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102 Cards in this Set
- Front
- Back
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Urine Specific Gravity (USG) evaluates _________________.
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*Renal tubular function
-how well they respond to ADH and reabsorb water back into the bloodstream |
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USG is measured with___________.
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Refractometer using the scale on the right side with NO units.
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USG measurement is a comparison of ______________________
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density of urine to distilled water (1.000).
-density is determined by number and types of dissolved substances in the urine sample as well as amount of water present. (concentration) |
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How does the written version of a USG measurement differ from the SPOKEN version?
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Write 1.025 but say ten twenty five
Write 1.015 but say ten fifteen |
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The refractometer scale is inaccurate ______________.
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Above the scale, so do not guesstimate. Re-run sample to check for mistakes.
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USG will fluctuate depending on ________________
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Hydration status of the animal
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What USG range is what we worry about in dogs?
Cats? |
1.008 - 1.012 in dogs
1.015 in Cats |
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Isosthinuric urine is when the USG reading is the same as the glomerular filatrate. This fixed USG range of 1.008 to 1.015 stays the same no matter how much animal drinks. This indicates __________________
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That the renal tubules are non-functional = renal failure.
--only a concern after multiple tests show same reading. Water is not being reabsorbed and renal tubules are not responding to ADH. |
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Reasons for DECREASED USG:
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*Pale urine, dilute
*PU/PD symptom of pyometra, Cushings *Diuresis from drugs, IV fluids *Renal failure |
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Reasons for INCREASED USG:
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*Dark yellow, increased concentration
*Dehydration, increased fluid loss due to V/D *Acute renal failure/shutdown (oliguria) *Shock-body trying to reabsorb water to increase blood volume -DM-urine is pale but has a high USG due to dissolved glucose ( **Increase in glucose in blood and urine-creates hypertonic solution that sucks water out of tissues leading to increased thirst.) |
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When doing urine chemistries, how should the urine be prepared prior to use?
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Mixed well and at room temp
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What is the preferred method for putting urine on the dip sticks?
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Lay stick horizontally and use a pipette/syringe to put 1gtt on each reagent pad.
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How should a urine chemistries test stip be loaded and read?
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load top to bottom and read bottom to top.
*bottom tests are the ones that take the least amount of time |
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If you are trying to do a urine chemistries dip stick with discolored urine, what can you do to avoid having the discolored urine affect the dipsticks color changes?
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Centrifuge the sample and do the dipstick of the supernatent.
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What 11 tests are typically included on a urine chemistries dip stick?
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ph
protein glucose ketones bilirubin blood -nitrites -leukocytes -creatinine -USG (refractometer better) |
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In regards to urinary pH, it is typically influenced by diet, therefore, carnivores urine is typically _________ and herbivores tends to be ____________.
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acidic
alkaline. |
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What are some reasons for acidic urine?
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*high protein diets
*nursing young *metabolic/respiratory acidosis *protein catabolic states (high fever, starvation |
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What are some reasons for alkaline urine?
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*Vegetable based diets
*Metabolic/respiratory alkilosis *UTI caused by urease positive organism -urine allowed to stand at room temperature (loss of acidic CO2) -urine retention |
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Protein reagent pad on dipsticks primarily detects_____________
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-primarily albumin, protein from cells, mucous, bacteria and casts
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Normal animal usually has how much protein in their urine?
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0 to trace amounts of protein when obtained by cysto. May be slightly higher in voided sample due to genital secretions.
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What are some causes of transient proteinuria?
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*Due to temporary increase in glomerular permeability
*Strenuous exercise *Stress *Convulsion *Parturition *1st few days of life |
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What are some causes of proteinuria?
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-In most cases this indicates disease of urinary tract, esp kidneys
*Acute and chronic renal disease *Urinary tract inflammation(UTI, nephritis, pyelonephritis) *Renal glomerular disease (glomerulonephritis) *urinary tract hemorrhage *Congestion of kidneys-CHF, hypertension *Multiple myeloma-leads to more protein being produced. |
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What is a second test for protein in the urine that does not use the dip stick and how does it work?
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Sulfosalicylic acid Test
-Mix equal parts of urine with with a 3-5% solution of Sulfosalicylic acid. More cloudy=More protein -Neg: no turbidity Trace: hazy 1+:hazy, can read newsprint though it 2+: cloudy, can't read newsprint 3+: cloudy with fine precipitate 4+:cloudy, flocculant |
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What are some causes of Glucose in the urine?
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-Glucosuria occurs when blood glucose exceeds the renal threshold (160-180mg/dl for dogs, 280-300 for cats)
*diabetes mellitus *stress, fear, excitement *high carb meal (fasting sample) *Occasionally w/pancreatitis, hyperthyroidism, Cushings, renal glucosuria (renal tubular disorders) |
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Ketones are acid by-products of fat metabolism and normal animals should be ___________ for ketones.
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Negative
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What are some causes of ketonuria?
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*DM/DKA
*Prolonged anorexia or starvation *Ketosis in lactating and pregnant cows, pregnant ewes, esp w/twins |
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Bilirubin is a metabolite of Hgb breakdown and only ______________ can be present in urine.
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conjugated
(unconj. is not water soluble) |
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Small amount of bilirubin can be seen as normal in what 2 species due to a lower renal threshold of bilirubin?
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Cattle and dogs (esp. male dogs with concentrated urine)
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Cats, horses, sheep and pigs should be ____________for bilrubin.
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Negative
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What are some causes of bilirubinuria?
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-excessive hemolysis of RBC's
-HBO-hepatobiliary obstruction--bypasses SI and goes to kidneys -liver disease-Liver cannot store and conjugated bilirubin is released from damaged hepatocytes. |
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Bilirubin pigment is ____________ when exposed to light.
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unstable
*tube should be wrapped in foil |
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How is urobilinogen created and excreted?
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Created in the intestines, bacteria converts bilirubin to urobilinogen and it is then reabsorbed back into the blood and it is excreted by the kidneys.
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Urobilinogen is unstable(esp to light) so reliability of test is questionable unless what type of urine is used?
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Fresh
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A decrease or total absence of urobilinogen is indicative of:
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*dilute urine
*HBO-no bilirubin going to the SI and being converted to urobilinogen *broad spectrum antibiotics-kill off normal gut flora, so urobiliogen is not produced. |
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The blood detection pad on the urine chemistries dipstick detects:
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hematuria, hemoglobinuria and myoglobinuria
*reagent pads will detect hematuria before macroscopically visible. |
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A speckled reaction on the blood reagent pad indicates?
Solid? |
Intact RBC's
Hemoglobin from lysed RBC's and myoglobin |
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What are some causes of hematuria?
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RBC's in urine
inflammation trauma urolithiasis neoplasia coagulopathy rough cath or cysto |
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In dilute urine, RBC's will __________
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lyse, which will lead to seeing ghost cells on microscopic exam.
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What are some causes of hemoglobinuria?
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*Usually occurs with hemoglobinemia
-AIHA -Incompatible blood transfusions -Toxins, poisons, snake venom -RBC parasites such as mycoplasma |
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What are some causes of myglobinuria?
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*occurs with muscle cell lysis
-exertional rhabdomyolysis -extreme muscle exertion -trauma/crushing injuries -heat stroke -electrical shock -snake bites |
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The nitrite pad on the urine chemistries dip stick detects
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bacteria in urine
*not very reliable microscopic eval is better for bacteria -eval of urinary sediment is best to detect bacteria |
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The leukocyte pad on a urine chemistries dipstick detects:
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WBC's in urine
*not reliable for testing feline urine -false negatives are possible -microscopic eval of urinary sediment is best way to detect WBC's |
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The creatinine reagent pad is useful for:
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interpreting protein test results nad the accuracy of protein test can be enhanced by calculating a protein/creatinine ratio.
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In regards to reporting urinary sediment, RBC's, WBC's and epithelial cells are reported how?
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#/hpf on 40x
epithelials reported Avg #/hpf |
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In regards to reporting urinary sediment, casts are reported how?
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#/lpf
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What is the basic procedure for spinning down a urine sample for microscopic evaluation?
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-Use well mixed fresh or refrigerated urine
-Use a 1/2 full conical centrifuge tube-about 5-10mls or 1 to 1.5 in a bullet tube. -Centrifuge at 1500RPM for 3-5 minutes -Pour off supernatent into sink -Re-suspend sediment-mix it with remaining drops that stay behind -Pipette onto a slide and put on a coverslip. -can scrap or tap if needed -Start on 10x and low light. Scan around and do final analysis on 40x -check a minimum of 10 fields - |
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May use what kind of stain on spun down urine to see nuclear detail of cells?
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sedi-stain
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List in order of size, from biggest to smallest, the cells seen on microscopic evaluation of urine.
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*Epithelial cells
*squamous epithelial cells Transitional epithelial cells Renal tubular epithelial cells-rarest *Leukocytes *Erythrocytes *Sperm |
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In regards to microscopic evaluation of urine, SQUAMOUS epithelial cells are the largest with a nucleus the size of an RBC. They originate from _______________ , look like ________and may appear as singles or clusters. Normal to see in MILD amounts depending on method of collection.
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*distal 1/3 of urethra, vagina, vulva, prepuce
-look like cornflakes *will not show up on a cysto |
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In regards to microscopic evaluation of urine,TRANSITIONAL epithelial cells are the large with a large nucleus and granular appearance. They originate from _______________. Can look __________________. Normal to see in MILD amounts depending on method of collection.
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*bladder lining, ureters, renal pelvis, proximal urethra
* round, pear shaped or caudate and vary in size and shape. |
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Increased numbers of transitional epithelial cells in a microscopic evaluation of urine is indicative of:
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Inflammation
Urolithiasis neoplasia trauma |
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In regards to microscopic evaluation of urine, leukocytes that will be most often seen are__________. It is normal to see less than ______. In regards to size they are _______bigger than an RBC.
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Segs
5/hpf 1.5 to 2 times |
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Presence of leukocytes in urine is indicative of_______________
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inflammation, so look carefully for presence of bacteria.
*blocked toms only have increased WBC but no bacteria. |
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In regards to microscopic evaluation of urine, it is normal to see how many Erythrocytes per hpf?
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5
-slightly more with a cysto, cath or manual expression. |
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Appearance of Erythrocytes in a urine sample will vary with what 2 qualities?
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USG and pH
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High USG is hypertonic, which leads to what type of RBC's in a urine sample?
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crenated (spikey)
-easily confused with a WBC. |
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Decreased USG is hypotonic, leading to what type of RBC's in a urine sample?
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Swollen or bursts (ghost cells)
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What does alkaline urine do to RBC's?
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destroys them
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What does acidic urine do to RBC's?
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nothing-preserves them
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How do you differentiate between a RBC and a fat droplet?
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-RBC's are all the same size, fat droplets will vary in size
-Fat droplets are green and refractile -Fat droplets tend to be on a different plane-float to top. |
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Fat droplets are seen more often in what 2 situations?
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Fatty diets, esp cats
DM Can be normal-still report |
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Mucous threads/ strands is normal in large amounts in __________ due to mucous glands in the renal pelvis and ureters. Combined with crystals, creates what type of urine that is typical of this species?
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horses
cloudy |
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In regards to microscopic evaluation of urine, yeast can be normal but can also cause ________ and is sometimes mistaken for ___________.
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bladder infections
parasite eggs |
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In regards to microscopic evaluation of urine, what artifacts are commonly seen?
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*depends on collection method
-pollen, fur, threads, litter, |
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In regards to microscopic evaluation of urine, bacteria with no WBC generally indicates
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CONTAMINATION!!
-may have gone through colon while doing cysto -free catch urine **gram stain sediment if you see bacteria and report reaction and shape. |
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Granular precipitates, also called bladder sludge, is composed of 2 types. The first is AMPORPHOUS PHOSPHATES and these show up when the urine is _________.
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Alkaline
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Granular precipitates, also called bladder sludge, is composed of 2 types. The second is AMORPHOUS URATES and these show up when the urine is _______
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Acidic
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Crystals in the urine may be of any size. Crystaluria may or may not be of clinical significance. The type of crystal depends on what 3 things?
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ph of urine
Concentration temperature of urine |
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What are the defining qualities of Triple phosphate/Struvite/ Ammonium Phosphate Crystals (AMP)?
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*can be any shape but ALWAYS 3-D
-form in alkaline to slightly acidic urine -Look like coffin lids, raised 3-D center -Colorless -NORMALLY seen in horses, dogs and cats -Can indicate urolithiasis -Tx is to acidify urine with diet |
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What are the defining qualities of both type of Calcium Oxalate crystals?
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-The 2 types are Monohydrate and Dihydrate
-form in acidic to slightly alkaline urine -Normally seen in dogs and cats, sometimes horses -Can indicate urolithiasis and Ethylene glycol toxicity Tx-make urine more alkaline with diet |
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What does a Calcium Oxalate Monohydrate crystal look like?
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Colorless, dumbell shape
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What does a Calcium Oxalate Dihydrate crystal look like?
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These more common crystals are colorless, "envelopes", Always a square with an X in the middle.
3-D but without the distinct raised center. |
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Hippuric acid crystals are thought to be a form of Calcium Oxalate Monohydrate Crystals. What are these indicative of?
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-Ethylene Glycol toxicity and the resulting trashed kidneys
-these crystals are not pH dependent -PICKET FENCE post appearance w/o being 3-D. |
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What are the defining qualities of Calcium Carbonate urinary crystals?
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-YELLOWISH brown dumbell shaped crystal or ROUND with radial striations
- Most common in horses and the reason the urine is cloudy when they combine with mucous. |
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What are the defining qualities of Bilirubin urinary crystals?
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-Spikey Yellow gold needles (twig or koosh ball)
-Can be normal in dogs due to their renal threshold for bilirubin. -Increased numbers indicate liver disease |
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What are the defining qualities of Ammonium Biurate/Urate urinary?
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-thorn apples, round with spicules.
-DARK brown -Can indicate portosystemic shunt and liver disease but are normally seen in dalmatians and primates |
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Most animals reabsorb uric acid, a metabolic by-product produced by the liver and filtered by the kidneys to be reabsorbed back into the bloodstream. In primates and dalmatians, this is not the case for what reason?
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They have higher levels of uric acid excretion.
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What are the defining qualities of Cystine urinary crystals?
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-Hexagon in shape, flat & colorless
*presence is NEVER normal -Indicates a congenital inability to metabolize certain amino acids. -Most commonly seen in dachunds |
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What are the defining qualities of Tyrocine and Leucine urinary crystals?
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-USUALLY seen together
-Presence is NEVER normal -Indicates liver disease, usually severe -TYROCINE are long clusters of spikey, dark brown long needles -LEUCINE-grapefruit, wheel with round O in the middle with radial striations (wheel w/ spinners...) |
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What are the defining qualities of Uric Acid urinary crystals?
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-look like chips of broken glass
-Normal in dalmatians -Form as urine is allowed to stand or if temp fluctuates **Have very little clinical significance |
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What are the defining qualities of Cholesterol crystals?
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-flat, colorless, transparent, look like stair steps
-Can be normal OR indicative of severe kidney disease -rarely seen |
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What class of drugs is known for causing the formation of certain crystals?
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Sulfonamides
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What are the defining qualities of urinary Casts?
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-recorded as #/lpf
-Are cylindrical structures that form in the lumen of the distal renal tubules -Some casts are made from just the Tamm-Horsefall protein while others have more incorporated into them -Need more acidic urine for casts to be formed and preserved -Degenerate quickly, so fresh urine is best -rare in herbivores due to their tendency towards alkaline urine |
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Why do urinary casts form?
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They form because renal tubular epithelial s secrete a protein called the Tamm-Horsfall protein, a geletin like substance. The lumen acts as a mold and these cylindrical jello casts are flushed into the urine.
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What are the defining qualities of a Hyaline Urinary Cast?
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-Colorless cylindrical gel cast
-Parallel sides and rounded ends -1 to 2 per lpf is normal -See increased numbers with fever, strenuous exercise and mild renal irritation. |
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What are the defining qualities of a Granular Urinary Cast?
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-Look like Hyaline cast with granules (degenerative cells)
-granules will vary in size -Seen more than hyaline casts -increased numbers can indicate nephritis |
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What are the 3 types of Cellular Urinary Casts?
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*ALL are NEVER normal
-Erythrocyte -Leukocyte -Epithelial |
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What are the defining qualities of Erythrocyte Cellular Urinary Casts?
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-RBC's incorporated into Tamm-Horsfall protein.
-Deep yellow to orange in color, sometimes appearing like cherries in jello -Presence indicates bleeding in kidney or pathological condition. |
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What are the defining qualities of Leukocyte cellular urinary casts?
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-WBC in the Tamm-Horsfall protein
-DISORGANIZED, spread out arrangement -Indicative of inflammation and most likely due to pyelonephritis |
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What are the defining qualities of Epithelial Cellular Urinary Casts?
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-Contain renal tubular epithelial cells **can see nucleus**
-Can be difficult to differentiate from WBC casts but these have a more organized arrangement. -Indicative of renal tubular damage |
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What are the defining qualities of Fatty acid urinary casts?
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-Tamm-Horsfall protein contains fatty droplets.
-Look round and refractile -Seen often in DM and high fat diets Seen more often in kitties |
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What are the defining qualities of Waxy Urinary Casts?
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*Broader with SQUARE ends
-consistency of hyaline cast but more opaque. -look brittle. -presence indicates chronic severe degeneration of urinary tubules |
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What is urolithiasis?
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Presence of stones or calculi in the urinary tract and are composed of various minerals.
* good to determine composition so best method for treatment, prognosis and control can be determined. |
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What are2 ways to determine the composition of a urolith?
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-In-house stone analysis kit-unreliable
-Sending to reference lab is best, which will give you a reference picture with a ruler as well as a composition report |
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In order for uroliths to form, what are 4 items needed?
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* Increased concentration of minerals in urine
*Adequate pH *Time *Nidus-something on which the stone can form such as a bacteria, crystals and suture. |
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What are some ways to decrease stone formation with diet?
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-Feed a food with lower minerals (cast-low ash diet)
-Alter concentration by increasing water intake -Avoid making animal hold their urine for long periods of time |
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An acidic diet tends to lead to what type of stones?
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Oxalate uroliths
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An alkaline diet tends to lead to what kind of stones?
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Struvite Uroliths
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What are the 3 more commonly seen stones?
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-Triple Phosphate/Struvite/AMP stones
-Urate/Ammonium Urate/Uric Acid Stones -Calcium Oxalate stones |
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What are the defining qualities of Triple Phosphate/Struvite/AMP stones?
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-Smooth
-Form in alkaline urine. Alkaline urine typically forms due to urease positive bacterial infection. Stones are SECONDARY to infection. Tx-Acidify urine with diet -Most commonly seen in dogs and cats |
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What are the defining qualities of Urate/Ammonium urate/uric acid stones?
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-Common in dalmatians because they excrete a lot of uric acid
-also seen in animals with portosystemic shunt -Hard to prevent -Restricting protein may help prevent |
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What are the defining qualities of Calcium Oxalate stones?
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-Hard stones with sharp protrusions
-look like jacks -Can damage the bladder -Tend to form in acidic urine Tx-change diet to make urine more alkaline |
