Urinalysis Flashcards
(125 cards)
1
Q
Indications for Urinalysis
A
- to eval clinical renal & lower UT abnormas (PU/PD, Dysuria, Haematuria)
- azotaemia
- assess hydration status
- assess metabolic & endocrine dzs
2
Q
Components of Urinalysis
A
- physical eval
- biochemical testing
- urine sediment
- urine culture
3
Q
Method of collection of urine
A
- free catch, midstream if possible
- catheterisation
- cystocentesis
4
Q
What important factors must be taken into account when taking a free-catch sample?
A
- morning sample best
- contains cells + bacteria from urethra & vulva/prepuce
- midstream reduces qty of contaminants
5
Q
What factors must be considered for catheterisation for urine collection?
A
- sterile polypropylene tubing
- Easiest in male dog
- female & some male anatomy is problematic
- blood contamination due to trauma of procedure
- bacteria & cells from terminal urethra may be collected
6
Q
What factors must be considered for cystocentesis for urine collection?
A
- clip & Surgical prep
- good restraint essential (chemical or physical)
- samples have only bacteria & cells from bladder, may get small amt of blood contamination from needle
7
Q
Physical exam of urine should include
A
- colour
- turbidity
- odour
- USG
8
Q
Colour physical exam indicates…
A
- concentration & presence of pigmentation
9
Q
Red urine
A
haematuria, haemaglobinuria
10
Q
Brown to black urine
A
myoglobinuria
11
Q
light to med yellow urine
A
assess depth of colour to assess kidney fxn
12
Q
mild urine smell indicates
A
ammonia from bacterial urease
13
Q
foul urine smell
A
cystitis, infection
14
Q
sweet urine smell
A
acetone = diabetes, starvation
15
Q
drug smell
A
Penicillin - yeast-like smell
16
Q
diet smells of urine
A
high protein increases ammonia smell
17
Q
lack of smell of urine
A
excretion of water, tubular dz
18
Q
Turbidity reflects
A
increase in suspended substances (crystals or cells)
19
Q
Definition of USG
A
Ratio of weight (density) of urine to that of an equal volume of water at the same temperature.
20
Q
Values of USG depends on
A
- hydration status & water intake
- kidney’s concentrating ability
21
Q
USG is a test of…
A
renal tubular fxn & w/ blood Ur/Cr discriminates btw dehydration & renal dz
22
Q
Hypersthenuria
A
increased strength (aka concentrated)
23
Q
Isosthenuria
A
1.008-1.012
Not dilute or concentrated
24
Q
Hyposthenuria
A
below 1.008, dilute
25
Causes of Low USG
* PD (common)
* Iatrogenic
* endocrine
* diuretic therapy
* renal dz
26
Contraindications of a water deprivation test
* depressed, dehydrated, or azotaemic animals or if renal failure is suspected
27
Indications for Water Deprivation Test
Confirmation of the animal's ability to concentrate urine when water is withheld
28
Protocol of water deprivation test
monitor USG q 2 hrs until 5% of body wt is lost or USG is >1.020
29
Interpretation of water deprivation test
* USG increases to 1.020: tubular fxn & ADH availability confirmed
* If USG remains <1.020: diabetes insipidus suspected
30
Important things to remember about urine dipsticks
* Ensure in-date or will give false +/-
* contamination of sample affects results
* requires cross check w/ history, signs
31
USG on dipstick
* inaccurate in animals
* ignore it
32
Dipstick protein values
* detect protein, esp albumin but may miss globulin-losing conditions
* trace or + protein may be normal in healthy animal, esp if high USG
* interpret w/ USG & serum albumin in mind
* increases w/ inflammation/infection, haemorrhage, protein-losing neuropathy
33
UPC Ratio
* used to assess clinical significance of proteinuria
* TP & creatinine conc. measured in single urine sample & expressed in same units
34
Interpretation of UPC
* <1.0: Proteinuria if present is not significant
* mild to mod increase (1-2): proteinuria from urogenital haemorrhage, urogenital inflammation, glomerular protein loss
* mod to marked increase (>2): glomerular protein loss
35
Dipstick glucose
* accurate for animals
* absent in healthy animals
36
Reasons why glucose may be present in urine
* Diabetes mellitus
* stress, cystitis in cats
* severe exertion, fits
* drugs - Rompun & ketamine
* Fanconi syndrome
37
What test should be done w/ a glucose dipstick?
* UPC
38
Dipstick ketones
* accurate in animals
* detects ONLY acetoacetate, not beta-hydroxybutyrate
* not common in urine normally, EXCEPT in rabbit
39
Reasons for ketonuria
* DM in small animals
* pregnancy toxaemia
* ketosis & fatty liver in cattle
* secondary to anorexia, starvation, other conditions
40
Blood on dipsticks
* reliable
* detects haem found in RBCs & Hb/Myoglobin
* check RBCs in sediment exam
* catehterisation & cystocentesis give positive blood results
41
Common illnesses that lead to blood in the urine
* oestrus, trauma, coagulopathy, urogenital inflammation, neoplasia
* most common from catheterisation
* FUS, IMHA
* Hburia - acute HA, baciliary
* Hburia - Cu toxicity
42
Bilirubin on dipstick
* reliable in animals
* normal dogs have 0 or + bilirubin
* no bilirubin in cat expected
* soluble: i.e. conjugated bilirubin detected
43
Diseases that cause increased bilirubin on dipstick
* increased in icteric animals - hepatic & post-hepatic
* haemolytic anaemia
44
Urobilinogen on dipstick
* unreliable in animals
* presence confirms patency of bile duct & bile is entering intestine
45
Unreliable dipstick measurements
* Nitrite
* WBC
* USG
46
Urea is measured in...
* serum or plasma
47
Urea is a
nitrogenous waste product excreted by kidneys & is non-toxic
48
Why would urea increase?
* pre-renal, renal, or post-renal causes
49
azotaemia
increased urea
50
BUN
Blood urea nitrogen
= concentration of nitrogen component of urea in blood
51
BUN value is lower than
urea value
52
BUN is often interchangeable with...
urea
53
BUN: urea ratio is approximately
1:2
54
Ammonia can be...
neurotoxic
55
Ammonia is detoxed in the
liver --> passses into urea cycle --> excreted by kidney after being in blood stream
56
Reasons urea is increased...
* due to renal dz (>75% fxnl mass lost)
* uraemia clinical syndrome due to reduced renal excretion of toxic substances - urea is increased w/ uraemia
57
Uraemia
clinical syndrome due to reduced renal excretion of toxic substances
58
Urea is increased w/ what clinical syndrome?
uraemia
59
Reasons for decreased urea
* usually anorexia, protein deficient diet or malabsorption
* markedly decreased liver fxn (PSS, hepatic insufficiency)
* overhydration
* young animals w/ hepatic metabolic system not fully fxning
60
Creatine breaks down to
creatinine
61
creatinine is from
spontaneous degradation of creatine in muscle
62
Rate of fomraiton of creatine is constant reflecting
muscle mass
63
Decreased creatinine may occur with...
loss of muscle mass (body weight)
64
Creatinine is filtered by glomeruli and...
not absorbed by tubules
65
Fxn of Creatine, Creatinine, cK
PCr works w/ CK to *buffer atp & shuttle energy* from mitochondria to cytoplasma & w/ ATPase as an *energy transducer* in muscle, heart, brain
66
Deficiency of fxn of creatinine, creatine, CK
* mitochondrial dysfxn, cell energy def, myopathy, marked intellectual disability
* May be dietary or AGAT, GAMT, CK, CrT mutation
67
Supplementation of Creatine
* treats deficiency
* increase muscle mass, strength, high-intensity exercise performance in humans/dogs
**Ruminants & horses do not have a mechanism for absorption, so is useless in these animals**
68
Reasons creatinine would increase
* 80-90% of nephrons must be lost for creatinine to rise significantly
* better marker of severe renal dz in ruminants & horses due to excretion of urea into digestive tract in species
69
Pre-renal azotaemia is due to
* decreased renal perfusion
* haemoconcentration, endotoxaemia or reduced CO, shock --> decreased perfusion of the kidney
* high protein diet or GI haemorrhage
70
Serum creatinine is a biomarker of
muscle mass
71
Creatinine is especially useful
in muscle wasting such as renal dz, anorexia
72
Creatinine is proportional to
muscle mass
73
serum creatinine is lower in
females over males
juveniles over adults
Adults over geriatrics
sedentary vs athletic mammals
Vegetarians
74
Cr dependence on muscle mass weakens its use as...
a GFR biomarker
75
Cr is a more effective muscle biomarker if corrected for...
renal fxn & dietary meat intake
76
Serum creatinine, creatinine, urinary creatinine excretion, endogenous creatinine clearance all
increase w/ body weight
77
Severe renal dz will cause what changes to creatinine or urea?
Creatinine normal
urea increase
78
chronic renal dz will cause a chronic & progressive loss of
muscle mass, & thus creatinine
79
In CRD, there will be a lower relative
increase in Cr than in urea but not when compared to resting or post-dialysis values
80
If creatinine is not increased as much as urea in CRD, then there is likely
muscle wasting to the degree to which increases differ
81
In acute renal dz, the absence of other debilitating dz means changes in Cr & Ur will be...
similar
82
Urine sediment will look for...
* rbcs, wbcs, casts, epithelial cells, bacteria, crystals, sperm, fat droplets, yeasts, contaminants unless from cystocentesis
83
Haematuria in FUS has mainly blood in its
urine & struvite crystals
84
primary finding in FUS
haematuria
85
Increased s/p urea/creatinine & USG greater than the ideal numbers means you should consider
pre-renal causes
86
Increased s/p urea/creatinine & USG is less than the ideal numbers means you should consider
primary renal dz
87
Normal USGs of importance for horse, dog, cat
Horse: 1.025
Dog: 1.030
Cat: 1.035
88
increased epithelial cells in a urinary sediment exam occurs in what conditions?
inflammatory conditions
neoplasia
89
When should a sediment smear be stained?
increase in epithelial cells to look for evidence of malignancy
90
transitional cells shed in urine
* small to mod no.'s may be shed by healthy animals
* high no's in inflammation & some neoplasias
91
squamous cells in urine
* small to mod no's shed in healthy animals
* common in non-catheterised samples or indication of contamination sample from tract
92
Neoplastic cells in urine
inconsistent finding, but positive is **diagnostic**
93
Formation of casts
distal tubules & collecting ducts
94
Matrix of casts
Tamm-Horsfall glycoprotein
95
Different types of casts have
Different clinical meanings
96
With casts in urine and BG is high, what is the high differential?
Diabetes
97
What type of cast?
Hyaline cast
98
What type of cast?
epithelial cast
99
What type of cast?
RBC cast
100
What type of cast?
WBC cast
101
What kind of crystals are found in acidic urine?
Ca Oxalate dihydrate
102
What types of crystals are common in birds & reptiles?
urate crystals
103
What type of casts were present in alkaline urine?
phosphate/struvite crystals
104
Crystalluria definition
Too many crystals in urine (above normal limits)
105
Dihydrate crystals are always...
harmless
106
What crystals are common in liver dz?
cystine, tyrosine, leucine
107
What crystals are common in Dalmatians, E. bulldogs, liver dz & pss?
Ammonium biurate
108
Crystalluria depends on...
pH & temperature of the urine sample
109
What type of crystals?
What conditions?
Calcium oxalate dihydrate
(Maltese cross)
Conditions: normal in cows/horses/cats, hyperparathyroidism, genetic defect in Schnauzers
110
What crystal? Conditions?
Calcium oxalate monohydrate
Conditions: ethylene glycol poisoning - pathognomonic
111
What crystal? Conditions?
Calcium oxalate monohydrate
Conditions: chocolate poisoning in dogs
112
What is present here? Condition present?
Haemoglobin globules w/ bilirubin crystals
Condition: IMHA w/ intravascular haemolysis (or extravascular)
113
What type of crystal? Condition?
Calcium carbonate crystals
Condition: alkaline urine, little or no clinical significance
114
What types of crystals? When are they seen and in what animal?
Calcium carbonate & calcium oxalate dihydride crystals
Equine, winter
115
What crystals are common with liver dz? What conditions?
* leucine - liver dz
* cysteine - genetic liver dz
* tyrosine - liver dz
* ammonium biurate - PSS (congenital or acq'd)
116
Crystal type?
Ammonium biurate - thorn apple
117
Crystal type?
Cystine (hexagonal)
118
Crystal type?
leucine
119
Crystal type?
tyrosine
120
What crystal type? Normal in what species?
Urate crystals
normal in Dalmatians & E. bulldogs
121
Struvite crystals are known as...
triple phosphate ("coffin lids")
122
struvite crystals are made of
Mg ammonium phosphate
123
What crystal is common in UTIs?
Struvite crystals
124
What crystals are pathognomonic for FUS if present in large no's?
Struvite
125
What type of crystals?
Struvite crystals
