Pigmenturia

Question 1

Endogenous pigmenturia likely

Answer 1

myoglobinuria, porphyria, haemoglobinuria, bilirubinuria, haematuria, melanuria

Question 2

Exogenous pigmenturia

Answer 2

admin of numerous drugs/chemicals will result in discoloured urine

Question 3

Normal urine coloured by

Answer 3

• urochrome
• urobilin
• uroerythrin
• uroporphyrins
• trace amts of riboflavin

Question 4

Urine colour should be analysed in relation to

Answer 4

USG

Question 5

If there is abnormal colour to urine, consider these differentials

Answer 5

• diet
• medications
• environment inborn error of metabolism
• haemolysis
• haematuria
• rhabdomyolysis
• metabolic effect

Question 6

Physical appearance of Haematuria

Answer 6

• contains clots or is red, red-brown, brown & cloudy
• dvlp a deposit w/ time & clear w/ centrifugation
• depends on oxidation of Hgb, more rusty over colour

Question 7

Microscopic appearance of Haematuria

Answer 7

• erythrocytes or ghosts in sediment
• crenation if SG >1.020
• spherocytes if SG <1.010
• high protein

Question 8

Occult haematuria

Answer 8

often incidental finding w/ other Sx of UT dz

Question 9

Spurious haematuria cause

Answer 9

Genital tract incl prostate

Question 10

Which is present on the right?

Answer 10

Haemaglobinuria

Question 11

Haematuria in FUS

Answer 11

• mainly blood in urine along w/ struvite crystals

Question 12

Renal Haematuria

Answer 12

• accounts for 15-30% of all haematurias
• of glomerular origin, RBCs distorted
• persistent or intermittent haematuria (hrs to days)

Question 13

What are some causes of renal haematuria

Answer 13

renal trauma, renal calculi or crystals (oxalate monohydrate), ARF, haemorrhagic diathesis, acute pyelonephritis, acute glomerulonephritis, renal neoplasia, arteriovenous malformation, parasitism, renal cysts, renal infarcts/embolism, radiation, idiopathic, passive congestion

Question 14

glomerular haemorrhage RBCs in renal haematuria have what appearance?

Answer 14

doughnut-like shape, membranous protrusions or blebs + target configuration

Question 15

MB & Hb are partially reabsorbed by

Answer 15

renal tubular cells & haem iron reincorporated into ferritin & haemosiderin

Question 16

spun urine for myoglobinuria is what colour?

Answer 16

orange-red to brown “mahogany brown”

Question 17

spun urine for haemaglobinuria is

Answer 17

red to red-brown “port wine red”

Question 18

Myoglobin has a greater susceptibility to oxidize leading to

Answer 18

a chocolate brown colour

Question 19

Myoglobinuria has what colour serum when spun?

Answer 19

clear

Question 20

Haemoglobin spun serum is what colour

Answer 20

pink

Question 21

Mild myoglobinemia occurs w/

Answer 21

renal failure & active cardiac injury

Question 22

Gross pigmenturia can occur w/

Answer 22

rhabdomyolysis

Question 23

Myoglobinaemia peaks in & is cleared from…

Answer 23

about 12 hrs injury & is cleared from plasma in 1-2d

Question 24

Myoglobinuria (port wine) means

Answer 24

• severe muscle damage & need to flush out kidneys to avoid renal damage –> can cause myoglobinuria renal necrosis

Question 25

Rhabdomyolysis in horse causes urine to become

Answer 25

* reddish tinge if very fresh if haemoglobinuria * if there is a lot & has oxidized, it is black

Question 26

What are haemaglobin globules

Answer 26

globules of hgb found w/ extensive Haemglobinuria w/ colour dependent on stain

Question 27

IHA & intravascular haemolysis & haemoglobinuria can create

Answer 27

Haemoglobin globules bilirubin crystals

Question 28

Leaves that can cause haemolytic anaemia in horses

Answer 28

red maple (acer rubrum), esp wilted Sugar maple, silver maple, Pistacia

Question 29

What Allium species cause haemolytic anaemia & in what species?

Answer 29

Onions - horse, cattle, dogs Garlic, chives, leek

Question 30

What other things can cause haemolytic anaemia?

Answer 30

minerals/drugs infectious genetic

Question 31

Dipsticks are super sensitive to what molecule?

Answer 31

Haem

Question 32

What test is most sensitive for myoglobinuria?

Answer 32

RIA

Question 33

How do you differentiate Myoglobinuria, haemoglobinuria, and haematuria with the urine dipstick?

Answer 33

Greenish dot = haem Free Hb/Mb = uniform colour (haem dissoleveD) Mburia = appropriate clin situation, + dipstick, no red coloured serum, no RBCs in urine sediment

Question 34

Differentiating between myoglobinuria, haemoglobinuria, haematuria, otheruria

Answer 34

* Dipstick test neg - likely porphyria or exogenous pigments * Microscopic analysis for rbcs & ghosts pos - likely haematuria * dipstick test & protein test pos & pink spun serum - hburia * Dipstick, protein, ammonium precipitation pos - mburia

Question 35

Porphyrin

Answer 35

tetra pyroles conjugated by double bonds giving light absorption & colour

Question 36

Porphyrin binds what metals?

Answer 36

Fe, Mg, Cu, Zn

Question 37

Haemoproteins contain..

Answer 37

oxidized Fe2+ at centre

Question 38

Roles of porphyrin

Answer 38

* Hb/Mb carry oxygen * cytochromes transfer electrons for hepatic detox or mitochondrial respiration * antioxidants * gas sensors (CO, NO) * pigments

Question 39

Porphyria

Answer 39

purple pigment in urine

Question 40

what causes porphyria?

Answer 40

excessive production & excretion of porphyrins or their precursors due to haem biosynthetic pathway defect

Question 41

Porphyria is associated w/

Answer 41

cutaneous photosensitivity & neurologic abnormalities

Question 42

Bovine Congenital Erythropoietic Porphyria

Answer 42

Causes: red-brown discolouration & fluorescence of bones & teeth (erythrodontia), urine that is pink to deep burgundy, photosensitization, normochromic haemolytic anaemia, fluorescytes

Question 42

Bovine Congenital Erythropoietic porphyria is a genetic deficiency of

Answer 42

Uroporphyrinogen III cosynthetase

Question 42

What are the steps of porphyrin/ haem synthesis?

Answer 42

1. gamma-aminolevulinate synthase 2. gamma-aminolevulinate dehydrase = porphobilinogen synthase 3. Uroporphyrinogen I synthase = porphobilinogen deaminase **4. Uroporphyrinogen III cosynthase (CEP)** 5. Uroporphyrinogen decarboxylase 6. Coproporphyringen III oxidase 7. Protoporphyrinogen oxidase 8. Ferrochelatase, **Haem synthase (BEP)**

Question 43

Uroporphyrin I accumulates in

Answer 43

urine in CEP & imparts red colour

Question 44

Bovine erythropoietic protoporphyria occurs in what species

Answer 44

Limousin cattle & humans

Question 45

When can melanuria a rare complication of dz?

Answer 45

metastatic malignant melanoma in grey horses