Diagnosing Blood In Urine

[Guest Angela]

Last year I adopted a senior greyhound who had been returned. He's 10.5 years old now. He's been having urinary issues, mainly not able to hold it while I'm at work, not making it through the night without having to go out or having an accident, and straining to pee. Other than that, he's still in good spirits, same activity level, still has a healthy appetite, has not lost weight, has normal bowel movements each day. Four weeks ago I took him to the vet and had his urine analyzed. They found blood in his urine and a high amount of bilirubin. They examined him and found him to appear to be in good physical health, and no reason to believe the bilirubin was a legitimate reading. There were no crystals present in his urine.

 

The gave me cephalexin to give him, 750 mgs twice a day. He did not get better, and within two weeks I spoke with the vet again and brought to their attention that he had been on cephalexin four times prior that I knew of (for a prior UTI and skin infections) and therefore was concerned that the strain of bacteria he may have may have become resistant to it. They gave me another antiobiotic to try, TMP-SMX, 480 mgs twice a day.

 

Strangely, he got better on the TMP-SMX, had a good week last week, urinated in his crate on Monday, but not on Tuesday and Wednesday, a small amount on Thursday, and clean crate on Friday. He seemed to be much better over the weekend, but then this week has returned to peeing in his crate while I'm at work, having to go out early during the night, and straining to pee.

 

Yesterday I took him back to the vet. In reviewing his previous urinalysis, they decided that while no crystals were present, an x-ray should be done next since his pH level had been 6.5, and stones are the next most common cause of blood in the urine. The other readings made them feel like his kidneys are functioning properly.

 

The results for the x-ray were inconclusive because his colon was full and his bladder was empty, which made reading the x-ray difficult. They did not see any stones from what they could see. The Vet told me that stones won't always show up on an x-ray anyways, and said an ultrasound would do better. They don't have this ability at their clinic so I'd be referred somewhere else, and I was told this test costs around $350.

 

Side note, there was nothing else on the x-ray that gave them any reason to suspect cancer, although they couldn't rule that out completely. They did a prostate exam and said it seemed normal, and from what they could see on the x-ray it appeared to be fine.

 

Here are my options for my next course of action:

 

1.)Redo the X-ray when he's had a recent bm and his bladder is fuller. Cost, less than $70

2.)Culture his Urine to rule out an infection that would have been resistant cephalexin and TMP-SMX. This costs around $100.

3.)Ultrasound - $350

4.)Vet offered to write a prescription for an antibiotic that is basically Batyrl. This is $20.

5.) Blood work - $112

 

If this was your dog, knowing what I've told you, what would you do next? I am limited financially what I can do, however, having said that, I will come up with whatever I need to, I just need to make sure I spend my money very wisely.

[Batmom]

Did they see anything in his urine besides blood? White cells, bacteria? He needs bloodwork either way. If there was anything in the urine besides blood, he also needs a urine culture.

[Guest Angela]

Honestly, I'm not sure...whatever they saw initially made the feel like it was a UTI. I do believe they mentioned white blood cells, but they didn't mention bacteria. I guess I've been under the impression that a uranlysis won't show bacteria, that's what the culture is for? Am I wrong? If so, I will call and ask them whether bacteria was present.

 

I prefer to do one test at a time, so would you do blood work or the culture first?

[Batmom]

Which to do first: It depends on whether the urinalysis was strongly indicative of infection. If it was strongly indicative, and it's been at least 5 days since he had an antibiotic, I'd do the culture. If it wasn't, I'd do the bloodwork and make sure kidneys and all other body systems are in decent working order.

In an infection, urinalysis will *usually* show bacteria (or bacteria by-products), but you need a culture to determine what antibiotic that bacteria is susceptible to. If they did see white cells, you're probably looking at an infection.

 

It is fairly common in both people and dogs to give an antibiotic for suspected urinary tract infection without culturing first. That's OK. But if the infection quickly comes back or appears to never go away, you need the culture.

[Guest d0ggiem0mma]

I would do the bloodwork first because of the pH issues and the bilirubin levels. A full CBC/Profile will give you a lot of information as to how his body systems are functioning, including kidneys and liver, plus the white cell count should tell you if there is an underlying infection somewhere. I recently had a foster dog that was drinking and peeing a lot. The urinalysis looked pretty decent, but the bloodwork showed that he was in end stage kidney failure. I'm not trying to scare you with that, just trying to illustrate that a simple urinalysis does not always give a good picture of kidney function.

 

Also, since he was on antibiotics a urine culture might show false info. He would need to be off all antibiotics for about 10 days before a culture would be effective.

 

If I was only doing 1 thing at a time, I would start with bloodwork and go from there since that will give you the most info.

[MaryJane]

I would do the blood work first to check the kidney values and if all looks pretty good there then I would do a culture.

[Guest Angela]

To update, we did the second x-ray, which showed nothing. I opted to try the Ciprofloxacin next as we couldn't do the culture anyways, and this only cost me $12. So far I've seen no results with this third, stronger antibiotic, so yesterday we did blood work, which came back today as completely normal.

 

We have decided to finish this antibiotic and then do another urinalysis, to verify blood is still there, and if so, then the next most likely cause is bladder cancer, which would show up on the ultrasound, which has been quoted to me as costing $231.

 

They want to verify blood is still there in case this has turned into an incontinence or psychological problem.

[greyhead]

Sending good thoughts to you and your senior boy. Let us know how things go.

[tbhounds]

It this was my hound I would jump right to the abdominal ultrasound. Think in the long run it actually might save you money rather than hunt and peck. Sadly, cancer can't be ruled out. TCC (transitional cell carcinoma-bladder cancer) is not a stranger in GH's. It's usually affects breeds such as shelties, beagles, westies and scottish terriers but, I have heard of more than one case in GH's. In dogs it's usually considered an aggressive cancer that doesn't respond well to chemo. You can slow it down by using Piroxicam. Fingers crossed that it's just a UTI but, if it is TCC you really need to start to treat it asasp. Keep us posted.

[Guest Angela]

Back again. My houndie will take his last dose of chiprofloxacin (sp?) tonight. He has seen some minor improvements, but for the most part, is still having issues.

 

We did another UA today, and the results were "essentially the same as they were on 1/17", per my vet. I had them fax me a copy of both UAs and the blood work.

1/17/2011 UA:

 

Leukocytes: neg

Nitrite: neg

Urobilinogen: 0.2 Avg

Protein: 30+ Avg

pH: 6.5

Blood: Moderate 80

Specific Gravity: >1.040

Ketone: neg

Bilirubin large+++

Glucose: neg

Sediment: mid-stream

WBC 2-5/hpf; RBC 10-20/hpf; Epithelial cells 0-1/hpf

2/25/2011 UA:

 

Leukocytes: neg

Nitrite: neg

Urobilinogen: 0.2 Avg

Protein: 100++ Avg

pH: 6.0

Blood: Moderate 80

Specific Gravity: >1.040

Ketone: neg

Bilirubin large+++

Glucose: neg

Sediment: mid-stream

WBC & Epithelial cells 2-5/hpf; RBC 10-20/hpf

 

2/17/2011 Bloodwork:

There is too much to type everything out....my Vet said at the time everything was "completely normal", but there are some readings that are high. Everything is Avg, Except these things that are showing as High:

 

Corrected Calcium: 9.9 ((line above this is Calcium, 9.8))

Na/K Ratio: 30

Cholesterol: 454

Eosinophils: 13 ***There is also an Absolute Eosinophils reading that shows 702, Avg.

 

 

SO, the Vet is still pushing for an ultrasound. I'm not completely convinced this should be done next. Any thoughts?

[GeorgeofNE]

To update, we did the second x-ray, which showed nothing. I opted to try the Ciprofloxacin next as we couldn't do the culture anyways, and this only cost me $12. So far I've seen no results with this third, stronger antibiotic, so yesterday we did blood work, which came back today as completely normal.

 

We have decided to finish this antibiotic and then do another urinalysis, to verify blood is still there, and if so, then the next most likely cause is bladder cancer, which would show up on the ultrasound, which has been quoted to me as costing $231.

 

They want to verify blood is still there in case this has turned into an incontinence or psychological problem.

 

Ah, too late! I was going to say not to spend your money on a second x-ray.

 

No point in checking for stones via x-ray if the first x-ray didn't show them, as their are 2 types, as you know, and only one of them shows on x-ray!

 

I went the ultrasound route--of course it showed simply that my dog is perfect in every way (at least inside!)...

 

At least I know now!

[Guest Stripeyfan]

No advice but I hope you can get this sorted out soon.

[Guest mcsheltie]

I would do sterile catch culture & the ultrasound.

Edited February 25, 2011 by mcsheltie

[Guest MZH]

I would get a cystocentsis and urine culture and sensitivity before giving any antibiotics. It's usually done along with a chemistry and CBC and that would check for other issues. If nothing shows up, then do the rads and/or ultrasound. The only thing that always bothers me about the cysto is that the procedure can cause blood to be in the urine from the stick.(I'm not a vet; I just have way too much experience with this.)

 

You may have to wait a couple of weeks before urine testing again because of the first antibiotic.

[Guest Angela]

Update: I went to another vets office who has an ultrasound machine and let them do a "second opinion" on my hound. The Vet felt like he has a resistant infection, and wanted to do a culture and sensitivity, using the ultrasound machine and something else to collect the urine directly from the bladder.

 

I told the Vet his bladder was empty - as not only does he have a urinary issue going on, but while he's at the vets office he gets nervous and keeps peeing every 5-10 minutes. We had waited over an hour so his bladder was completely empty. The Vet said he's a large dog and there is always urine in their bladder, and they can only try.

 

They came back and told me that his bladder was empty, so they couldn't do a urine culture and sensitivity, but they found that his prostate "has an irregular boarder". The Vet did a prostate exam and said my hound was in a lot of discomfort when he did it. Bottom line, the Vet feels like there is a high probability that he has prostate cancer, with the only other less likely possibility being a prostate infection. They could do around $200 worth of testing to confirm prostate cancer, but after speaking with the vet more, we opted to treat him with two weeks of doxycycline, which would treat a prostate infection if there is one. Basically, if that doesn't work, I'm told to assume the worst.

 

I took these findings to my other vet this morning, with a copy of the ultrasound, to get their opinion. They have called me and said they agree with this other vets findings, and have even less hope that it could be an infection. The vet mentioned that the second antibiotic we tried, TMP-SMX, is actually what she prefers to use when treating prostate infections, and since that didn't work, she doesn't feel like it would be an infection.

 

Really bummed with these findings, and honestly, completely baffled as I've read about prostate problems several times through this whole process and didn't think it was likely since he didn't many of the symptoms(constipation and straining to have BM's, mainly) and the first vet checked his prostate and thought it was fine. Even read that prostate cancer is uncommon.

[Guest MZH]

I'm sorry you had such uncertain findings despite them doing the right things. Years ago we had a dog with a bad prostate infection; we got him intact as this was before the days of adoption groups. The neuter fixed the problem. I don't know if this is related to your guy's issue or not. I hope this is transient.

 

Can they do PSA type test on a dog?