Epistaxis Secondary to Suspected Hypertension in Malayan Tapirs (Tapirus indicus) with Hypercalcemic Chronic Renal Disease
American Association of Zoo Veterinarians Conference 2011
Dominique L. Keller1,2, DVM, PhD; Margaret A. Highland3, DVM; Victoria L. Clyde2, DVM; Roberta S. Wallace2, DVM
1School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA; 2Milwaukee County Zoo, Milwaukee, WI, USA; 3College of Veterinary Medicine, Washington State University, Pullman, WA, USA


Two Malayan tapirs (Tapirus indicus), a 21-year-old female and a 35-year-old male, displayed intermittent, often severe bouts of epistaxis, lasting from 1 to 3 days in duration for nearly 2 years. Hematocrit following these episodes ranged from 11% to 30%, and blood work revealed uremia and hypercalcemia. Both tapirs were diagnosed with chronic renal disease (CRD). Indirect blood pressure measurements from the female were suggestive of hypertension. Antemortem nasal endoscopy and postmortem gross and histologic evaluations revealed no evidence of mucosal ulcerations to account for the epistaxis. At necropsy, both tapirs showed severe nephropathy, and generalized arteriosclerosis and mineralization of vessels within multiple organs including kidneys, brain, eyes, and heart. The female tapir had generalized vascular changes supportive of hypertensive adaptations.

The intermittent epistaxis in these tapirs was most likely due to underlying hypertension. Hypertension is common in domestic animals and people with renal disease, but its association with CRD in large animals has been poorly studied.1,2 A syndrome of CRD with hypercalcemia has been reported in the horse, another perissodactylid.2,3 The underlying pathophysiology of hypercalcemia remains unclear, but may be related to the large amount of calcium renally excreted by both horses and tapirs.

Epistaxis or hypercalcemia may be signs of CRD in Malayan tapirs. Treatment with antihypertensive medication may be warranted to help slow the decline in renal function and manage epistaxis.

Literature Cited

1.  Bartges, J.W., A.W. Willis, and D.J. Polzin. 1996. Hypertension and renal disease. Vet. Clin. N. Am. Small Anim. 26:1331–1345.

2.  Schott, H.C. 2007. Chronic renal failure in horses. Vet. Clin. N. Am. Equine 23:593–612.

3.  Tennant, B., P. Bettleheim, and J.J. Kaneko. 1982. Paradoxic hypercalcemia and hypophosphatemia associated with chronic renal failure in horses. J. Am. Vet. Med. Assoc. 180:630–634.


Speaker Information
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Dominique L. Keller, DVM, PhD
School of Veterinary Medicine
University of Wisconsin-Madison
Madison, WI, USA

Milwaukee County Zoo
Milwaukee, WI, USA

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