Adelman Lauren B, Bartges Joseph, Whittemore Jacqueline C
J Am Vet Med Assoc. 2017 Jan 15;250(2):205-210. doi: 10.2460/javma.250.2.205.
CASE DESCRIPTION A 6-year-old spayed female Great Pyrenees (dog 1) and a 2-year-old spayed female German Shepherd Dog (dog 2) were evaluated because of gross hematuria of 5 and 2 months' duration, respectively. CLINICAL FINDINGS In both dogs, coagulation times were within reference limits, results of aerobic bacterial culture of urine samples were negative, echogenic debris could be seen within the urinary bladder ultrasonographically, and hematuric urine could be seen exiting the right ureterovesicular junction, with grossly normal urine exiting the left ureterovesicular junction, during cystoscopy. A diagnosis of idiopathic renal hematuria was made in both dogs. TREATMENT AND OUTCOME Both dogs underwent retrograde ureteropyelography, unilateral povidone iodine sclerotherapy, and ureteral stent placement. The right ureter was occluded with a ureteropelvic junction balloon catheter, and a 5% povidone iodine solution was infused into the renal pelvis 3 times. A double-pigtail ureteral stent was then placed. Both dogs recovered without complications, with cessation of gross hematuria within 12 hours. Cystoscopic removal of the ureteral stent was performed in dog 1 after 4 months; at that time, the urine sediment contained 5 to 10 RBCs/hpf. In dog 2, urine sediment contained 50 to 75 RBCs/hpf 2 weeks after sclerotherapy, with continued resolution of gross hematuria 8 weeks after sclerotherapy. The owners declined removal of the stent in dog 2. CLINICAL RELEVANCE Findings suggested that povidone iodine sclerotherapy may be an effective renal-sparing treatment for idiopathic renal hematuria in dogs. Further evaluation with longer follow-up times is warranted.
病例描述 一只6岁已绝育的雌性大白熊犬（犬1）和一只2岁已绝育的雌性德国牧羊犬（犬2）分别因持续5个月和2个月的肉眼血尿接受评估。临床发现 两只犬的凝血时间均在参考范围内，尿样需氧菌培养结果为阴性，膀胱超声检查可见回声性碎屑，膀胱镜检查时可见血性尿液从右输尿管膀胱连接处流出，而左输尿管膀胱连接处流出的尿液大体正常。两只犬均被诊断为特发性肾血尿。治疗与结果 两只犬均接受了逆行输尿管肾盂造影、单侧聚维酮碘硬化治疗和输尿管支架置入。用输尿管肾盂连接部球囊导管阻塞右输尿管，并向肾盂内注入3次5%聚维酮碘溶液。然后置入双猪尾输尿管支架。两只犬均康复且无并发症，肉眼血尿在12小时内停止。4个月后对犬1进行膀胱镜下取出输尿管支架；此时，尿沉渣中每高倍视野含5至10个红细胞。在犬2中，硬化治疗后2周尿沉渣中每高倍视野含50至75个红细胞，硬化治疗后8周肉眼血尿持续消退。犬2的主人拒绝取出支架。临床意义 研究结果表明，聚维酮碘硬化治疗可能是犬特发性肾血尿一种有效的保留肾脏的治疗方法。有必要进行更长随访时间的进一步评估。
