Blood in urine, but tests came back normal.

[Bunbun70]

Hello all, this is my first time here, so not sure if this is the right place to post this.

My bunny (2 year old female) has been passing blood in her urine for a month now. I've taken her to a vet and we did a complete blood test, urine test, liver function and kidney test, as well as ultrasound scans and Xrays. Everything came back normal. The vet said it isn't anything to worry about, but confirmed the "red thing" was blood. This has been happening for about a month now. I'm so worried. What could the reason possibly be? She is unspayed. Could it have anything to do with that? My bunny eats well and is active, like always. Any inputs would be greatly appreciated. TIA!

 

[JBun]

I know you said this, but was the vet absolutely certain it was blood and not plant pigments(actually tested for and found blood in the urine)? If actual blood was found, was a culture attempted of the urine? Were antibiotics tried, and if so what were the results? Have any other medications been tried?

Have there been any other signs of a urinary infection or bladder sludge, like having accidents outside the litter box, dribbling urine, urine soaked bum, straining to urinate, signs of pain, not eating, thickened creamy or pasty or gel like urine? Is the urine all bright red, reddish orange, beige or brownish, pinkish, foamy, or are there just spots of blood in it?

https://wabbitwiki.com/wiki/Urine
https://wabbitwiki.com/wiki/Urinary_tract_infection
https://wabbitwiki.com/wiki/Bladder_sludge_and_stones
Did the vet find any abnormalities with the uterus in the xrays and scans? When there's blood in the urine and it's not coming from the urinary tract, uterus would be the other possibility. And an aging unspayed doe can be more at risk of developing uterine cancer. Even though 2 isn't that old, uterine problems can start early in some rabbits. Is the vet you're seeing an experienced rabbit vet?

https://wabbitwiki.com/wiki/Uterine_cancer

 

[Bunbun70]

Hi JBun, there was no testing done to determine if it was blood. I showed the vet a cloth with a stain of blood and she said it was blood No other tests were done to determine it. It is bright red and looks very much like blood.
I'm not sure if I'm overthinking, but now I feel like my bunny is straining to urinate/poop. She first pees a fair amount and then poops a little and then pees some more and then poops again - all in one sitting. I'm not sure I've seen this pattern before. She's eating like usual and begs for treats. She plays around and sleeps normal too.

I did ask about any possible problems with her uterus. The vet said there's no necessity to check that as she's too young. To be specific, 1 year and 9 months.

It's been so stressful the past month as I can't seem to figure out what's wrong and neither can the vet

 

[JBun]

So was an actual urinalysis done? A urinalysis should have determined if there was blood present. Antibiotics weren't tried at all? Before this, had you ever seen thick white or pasty urine deposits? What foods is your rabbit fed? Any alfalfa based food or high calcium veg/greens?

If you have a photo of a urine puddle that you can post, that might help in determining what's going on.

 

[Bunbun70]

Oh yes, I forgot to mention, the vet had put my bunny on antibiotics for a week. She was injected for the bleeding to stop as well twice (one week apart).
The urine does seem pasty, but the vet said it's calcium when I described it. A urine test was done which showed the presence of protein in the urine, but the vet ruled out kidney problems because the kidney test came back normal too.
I don't have a picture now, but will take one and upload it the next time I see it.
I must mention that this doesn't happen every time she urinates, but it happens once at least every day. Sometimes the amount of "red" is very little, sometimes it's a whole lot.

 

[JBun]

There will be different levels of calcium sediment. A little bit of white milky/chalky urine with a thin consistency is normal calcium sediment. Urine that is thickened, sticky, creamy, gel like, gritty, or pasty, is a sign of bladder sludge. With that description, are you just seeing urine that is milky/chalky but with a normal consistency, or are you seeing thickened urine at all? Did the xrays of the bladder show any build up of calcium sediment?

Besides the protein in the urine, was blood actually found? Do you know what antibiotic was given, and what medication was injected? Was there any improvement or changes while on the antibiotic?

What types of veggies do you feed your rabbit? And any alfalfa products? Some plant pigments that are excreted in the urine, can have a very similar look to blood.

 

[Bunbun70]

Thank you for your reply, JBun! The urine is not all chalky/pasty. There are times when it's just watery. It was a lot more chalky about a year ago, but that seems to have gotten better.
The urine test didn't suggest the presence of blood. I'm assuming that as the RBC count wasn't highlighted as an abnormality. I could upload a copy of the test report if that's allowed here.
The Vet did mention sludge, but said it was not anything to worry about and didn't prescribe any medication for it. Just a change of diet.
She was still urinating blood while on the antibiotics too..
I feed her Timothy hay. And for greens, it's mostly a leafy diet of fenugreek leaves, celery, romaine lettuce. I feed her cabbage at times and very little fruit as treat very rarely.
The new pellets I feed her contain a little bit alfalfa.

 

[Bunbun70]

Just checked the pellet info. It does contain a fairly good amount of alfalfa and crude protein.

 

[JBun]

The urinalysis rbc should be less than 5 rbc/hpf. If it's more than that then it indicates a potential problem. if you do attach a copy of the urinalysis, just make sure to cover up any of your personal details as well as your vets.

Thin and chalky urine is normal. If it's ever thick and pasty, your rabbit has a bladder sludge issue. Have you seen thick and pasty ever?

 

[Bunbun70]

The RBC count says absent.
Her urine is sometimes thick and pasty, yes. But that isn't the case always.

 

[JBun]

What I'm wondering is if your vet isn't particularly rabbit savvy, that the red coloration of the urine was mistaken for blood when in fact it might just be plant pigments. Alfalfa and fenugreek, even cabbage, are things that could potentially cause more pigmentation to the urine. Which could also explain why you aren't seeing it consistently throughout the day but just at certain times, possibly to coincide with a food that had been eaten not too long prior. Except for the reddish urine, your rabbit doesn't seem to be having any other indications of a URI. If it had been a URI going on for a month, you would most likely be seeing other signs like dribbling urine and a urine soaked bum. So I would suspect that you could very well be dealing with plant pigments from some of the foods you're feeding.

https://rabbit.org/red-urine-blood-or-plant-pigment/
Though the possibility of it being blood isn't completely ruled out. If you still feel it could be blood and a potential health issue, I would say it's due to bladder sludge, and/or possibly a uterine problem, even possibly pre cancerous. Under 2 years doesn't mean a doe isn't at risk for uterine cancer. I've read of instances where it's been found in does less than 1 year of age. So a spay may be something to strongly consider.

If it is blood, because of the thick pasty urine you say your rabbit sometimes has, it would have to do with bladder sludge and calcium build up, irritating the bladder. Which means your rabbit does have a bladder sludge problem and needs to be on a different diet, or excess calcium sediment can build up in the bladder and cause complications. The alfalfa pellets would need to be changed immediately to a low calcium grass based pellet, and fed in very limited quantities, and in some instances pellets have to be removed completely. Alfalfa based food shouldn't be fed because it's very high in calcium. I would also limit any high calcium greens, which might include the fenugreek(you would need to check). There does need to be some calcium in the diet for healthy bones, but just not an excess so that you are seeing a lot excreted in the urine and it causing build up in the bladder.

https://rabbit.org/bladder-stones-and-bladder-sludge-in-rabbits/
https://rabbit.org/bladder-disease-and-bladder-stones-in-the-rabbit/
https://rabbit.org/lowering-calciumverlaging-van-het-calcium/
https://rabbitsindoors.weebly.com/pellet-food.html
So if you do want further investigation of this, I would suggest finding a more experienced rabbit vet to take your rabbit to. I'm not feeling at all impressed with the vet you're seeing based on what you've relayed your vets response and information has been. If you do find a better rabbit vet to go to, I would suggest getting copies of all paperwork, imaging, and lab work that has been done so far, to take with you to the new vet so you don't have the added cost of having it redone. They may be a bit touchy at this request, but they do have to give it to you, though a small fee may be involved.

https://rabbit.org/vet-listings/

 

[JBun]

If you wanted to see if it was just plant pigments causing the reddish urine, you could stop the alfalfa pellets, fenugreek, and cabbage to see if it makes a difference. Romaine could have some effect, though I haven't seen it make urine reddish. If you remove pellets from the diet temporarily, you do need to make sure your rabbit is free fed the timothy hay(or other grass hay) and is eating it really well so that digestive function doesn't slow down.

 

[Bunbun70]

Thank you for the elaborate reply, JBun!
My apologies for the late reply. I am hoping it is just pigmentation, though a part of me feels strongly it is blood.
I managed to get a picture though. I will attach it below. This has been continuing the past few days as well, although the amount of "red" has decreased.

 

[JBun]

That is blood. I think you need a more experienced rabbit vet for a second opinion. By this point you've had enough testing done that an experienced rabbit vet would have been able to give you a better idea of what's going on(or what definitively isn't), and the proper treatment to correct it.

The fact that your vet didn't even consider the possibility of uterine cancer being a possible cause, or bladder sludge based on your description of your rabbit having pasty urine in the past, makes me doubtful about the vets rabbit knowledge. An experienced rabbit vet really can make all of the difference in the world of getting the proper diagnosis and treatment. Vets with less experience with rabbits, may not have the knowledge base or can miss things that would be obvious to an experienced rabbit vet. If finding a different vet isn't a possibility, there's asking your current vet to consult with a specialist to help get this figured out and the proper diagnosis.

Things that I would do. If a proper urine culture and sensitivity test to determine if and what bacteria were involved, and what antibiotic would be effective wasn't actually done, there would be having that testing done. And a much longer course of the proper rabbit safe antibiotic. One week on antibiotics is never enough to clear up bacterial infections in rabbits. Never anything less than 2 weeks, but 4-6 weeks isn't unusual. Infections in rabbits can be very difficult to clear up, and all a too short of a course of antibiotics does is create antibiotic resistant bacteria. I would also want to be giving daily meloxicam(NSAID) to reduce inflammation.

There's also having a second look at the xrays and scans to verify there's no evidence of sediment and calcium build up in the bladder, no evidence of bladder or kidney stones, and no visible evidence of uterine cancer.

If all scans and xrays were clear of stones and sludge build up, and nothing showing that there's the start of uterine abnormalities, and the urine culture showed no sign of bacteria, then I would say that this could very possibly be crystals in the urine irritating the urinary tract due to your description of seeing pasty urine in the past, in which case a change of diet and removing high oxalic veggies and high calcium foods like the alfalfa pellets, will hopefully be enough to stop the problem. Or the bleeding is linked to the start of uterine problems, in which I would want to have my rabbit spayed to eliminate that risk and hopefully be what resolves the bleeding. Given the choices, I'm leaning towards a uterine abnormality because it's bright red spots of blood and the urine isn't beige/brownish, white/cloudy, or thickened, which is what typically happens with sludge and/or a UTI. And the beginning of uterine problems won't necessarily always show up on xrays/scans, but can still be the cause of bleeding.

https://www.stortvet.com/red-urine/
So that's what I would be looking at doing next to get this resolved. Blood in the urine isn't that complicated to figure out. It's either going to be an infection, growth, or something irritating the urinary tract/kidneys, or it's going to be connected to the uterus.

 

[Bunbun70]

I will be taking her for another scan today. Again, I was asked to get a second scan of the lower abdomen and no mention of the uterus. (This is another vet - I wanted a second opinion.) It worries me now that neither mentioned anything about the uterus. I guess I will ask then to check the uterus as well. Is there a different scan that's needed for the uterus? Or is there anything in specific I need to ask for to have her uterus checked?

 

[JBun]

No, just the same xrays and ultrasound. But I would still ask them to also check the uterus.

This list gives the possible causes for blood in the urine, some causes more common than others.

Medirabbit: causes for blood in the urine