Tags: renal failure, epithelial cells, urine sample, hydronephrosis, pyelonephritis, examination, cattle, urinary bladder, renal cortex, cases, Grass Sickness, K. J. CHANDLER, Clinical signs, Veterinary The Veterinary Formulary, Histopathological examination, bracken fern, postmortem examination, Easter Bush Veterinary Centre, Polyuria and polydipsia, amyloidosis, Friesian cow, haematuria, rectal examination, Professor Max Murray, urinary tract, specific gravity, enlargement, urine protein concentration, British Veterinary Association, H. Thompson, Veterinary Research Communications, Veterinary Ultrasonography, horses, trigone of the bladder, Journal of the American Veterinary Medical Association, Veterinary Record, papillary hyperplasia, University of Glasgow Veterinary School, MRCVS, University of Bristol Veterinary School, lesions, The Veterinary Formulary, Friesian cows, renal pelvis, Department of Veterinary Pathology, Pharmaceutical Press, Veterinary Studies
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=~~~~~~~=~~~N ~~-smNormal neurons Marginated Chromatolytic
Grass sickness horses 99.04 Normal horses (n=16) 99-62
Hydronephrosis and renal failure in two Friesian cows
In all cases there was a dramatic fall in the number of neu- K. J. CHANDLER, K. O'BRIEN, J. N. HUXLEY,
rons seen in the ileum and a less dramatic, but still very obvi- H. THOMPSON, J. L. FITZPATRICK
ous, reduction in the jejunum. It is difficult to understand
how the group A horses led such a normal life for so long, but renal disease is uncommon in cattle, with lesions severe
either some major redistribution of neuronal function within enough for rejection of the kidney for human consumption
the intestine took place or control may have been from the representing only 4-2 per cent of over 4000 cattle with abat-
autonomic ganglia. Alternatively, the reduced neuron num- toir lesions (Monaghan and Hannan 1983). Focal intersti-
bers after grass sickness may have been further reduced as the tial nephritis, due to infection with Leptospira species, was
animal aged and a crisis level was only reached at the time of the most common lesion in that survey. A large number of
the final colic. The group B animals had clearly adapted their lesions can affect the kidneys of cattle, including tubular
intestinal musculature, presumably to act as a pump which necrosis, pyelonephritis and congenital renal cysts (Divers
drove food through the flacid ileum to the ileocaecal junction. 1983).
Three of the four cases presented had clinical signs resem- Exposure to bracken fern (Pteridium aquilinum) is responbling acute grass sickness at the time of euthanasia. Neither sible for the development of a number of different neoplasms the gross pathology nor the ganglion histology mimicked of the bladder, including transitional cell carcinomas in cat-
classical grass sickness. There was, however, severe small tle (Maxie 1993). This report describes two adult cows in
intestinal neuronal depletion in all cases, to an extent that which transitional cell tumours located at the trigone of the
makes it difficult to understand how the intestinal tract func- urinary bladder resulted in bilateral hydroureter, hydro-
tioned. The horse which died as a result of an accident showed nephrosis and renal failure.
the same histological results as the animals which had termi- Case 1 was a seven-year-old, homebred Friesian cow,
nal colic.
which was referred to the University of Glasgow Veterinary
Further work is being undertaken to investigate these ini- School (GuvS) with a three-month history of gradual weight
tial findings further. Any Additional material from treated loss progressing to dullness and dysuria. As a heifer, the cow
cases which subsequently die would be welcomed by the had been grazed with a group of replacement heifers on pas-
ture with access to bracken fern. It had no further access to
this, or similar pastures, since calving for the first time, a
period of four years.
On clinical examination, the cow was bright, in poor body
condition (body score of 1-5), inappetent and had an
The authors would like to acknowledge the help of Mr J. C. increased frequency of micturition. The cow was dysuric and,
Wainwright, Mrs Phillipa Gammell and Mrs Audrey Barron for the Edinburgh cases, and Mr David Sutton for the case
on one occasion, the urine contained blood clots. On Rectal examination, the left kidney was enlarged and the ureters
Veterinary Record (2000) 146, 646-648
treated in Glasgow. The financial help given by the Equine were also easily palpable. A firm, lobulated mass was located
Grass Sickness Fund and the International League for the within the pelvic cavity ventral to the rectum. On subsequent K. J. Chandler, BVMS,
Protection of Horses towards the cost of treating the vaginal examination, it was considered to be a firm, nodu- CertEP, MRCVS,
Edinburgh cases, is gratefully acknowledged.
lar mass lying below the vagina, cranial to the external J. L. Fitzpatrick, BVMS,
urethral opening.
PhD, MRCVS, Department
........................ References
A urine sample, obtained by urethral catheterisation, was of Veterinary Clinical grossly normal. There was a high urine protein concentration Studies,
DOXEY, D. L., MILNE, E. M., WOODMAN, M. P., GILMOUR, J. S. & CHISHOLM, H. K. (1995) Small intestine and small colon neuropathy in equine dysautonomia (grass sickness). Veterinary Research Communications 19, 529-543 POGSON, D. M., DOXEY, D. L., GILMOUR, J. S., MILNE, E. M. & CHISHOLM, H. K. (1992) Autonomic neurone degeneration in equine dysautonomia (grass sickness). Journal ofComparative Pathology 107, 271-283
and a low specific gravity, and on cytological examination there were a large number of erythrocytes, no leucocytes and a small number of small and medium-sized epithelial cells. A heavy growth of Streptococcus species was obtained on culture of the urine sample. Abnormal findings on urinalysis are shown in Table 1. blood samples showed only severe uraemia
H. Thompson, BVMS, PhD, MRCVS, Department of Veterinary Pathology, University of Glasgow Veterinary School, Bearsden Road, Glasgow
D. F. (1993) Enteric neuropathy in horses with grass sickness. Veterinary Ultrasonography of the left kidney was performed per rec- K. O'Brien, MVB, PhD,
Record 132, 647-651
tum using a 7-5 MHz linear array transducer. There was a nar- MRCVS,
rowed renal cortex with a normal pattern of echogenicity and J. N. Huxley, BVetMed,
a clearly defined, distended, non-echogenic medulla, and MRCVS, Department of
renal pelvis. It proved very difficult to visualise the mass ven- Clinical Veterinary
The Veterinary Formulary
tral to the vagina because of its mobility.
Science, University of
Although initially the cow was bright and alert, it deteri- Bristol, Langford, Bristol
orated rapidly on the eighth day after admission, became BS40 5DT
THE fourth edition of The Veterinary Formulary, published very weak, developed pale mucous membranes and was
by the Pharmaceutical Press in association with the British Veterinary Association, has been extensively revised and is available, price Ј59.95, overseas Ј65, UK members Ј49.95, overseas members fЈ55 from the Pharmaceutical Press, PO Box 151, Wallingford, Oxon, OXIO 8QU, UK, telephone 01491 824486, fax 01491 826090, e-mail: [email protected] (Visa/ Mastercard/Eurocard accepted.)
euthanased the same day. A postmortem examination was performed and there was a flattened irregular lesion, 2 cm deep and approximately 5 cm in diameter, at the trigone of the bladder. The underlying bladder wall was thickened and firm; the thickening extended around and along the distal end of the right ureter for a distance of 3 cm. The opening of the ureter was sealed and its lumen was distended with
Mr Chandler's present address is Large Animal Practice, Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG
The Veterinary Record, May 27, 2000
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aTf71 I1LY
urine. The bladder mass also involved the opening of the left ureter but urine could still be expressed into the bladder with manual pressure. Both kidneys were swollen and tense. In the right kidney, the pelvis and calyces were dilated, while the pyramids were atrophied and cupped (Fig 1). The pelvis of the left kidney was dilated but the tips of the pyramids were atrophied in only a few lobules. Histopathological examination identified the bladder tumour as a transitional cell carcinoma. In the right kidney there was no cellular reaction as a result of atrophy of the renal pyramids. The collecting tubules extending into the cortex were dilated and there was diffuse interstitial fibrosis of the cortex. In the left kidney, the changes were more dramatic and varied from lobule to lobule. In some lobules there was necrosis of the cortex and the glomeruli were swollen and congested, in other lobules the glomeruli were normal but there was degeneration and necrosis ofthe proximal tubules with marked oedema ofthe interstitium. Case 2 was a three-year-old homebred Friesian cow that had calved for the first time six months before referral to the University of Bristol Veterinary School. In this case, the cow had had no Direct Access to bracken fern, although the fern was known to grow on land adjacent to the farm. The cow had a one-month history of progressive loss of appetite, bodyweight and milk production. The cow was polydipsic and had an increased frequency of micturition. On clinical examina- tion, the cow was in poor body condition and refused concentrate but continued to eat hay. There was an increased frequency of micturition accompanied by dysuria and haematuria. The cow drank frequently; its Water intake over a single 24-hour period was 104 litres. On cytological examination of a freely voided urine sample, there were degener- ate macrophages and epithelial cells; no neoplastic cells were recovered (Table 1). Blood samples were taken on the day of admission and the cow was uraemic (Table 2). On rectal palpation the left kidney was markedly enlarged but painless; it was not possible to palpate the bladder due to the presence of the uterus containing a 12-week-old fetus. Transrectal (left kidney) and percutaneous ultrasonography of the kidneys using a 7.5 MHz linear array transducer and a 3.5 MHz sector transducer, respectively, was performed. There was minimal renal cortex and grossly distended renal calyces in each kidney. The cow was euthanased four days after admission, fol- lowing a progressive deterioration. Postmortem examination confirmed the enlargement of both kidneys. Both ureters were distended and both kidneys were hydronephrotic. A verrucose neoplastic mass (8 cm x 4 cm x 2 cm) was present in the trigone region of the bladder, projecting into the lumen and extending around the right ureter. On histopathological examination, the mass was found to be a transitional
FIG 1: Hydronephrotic right kianey of case 1 at posanortem examination. There is marked pelvic dilatation and variable atrophy of medullae cell carcinoma. There was also a marked diffuse interstitial fibrosis of both the cortex and medulla of both kidneys. This report describes an unusual sequel to neoplasia of the bladder, that is, hydronephrosis and subsequent renal failure. Clinical signs of urinary tract disease in cattle are either related to haematuria, pyuria or to the development of dysuria or azotaemia. There may also be non-specific signs of inappetence, dullness, weight loss and a drop in milk yield (Fetcher 1986). Polyuria and polydipsia are frequently not observed in the loose-housing or extensive systems in which most adult cattle are kept. In both cases presented here, the animals had a reduction in appetite and bodyweight, and both showed increased frequency of micturition and dysuria. Although renal enlargement can be difficult to appreciate on rectal examination, in both cases the left kidney was palpably enlarged. Uniform renal enlargement may suggest amyloidosis (Murray and others 1972), pyelonephritis, or hydronephrosis (Rebhun and others 1989, Radostits and others 1994). In the first case, enlarged ureters were also palpated and this is usually indicative of renal involvement as opposed to lower urinary tract disease (Rebhun and others 1989). In both cases, ultrasound examination of the kidneys was found to be useful for diagnosis (Harrison and others 1992). The absence of massive proteinuria in both cases precluded amyloidosis as a diagnosis (Johnson and Jamison 1984). In a study of amyloidosis in eight cattle, urine protein concentration ranged from 245 mg/dl to over 1200 mg/dl (Murray and others 1972). The urine specific gravity of cows in renal failure is usually less than 1-022, in spite of azotaemia and dehydration (Divers 1983, Fetcher 1986) and this is considered by Divers and others (1982) to be a useful means of diagnosing renal dysfunction in cattle. In the first case, the specific gravity was 1-018 and in the second case, which demonstrated massive polydipsia, the specific gravity of the urine was 1 008. Cytology was useful in these two cases
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because the absence of leucocytes in the urine made the diagnosis of pyelonephritis less likely (Divers 1983) and all 15 cows affected by pyelonephritis in one study had microscopic evidence of pyuria (Rebhun and others 1989). Although both cows had intermittent haematuria, no blood was present in the bladder of either cow at postmortem
mary tumour (metastasis or paraneoplasia) and those in which tumours, through their position or local spread, lead to other clinical signs. This report describes the latter category whereby a bladder tumour led to renal failure in two cows through the development of hydronephrosis.
examination. In the one previous report of a urinary bladder
neoplasm resulting in hydronephrosis, haematuria was a fea- ACKNOWLEDGEMENTS
ture (Karcher and others 1988).
Increases in blood urea and creatinine concentrations are expected in cases of renal failure. In both cases the blood urea and creatinine concentrations were increased reaching a maximum of 102-6 mmol/litre and 2050 itmol/litre, respectively, in case 1. The urea and creatinine levels in this case would be in the top percentile of 754 bovine cases referred to GuvS and
The authors would like to thank the veterinary surgeons who referred these cases; Dr D. R. Pearson at the University of Bristol and Professor Max Murray, Professor Philip Duffus, and Professor David Onions, for the provision of clinical and pathological facilities.
would be classified as 'extremely high' (Knox and others
1998). From records held in the GUVS hospital biochemical database, only a bovine case with a ruptured bladder showed higher blood creatinine levels than case 1. Acorn poisoning is one of the few conditions affecting cattle which causes severe renal disease due to acute tubular necrosis, and Dixon and others (1979) reported urea values of up to 73-7 mmol/litre and suggested that blood urea concentrations are of prognostic value in that particular condition. Urea and cre-
.........................................................................I.......... References DIVERS, T. J. (1983) Diagnosis and therapy of renal disease. Proceedings Annual Convention ofBovine Practitioners 15, 74-78 DIVERS, T. J., CROMWELL, W. A., DUNCAN, J. R. & WHITLOCK, R. H. (1982) Acute renal disorders of cattle: a retrospective study. Journal of the American Veterinary Medical Association 181, 694-699 DIXON, P. M., McPHERSON, E. A., ROWLAND, A. C. & MacLENNAN, W. (1979) Acorn poisoning in cattle. Veterinary Record 104, 284-285
atinine concentrations would be expected to offer some prog- FETCHER, A. (1986) Renal disease in cattle. Part II. Clinical signs, diagnosis
nostic value because 75 per cent of the functional renal tissue must be compromised before azotaemia develops (Divers 1983). Wiseman and Thompson (1984) reported values of between 75 and 146 mmol/litre and 1600 and 3300 [imol/litre for urea and creatinine, respectively, in cases that died of acorn poisoning. Uraemia is generally a terminal biochemical finding in cases of amyloidosis (Murray and others 1972). Most cattle with acute tubular necrosis, for example, as a result of a toxic insult, have biochemical findings of hypochlo-
and treatment. Compendium on continuing education for the Practicing Veterinarian 8, 338-344 HARRISON, G. D., BILLER, D. S., WILSON, D. G. & CASTLEMAN, W. L. (1992) Ultrasonographic diagnosis of hydronephrosis in a cow. Veterinary Radiology and Ultrasound 33, 49-51 JOHNSON, R. & JAMISON, K. (1984) Amyloidosis in six dairy cows. journal of the American Veterinary Medical Association 185, 1538-1543 KARCHER, L. F., ANDERSON, W. I. & DIETZE, A. E. (1988) Urinary bladder carcinoma suggestive of enzootic haematuria with secondary hydronephro- sis in a Holstein cow. Bovine Practitioner 23, 94-96
raemia, hypocalcaemia, hypokalaemia, hyponatraemia, hyperphosphataemia, and hypermagnesaemia (Divers and others 1982, Divers 1983). The diagnosis of renal toxicosis is usually dependent on history of recent exposure (Fetcher 1986). The degree of hydronephrosis depends on the completeness of the obstruction of the ureters and whether the
KNOX, K. M. G., REID, S. W. J., IRWIN, T., MURRAY, M. & GETTINBY, G. (1998) Objective interpretation of bovine biochemistry data: application of Bayes law to a database model. Preventative veterinary medicine 33, 147-158 McNEIL, P. E. (1984) Pathology of bracken associated tumours in cattle. PhD thesis, University of Glasgow Veterinary School MAXIE, M. G. (1993) The Urinary system. In Pathology of Domestic Animals. 4th edn. Vol 2. Eds K. V. F. Jubb, P. C. Kennedy, N. Palmer. San Diego, Academic Press. pp 473-475, 534
obstruction is unilateral or bilateral (Maxie 1993). The dura- MONAGHAN, M. L. M. & HANNAN, J. (1983) Abattoir survey of bovine kid-
tion of the clinical disease does not reflect the duration of the ney disease. Veterinary Record 113, 55-57
renal pathology (Syke 1975) and renal failure usually develops when the obstruction is bilateral (Smith 1990, Maxie 1993). It is likely that in the cases described here, both the bladder tumour and hydronephrosis would have been developing for some time. In case 1, there were two different pathological processes occurring in the same animal. There was chronic progressive interstitial fibrosis in the right kid-
MURRAY, M., RUSHTON, A. & SELMAN, I. (1972) Bovine renal amyloidosis: a clinicopathological study. Veterinary Record 90, 210-216 RADOSTITS, 0. M., BLOOD, D. C. & GAY, C. C. (1994) Diseases of the urinary system. In Veterinary Medicine. 8th edn. London, Bailliere Tindall. pp 646- 648 REBHUN, W. C., DILL, S. G., PERDITZET, J. A. & HATFIELD, C. E. (1989) Pyelonephritis in cows: 15 cases. Journal of the American Veterinary Medical Association 194, 953-955
ney, but the back pressure in the left kidney led to renAl Smith, B. P. (1990) Alterations in urinary function. In Large Animal Internal
venous infarction and a subsequent dramatic rise in urea Medicine. St Louis, Mosby Wolfe. pp 195-203
concentration and renal failure. In the second case, the lesion in both kidneys was limited to chronic interstitial fibrosis. These differences may partially explain the relatively rapid deterioration in case 1. Exposure to bracken can be responsible for a variety of
SYKE, D. V. (1975) Hydronephrosis secondary to focal papillary hyperplasia of the urinary bladder of cattle. Journal of the American Veterinary Medical Association 166, 596-598 WISEMAN, A. & THOMPSON, H. (1984) Acorn poisoning. Veterinary Record 115, 605
different neoplasms including transitional cell carcinomas in
the bladder (Maxie 1993). The location of a tumour at the
trigone of the bladder as reported by Karcher and others
(1988) may be the result of deposition or concentration of an aetiological agent from the ureters. However, there was no
Notes for contributors
predilection site noted in a survey of 73 bladder tumours in
60 cattle (McNeil 1984). Hydronephrosis has also been A full version of notes for contributors can be found on The
reported secondary to papillary hyperplasia in the trigone of Veterinary Record/In Practice website at:
the bladders of four Holstein-Friesian cattle, although these animals had no history of exposure to bracken fern (Syke
Where possible we encourage the use of colour illustrations,
The effects of neoplasia can generally be divided into two and there is no extra charge for the reproduction of colour
categories; those in which there are effects far from the pri- figures.
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Mastercard/Eurocard accepted. Hydronephrosis and renal failure in two Friesian cows K. J. Chandler, J. L. Fitzpatrick, H. Thompson, et al. Veterinary Record 2000 146: 646-648 doi: 10.1136/vr.146.22.646
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