recurrent hematuria, negative culture, 3 year old FS dog


This 3 year old lab mix FS dog was treated for her first episode of hematuria and pollakiuria 12/9/19. USG 1.033, pH 8.5, 3+ blood in urine, sediment was not examined. She was given 10 days of Amoxi-Clav and seemed to respond. 

On 1/17/20 the owner reported the symptoms reoccured, and Amoxi-Clav was dispensed for another 10 days. The problem again seemed to resolve.

This 3 year old lab mix FS dog was treated for her first episode of hematuria and pollakiuria 12/9/19. USG 1.033, pH 8.5, 3+ blood in urine, sediment was not examined. She was given 10 days of Amoxi-Clav and seemed to respond. 

On 1/17/20 the owner reported the symptoms reoccured, and Amoxi-Clav was dispensed for another 10 days. The problem again seemed to resolve.

She then presented on 3/30/20 for a recurrence of symptoms. USG 1.039, blood 3+, pH 6, WBC 6-10 per hpf, RBC>100 hpf, No bacteria seen, epi cells rare. This was a cysto sample which was also cultured, and the culture was negative (we do in-house cultures, which I believe catch some of the bacteria that don’t survive to be grown in the lab, so I’m pretty confident of our result).

The dog is overweight,and does have somewhat of a hooded vulva –not extreme and there is no evidence of perivulvar dermatitis. 

What is the mineralization I am seeing? In the bladder wall? Would you suspect that there is infection in the wall itself at this point? Or a sterile cystitis?

My plan is to stay on Amoxi clav for an extended course- maybe 3 weeks, and then re-ultrasound. 

Perhaps radiographs would be helpful as well. 

Any thoughts appreciated-

Pam 


6 responses to “recurrent hematuria, negative culture, 3 year old FS dog”

  1. Certainly a curious

    Certainly a curious presentation that the specialists will address shortly. Just a helpful tip rearding your focal points on your ultrasound. You have 3 points selected, to get better image quality it helps to have one focal point. I think on the Logiq e defaults to 3 focal points, but I would definitely take 2 out. 🙂 -Kelly

  2. Given the age and pattern

    Given the age and pattern likely chronic cystitis… TCC cant be ruled out and scope best or traum cath if you can catheterize a female but cystitis til proven otherwise. Consider the predisposing issues given the early age ..recessed vulva, perivulvar dermatitis in the past that may not be present now… and urine pooling especially if you culture a “wet bug” like pseudomonas or proteus and such on cutlure but with the pyuria and chronic changes i would tx 4 weeks and recheck the sonogram.

  3. the culture was negative, and

    the culture was negative, and the pyuria was mild. If we had a positive culture I would have called it chronic cystitis for sure but without a culture result… anyway I will treat for 4 weeks as suggested and recheck. Thanks

     

    Kelly, thanks for the tips.

    Pam 

  4. Would also considering doing

    Would also considering doing a BRAF assay for TCC.

  5. Maybe conider in house

    Maybe conider in house culture for better growth potenital and then send out the bug for ID

  6. The culture was done in-house

    The culture was done in-house for exactly that reason, as explained above. 

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