine The last two conditions may require 1. Presence of large epithelial cells irregu­ lar in size (a certain amount of squam­ additional explanation. Generalized acute ous cells may be found in normal urine) infections may cause hematuria by the li­ 2. Larger cuboidal to columnar cells indi­ beration of toxins and thus resulting in an dicates deeper damage to the bladder mucosa increased permeability of the glomerular 3. Presence of calculi filter. Accidental hematuria may be re­ III. Indications of ureter damage garded as blood from the genital tract A. Presence of -long filaments mixing with the urine and giving the false B. Presence of small, round globular-like cells (These cells are larger than those impression that the blood had its origin in from the tubules but smaller tban those the urinary tract. from the pelvis of the kidney) Methods of attempting to reach a con­ IV. Indications of renal pelvis damage clusion as to the location of the disorder A. If hemorrhage is_rapid, may have a cast of the pelvis formed giving rise to the hematuria will vary B. Presence of pear -shaped, lenticular to ir­ somewhat with the species of animal. In regular cells which are smaller than large animals rectal palpation would be of bladder cells but larger than cells of the ureters. importance. The bladder would be pal­ V. Indications of damage to the nephron unit pated for the presence of calculi, tumors and collecting units or other pathological changes in the wall. A. Presence of very small clots In thin animals the ureters could be pal­ B. The more intimate mixture of blood with urine. Blood is more or less evenly dis­ pated to detect any disturbances such as tributed throughout urination (!alculus or thickened wall. C. More fragmentation of the erythrocytes It is not always possible but attempts D. Presence of casts which may be the en­ entire epithelium of a tubule or a mold­ should be made to palpate the kidney. ed exudate. The presence of erythrocytes Over-distention or constriction may be de­ attached to the casts is good evidence that tected. Slight pressure should be applied the lesions are of renal origin E. Large amount of albumin in comparison to the kidney to check for pain; this may to the amount of blood, with or .with- also be done externally on some species out the presence of bacteria \ of animals. Rectal palpation may also be F. Presence of very small cuboidal 'cells from the convoluted tubules, or ~ery used in dogs to detect disorders of the small columnar cells from the collecting prostate gland. ducts A careful examination of the urine may yield evidence indicating the specific lo­ Hematuria Associated with Pyelonephritis cation of the lesion. The condition of the blood in the urine, the type of epithelial The mechanism by which a common cells present, and the type of sediment disease may result in hematuria can be il­ present are clinical signs which are used, lustrated by a brief account of pyeloneph­ especially by the small animal practition­ ritis as it occurs in animals. Obviously, er. A summary of the evidences indica­ not all the diseases causing hematuria fol­ ting lesions of specific regions of the uri­ low the same mechanism in regard to the nary system follows. It should be remem­ manner by which the blood gains entrance bered that in a given situation all or none into the urinary system; however, many of these conditions may be met; they are of them follow a similar pattern. presented as a clinical aid to diagnosis. Pyelonephritis is a highly fatal, chronic

Issue 3, 1954-55 161 POLYOTIC· INTRAMUSCULAR: 100 mg.-500 mg.-to Gm.-5.0 Gm. POLYOTIC INTRAVENOUS. 100 mg.-2.5 Gm. POL YOTIC OBLETS@: 4'5-6 x 4'5 POLYOTIC CAPSULES: 50 mg., 25'5-100'5; 100 mg., 100'5; 250 mg., 16'5-100'$ POLYOnC TABLETS: 50 mg., 25'5-100'5; 100 mg., 25'5-100'5; 250 mg., 16'5-100'5 POLYOnC MASTITIS OINTMENT: ~ OZ. POL YOTIC COMPOUND MASTITIS OINTMENT: ~ OZ. POL yonc OPHTHALMIC OINTMENT 1%: 6 x Y. oz. POlYOTIC TOPICAL OINTMENT 3%: 1 oz. POL YOTIC SOLUBLE (Tinted) POWDER : ~ Ib.-Yz Ib.-1 Ib.-5 lb. AVIANIZED@ RABIES VACCINE: (Canine): 1 dose-5 x 1 dose ~ 10 doses A-VIAI'IIZED RABIES VACCINE : (Cattle): 10 doses AVIANIZED CANINE DISTEMPER VACCINE. 1 dose-l0 x 1 dose ANTI· CANINE DISTEMPER SERUM AND ANTI. INFECTIOUS CANINE HEPATITIS SERUM : 20 cc. 100 cc. INFECTIOUS CANINE HEPATITIS VACONE: 2 cc.-10 cc. BRUCELLA ABORTUS VACCINE: 1 dose-5 x 1 dose­ S doses (25 cc.) FEUNE DISTEMPER VACCINE : 1 immunization (2 vials Vaccine, 2 vials Sterile Diluent, 2 cc.) ANTI.FEUNE DISTEMPER SERUM : 50 cc. CARICIDE@ Diethylcarbamazine TABlETS . 400 mg., 25's DIETHYLSTILBESTROL SOLUTION . 10 cc.-50 cc. LEPTOSPIRA CANICOLA·ICTEROHEMORRHAGIAE BACTERI~ Whole Culture Inactivated Vacuum-Dried. Other products to be added. lib. POLYone· T"'IIIy~ HydrOlhloricre SOLUBLE '~ (Tinted) s..., .. ~... HeI'3 ...... c...... '""""",-, ~ s...... '-".,.. Circ ......

POLYone' '~,':X~ w."~~o." 164 Iowa State College Veterinarian purulent inflammation of the bladder, may last for several weeks. This IS the ureters, and pelvis portion of the kidneys. cause of the hemoglobinuria which may It occurs chiefly in cows but has been be an important symptom of the disease. found in horses, sheep, swine and dogs. Obviously, the hemoglobinuria may result The infectious agent responsible for pye­ in anoxemia which is responsible for many lonephritis is Corynebacterium renale. of the lesions observed in a case of leptos­ The organism is spread by contact with pirosis. The urine varies in color from a infected animals via the urogenital tract. light pink in the mild cases to a deep red­ Probably the most important diagnostic dish-black in severely infected animals. In symptom of the disease is hematuria. This severe cases death may occur by the sec­ condition is caused by an increased per­ ond day and is frequently attributed to meability of the blood vessels and rupture massive erythrocyte destruction and the of the capillary walls due to necrosis. The resulting fatal anoxemia. animal is restless due to the inflammation in the kidneys, ureters, and bladder and Bibli~raphy thus the swelling exerts pressure on the Boddie, G. F. Diagnostic methods in veterinary sensory nerve. There is a straining and medicine. Brooks and Alyea. Poisons. frequent urination due to the large Coffin, D. L. Manual of veterinary clinical pa­ amount of urine formed. This increased thology. 3rd edition. amount of urine results in damages to the Cotten. Toxicology text. Not bound. Davison, F. R., Synopsis of materia medica, tox­ glomeruli and tubules and also because of icology, and pharmacology. irritation produced by the urine in the in­ Friedberger and Frohner. Veterinary pathology. flammed bladder. Severe anemia is pro­ 6th edition. Gradivohl. Clinical laboratory methods and dia­ duced as a result of loss of blood by way gnosis. 3rd edition. of the urinary tract. The circulatory and Hawk, Oser, and Summerson. Practical physio- respiratory systems have an increased load logical chemistry. Hemoglobinuria. Physiological reviews. 1942. placed upon them. This, coupled with the Kelanffe. Clinical urinalysis. effect caused by toxic products from ne­ Lander, G. D. Veterinary toxicology. Merchant, I. A. Veterinary bacteriology and vi­ crosis and suppuration, produce myocard­ rology. ial degeneration and final collapse of the Morgan and Hawkins. Veterinary helminthol- heart with death by asphyxia. Death may ogy. Morgan and Hawkins. Veterinary protozoology. be sudden if there is a rupture of the clots Runnels, R. A. Animal pathology. 5th edition. found in the ureters of bladder. Stengel and Fox. Textbook of pathology. 6th edition. Underhill. Tox:cology. Hemoglobinuria Associated with U.S.D.A. Bulletin. Oak poisoning. L.eptospirosis Van Brand, Theodor. Chemical physiology of endoparasitic animals. One of the important diseases in which 1953 Reports on hematuria and hemoglobinuria. hemog10bin occurs in the urine is Lepto­ Acknowledgements: spirosis and it can be used as an example D. G. Erickson to describe one mechanism by which a dis­ G. S. Firkins ease process can cause hemoglobinuria. O. W. Nelson After the leptospira organism enters the W. J. Owen J. H. Post respiratory tract it enters the blood stream W. R. Richter and produces a septicemia and fever. He­ J. B. Doudna molysis of the erthrocytes is produced and this is thought to be caused by toxins * Report which are liberated by the leptospira. The (Continued from page 153) organism then localizes in the kidney an exotic disease to gain a foothold in this where it produces interstitial nephritis. country with disastrous results to our en­ Reinhard has divided the disease into four tire cattle industry. stages: (1) incubation stage (2) septice­ The following objectives were set up for mic period (3) hemolytic stage (4) inter­ future work on this problem. (1) To des­ stitial-nephritis. The hemolytic period cribe or classify each of these diseases

Issue 3, 1954-55 165