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Lab D > 13. Urinalysis > Flashcards

13. Urinalysis Flashcards

1
Q

Why should samples during storage and/or transportation be protected from light?

A

Because some of its components are light-sensitive (e.g.

bilirubin is converted to biliverdin).

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2
Q

Why should samples not be frozen?

A

Because cellular elements get damaged and crystal composition altered during freezing

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3
Q

Types of sampling procedures

A
  1. Free catch sample
  2. Catheterisation
  3. Cystocentesis
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4
Q

Advantages and disadvantages of Free catch sample

A

Advantages:
(1) no restraint or sedation is necessary
(2) no special equipment is needed
(3) can be carried out by the owner at home
Disadvantages:
(1) samples easily contaminated - not for microbiological culturing!
(2) animals may stop urinating when they feel they are disturbed during voiding
(3) free catch is rarely possible with cats urinating to the litter box. Alternatives: litterless litter-box, non-absorbent kitty litter or other methods

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5
Q

Advantages and disadvantages of Catheterisation

A

Advantages:
(1) sample gets less contaminated from environment (however not for microbiological culturing!)
(2) may provide additional info e.g. for the diagnosis of
urethra obstruction
(3) may provide a small amount of sample even when the urinary bladder is almost empty
(4) enables vet to measure volume of urine produced during a period of time
(5) can be performed when the owner is not capable of providing a free catch sample.
Disadvantages:
(1) good quality and proper size of the catheter is essential
(2) in small females it is difficult to perform, especially in the queen. In large animals catheterisation is easily performed only in females
(3) danger of passing bacteria from orifice of urethra (etc) into the urinary bladder and cause UTI.
(4) risk of traumatic injury to the urinary tract, especially upon repeated catheterisation
(5) even min. trauma can cause bleeding -> false positive test result for presence of blood in the urine
(6) sedation/anaesthesia may be necessary

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6
Q

Advantages and disadvantages of Cystocentesis

A

Advantages:
(1) only method which provides sterile samples, for bacterial culture
(2) sample comes directly from bladder, it is usually not influenced by urethral or genital tract problems
(3) generally safe and well tolerated procedure, in most cases no anaesthesia or sedation is needed.
Disadvantages:
(1) adverse effects are rare and include bruising, haemorrhage, urine leakage, bladder rupture and peritonitis
(2) even minor bleeding can provide false positive test for presence of blood in urine
(3) in cats vagal stimulation can cause transient side-effects (retching, panting, collapse), from which recovery is spontaneous within a few minutes.

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7
Q

What is important with urine samples of horses?

A

Should always be filtered before analysis because they contain mucous and crystals which can disturb the analysis.

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8
Q

Physical evaluation - normal appearance

A

Urine is yellow because of urobilins, specifically d-urobilin, i-urobilin, l- stercobilin, and possibly others. Normal urine should be clear and yellow to straw-coloured (urine of horsesmay be turbid).

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9
Q

Physical evaluation- ABNORMAL appearance

A
  • Very light yellow or very pale straw colour and clear (may be water-like): low SG i.e. very diluted urine e.g. polyuria, polydipsia in DM or chronic kidney failure
  • Deep yellow or orange: (1) very cc. urine (2) in case of jaundice (3) effect of drugs (4) food sources
  • Dark yellow-greenish - biliverdin in case of (1) long term stasis of urine in the bladder (2) long storage of sample
  • Red, yellow-reddish: (1) haemoglobinuria or haematuria (2) Consumption of beetroot or red food dyes
  • Dark red-brown, chocolate: (1) older haemoglobin or methaemoglobin present (2) myoglobinuria
  • Blue: (1) methylene blue, multivitamins, B vitamins, food dyes and any drugs that contain blue dye (2) pyuria (3) in humans some genetic diseases
  • Green: (1) food sources (2) drug sources
  • Cloudy or opaque: (1) mucus – physiological in the horse (2) proteinuria (3) lipiduria -can be physiological both in dog or cat, or linked to obesity, feline hepatic lipidosis etc. (4) pyuria (5) crystals or amorphous materials
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10
Q

Physical evaluation - odour - normal and abnormal

A

Normal: specific, varies among species and is usually stronger in male animals than in females.
Abnormal:
-In case of lower UTI: (urease pos. bacteria) or bladder retention: ammoniacal odour.
-In case of ketoacidosis e.g. diabetes mellitus or starvation: sweet, fruity or acetone-like.
-Faecal contamination or E. coli infection: faecal odour.
-Some drugs e.g. penicillin or foods e.g. asparagus, B vitamins excreted through the kidneys can cause special odour (and/or colour) change.

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11
Q

Physical evaluation - Transparency - normal and abnormal

A

Normal: transparent in healthy animals, except from the urine of horses, because it contains a lot of mucous and calcium-carbonate crystals which cause opacity.
Abnormal:
-When urine samples are stored for too long, cell destruction occurs and dissolved salts in the urine become precipitated which decrease transparency.
-Opacity due to lower UTI, lipiduria and contamination
with preputial or vaginal discharge

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12
Q

Specific gravity (SG):

  1. What is it an indicator of?
  2. SG of distilled water?
  3. When does the SG increase?
  4. How can it be measured?
A
  1. Indicator of concentrating ability (tubular function) of
    the kidneys. SG is the ratio of the weight of the liquid to an equal volume of distilled water.
  2. Distilled water: 1.000
  3. Urine: always greater than that of distilled water.
  4. SG increases with the increasing cc. of dissolved ions, glucose, proteins, lipids and contrast material.
  5. Measured by urinometer, refractometer, or test strip
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13
Q

Urinometer measurement

  1. When is it not reliable?
  2. Advantages
  3. Disadvantages
A
  1. Urinometers are calibrated to normal room temp - 21 oC, so results are less reliable in lower or higher temp.
  2. Advantages: (1) most accurate method for urine SG measurement, because it is not influenced by opacity of
    urine (2) easy to perform and cheap.
  3. Disadvantages: amount of urine required is high
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14
Q

Refractometer measurement

  1. Important before measurement?
  2. What is it also used for together w. urine measurement?
  3. Advantages
  4. Disadvantages
A

Refractometer measurement

  1. calibrated with distilled water before measurement
  2. Also for measurement of TP cc. of the plasma
  3. Advantages: easy to perform, one droplet of urine sample is enough for the measurement.
  4. Disadvantages: not reliable when urine sample is not transparent
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15
Q

Test strip measurement - why is not very reliable?

A

The SG region on the test strip contains precipitated polyelectrolyte reacts with the ions in urine, results in local pH change which gives the colour change. In
animals however, other osmotically active substances influence SG e.g. glucose, proteins, urea

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16
Q

Interpretation of urine SG

  1. Physiological range
  2. Abnormal range
A
  1. Physiological range: dogs 1.015-1.040; cats 1.035-1.060
  2. A) Hyposthenuria: SG < 1.008. Temporary hyposthenuria can be normal, due to incr water intake
    B) Isosthenuria: SG 1.008-1.012.Temporary isosthenuria can be normal, due to incr. water intake.
    C) Hypersthenuria: SG > 1.012. Normally urine is hypersthenuric.
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17
Q

Causes of hyposthenuria

A
  • Hyperadrenocorticism
  • Decreased ADH-production (CDI)
  • Resistance to ADH (peripheral or nephrogenic DI)
  • Renal tubular damage
  • PP
  • Medullary washout leading to hypoadrenocorticism, liver disease or prolonged fluid therapy
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18
Q

Causes of Isosthenuria

A

Tubules are not able to concentrate (or dilute) primary glomerular filtrate. Indicator of severe tubular damage.
-Also in cases of medullary washout, CDI, NDI or PP

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19
Q

Causes of pathological hypersthenuria

A

(1) decreased water intake
(2) substantial water loss (vomiting, diarrhoea, excessive exercise: panting – dog, sweating - horse)
(3) acute kidney failure (oliguria).
- Also in DM because of increased glucose cc. – however, urine SG usually does not exceed the physiologic range because concurrent PU/PD causes dilution of urine.

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20
Q

Water deprivation test (WDT)

  1. Goal
  2. Principle
  3. Indications
  4. Contraindications
  5. Procedure
    6) Interpretation
  6. What can be done to differentiate between CDI and NDI?
A
  1. Goal: to assess concentrating ability of tubules, to differentiate bw CDI, NDI and PP.
  2. Principle: artificial induction of 5% dehydration in controlled environment and repeated measurement of urine SG.
  3. Indications: persistent PU/PD, more than one
    urine SG measurement result in the range of hyposthenuria.
  4. Contraindications: severe endocrine disturbance (diabetes mellitus, Cushing’s disease, Addison’s disease), dehydration, azotaemia, uraemia, liver dysfunction, pregnancy, lactation, growth and inflammatory disease
    (e.g. UTI).
  5. Procedure:
    A) Partial water restriction (90-110 ml/kg BW) is for 2-3 days prior to the test.
    B) Bladder is emptied by catheterisation, urine SG and body weight is recorded. Water and food is withheld.
    C) In 1-2 hourly intervals BW is monitored and bladder
    is emptied (urine SG measured) by catheterisation.
    D) The procedure is continued until BW reaches 5% decrease from the starting BW or urine SG > 1.025 or the animal becomes depressed and/or azotaemic.
    6) Interpretation:
    a) in case of PP urine SG will become > 1.025.
    b) In case of CDI or NDI urine SG will be ≤1.010
    c) Values bw. 1.010-1.020 are equivocal and may suggest suboptimal concentration ability in the tubules.
  6. To differentiate bw CDI and NDI the desmopressin response test can be performed
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21
Q

Desmopressin response test

A

(a) IN HOSPITAL: 2 µg for dogs <15 kg BW, and 4 µg for dogs >15 kg BW iv or im. Then urine SG is measured every 2 hours (for 12 hours) and after 24 hours. Restrict slightly water intake (3 ml/kg/hour) to prevent cerebral oedema!
- Interpretation:
>1.015: indicate CDI as substitution therapy restored concentration ability of renal tubules
≤1.010: indicate NDI as ADH could not bind to receptors of damaged tubular cells.
1.010-1.015: equivocal and may indicate medullary washout
(b) AT HOME: analogue desmopressin tablet or 1–4 drops of nasal spray from an eye dropper into the conjunctival sac every 12 hours for 5–7 days. If CDI, owners should notice a decrease in PU/PD by the end of treatment period. Increase in urine SG by 50% or more, compared with pre-treatment values, also support diagnosis of CDI. In the first 2-3 days limit water intake 90-110 ml/kg to prevent cerebral oedema!
(c) CATS: 1 drop into the conjunctival sac twice daily for 2–3 days; a dramatic reduction in water intake or a 50% or greater increase in urine cc. gives strong evidence for a deficit in ADH production.

22
Q

Urine pH

  1. How can pH of urine be measured?
  2. Physiological value in herbivores
  3. Physiological value in carnivores
  4. pH value in case of acidbase balance alterations
  5. What are urine ph affected by?
  6. When can false pH occur?
A
  1. Measured by pH meter (ion specific electrode - most precise method), urinary test strips or by indicator papers. 2. Herbivores: 7.0-8.5 (neutral to alkaline)
  2. Carnivores: 5.5-7.5 (mostly acidic to neutral)
  3. In case of acidbase balance alterations: 4-8.5, due to renal compensation.
  4. By diet, recent feeding, bacterial infection and storage time
  5. False low pH: due to contamination by acid from the protein region of the test-strip
    False high pH: due to contamination with detergents, bleach, disinfectants
23
Q

Causes of decrease urine pH

A
  1. metabolic and respiratory acidosis
  2. vomiting
  3. hypokalaemia
  4. treatment with acidifying drugs
  5. distalis renalis tubularis acidosis
  6. abomasal displacement
  7. toxicosis with acidifying substances
24
Q

Causes of increase urine pH

A
  1. feeding in carnivores: transient postprandial alkalisation of urine
  2. UTI caused by urease-producing bacteria
  3. metabolic and respiratory alkalosis
  4. proximal renal tubular acidosis
  5. alkalizing substances, overload of bicarbonate- or lactate containing infusion
  6. long storage time causes urea decomposition
    to ammonia, also occur in the bladder in case of urinary tract obstruction etc.
25
Q

Proteinuria

  1. Normal protein concent of urine
  2. Methods
A
  1. Normal urine protein content is very low and consists of low molecular weight proteins - physiological protein content of urine approx. <0.5 g/l
  2. Test strips, Sulphosalicylic-acid test, Heller test, Spectrophotometric method, Urine protein : creatinine ratio (UPC), Specific methods, Determination of Bence-Jones proteins, Microalbuniuria (MA)
26
Q

Test strips

  1. Reagent used
  2. Result
  3. What is the test most sensitive to?
  4. What does it not detect?
  5. Physiological outcome
  6. False test results
A
  1. Reagent: Indicator (brome-phenol-blue)
  2. Colour change:
    a) blue-greenish: aminoacids of proteins induce pH change
  3. Albumin
  4. Globulins and Bence-Jones proteins
  5. Physiological outcome: negative.
  6. False positive: if urine pH is very alkaline (>8.0) or in presence of chlorhexidine, in very concentrated
    urine and after Oxyglobin administration.
    False negative: if the strip is dipped into urine and the citrate-puffer precipitated on the strip is washed out.
27
Q

Sulphosalicylic-acid test

  1. Reagent used
  2. Result
  3. Sensitivity
  4. What does it not detect?
  5. False test results
A
  1. Sulphosalicylic-acid
  2. Acidic reagent coagulates each type of proteins.
  3. higher sensitivity compared to the urinary test-strip
  4. not specific i.e. it does not differentiate bw types and causes of proteinuria.
  5. False negative: in case of very alkaline urine
    False positive: after iv administration of X-ray contrast material and during therapy with penicillins and cephalosporins.
28
Q

Heller test (Gmelin test)

  1. What does it show?
  2. Reagent used
  3. Result
A
  1. Show bile-pigment metabolites and protein content of the urine.
  2. Reagent used: cc. HNO3
  3. Bilirubin derivates, presence and the thickness of the opaque zone above biliverdin and below the clear urine. This opaque zone is formed by coagulation of proteins
29
Q

Spectrophotometric method

  1. What does it show?
  2. Groups
  3. What does it not detect?
A
  1. TP content of the urine - using ultrasensitive spectrophotometric methods.
  2. Two main groups – depending on whether (1)
    colour intensity of a complex formed by direct reaction of urinary proteins with a dye-reagent is measured or whether (2) it is first necessary to concentrate the protein 3. Does not allow differentiation of types and causes of proteinuria.
30
Q

Urine protein : creatinine ratio (UPC)

  1. What does it show?
  2. Interpretation
A
  1. Info about the severity of proteinuria if the evaluation of the sediment does not show evidence of inflammation or macrohaematuria.
  2. Interpretation: normal:
    - < 0.5 = grey zone
    - equivocal result: 0.5-1.0
    - proteinuria: >1.0
    - significant proteinuria: >2.0.
31
Q

What is proteinuria indicative of?

A 
Glomerular disease (glomerulonephritis, protein loosing
nephropathy, amyloidosis).
32
Q

Determination of Bence-Jones proteins

  1. What is Bence-Jones proteins?
  2. How are they synthesized?
  3. How are they filtered?
  4. Why can they be detected orientative?
A
  1. Bence-Jones proteins or paraproteins (sometimes also called M component - Myeloma or Macroglobulinemia) are structurally homogeneous proteins in serum or urine
    appearing as a sharp spike in the beta or gamma globulin region on protein electrophoresis. These proteins are in most cases monoclonal immunoglobulins or heavy chain fragments, or a monoclonal immunoglobulin light chain or light chain fragment.
  2. Synthesized in neoplastic plasma cells due to plasma
    cell myeloma, some types of lymphoma, systemic amyloidosis or some advanced autoimmune diseases.
  3. They readily get through to the primary filtrate.
  4. Because they are heat labile.
33
Q

Microalbuniuria (MA) - Methods

A

Specialized methods: urine electrophoresis, HPLC, and special test-strips.

34
Q

Causes of proteinuria

A

Glomerulonephropathy, tubular transport defect, inflammation, infection or marked haematuria within the urogenital tract.
A. Pre-renal (non-renal) causes of proteinuria:
(1) physiologic or benign: in neonates below 40 hours of age, after strenuous exercise, after exposure to extreme heat or cold or after stress.
(2) pathologic: increased protein catabolism: in fever, seizures, increased BP, dysproteinaemias, haemoglobinuria, in states of severe intravascular haemolysis and in severe muscle injury.
B) Real proteinuria i.e. nephrogenic:
(1) when intermediate molecular weight proteins appear in the urine: milder glomerular damage, specific tubulointerstitial lesions or infectious diseases.
(2) non-selective proteinuria: high molecular weight proteins appear in the urine. Caused by glomerular dysfunction and in some cases severe tubular damage.
(2) non-selective proteinuria: high molecular weight proteins appear in the urine. Caused by glomerular dysfunction and in some cases severe tubular damage.
C) Pseudo-proteinuria - proteinuria spuria: originate from the lower urinary or genital tract
(1) physiological: after parturition in female animals, or in males due to high amount of sperm cells or mucous from the praeputium. Nnormal in horses as their urine contains highly viscous mucous
(2) pathological: lower UTI, urolithiasis, prostatic or
testicular inflammation, hypertrophy or tumour of the prostate gland, vaginal tumour, etc.

35
Q

How can we can differentiate between proteinuria vera and spuria?

A

By centrifuging the sample and repeating protein detection from the upper layer.
- In case of true proteinuria: proteins are mainly small molecules dissolved in the urine, and they do not
sediment, thus proteins can be detected in the supernatant.
-In case of pseudo-proteinuria: large portion of the proteins are related to cellular elements which sediment during centrifugation, thus we can not detect proteins from the supernatant.

36
Q

Pus (pyuria)

  1. What is pus?
  2. Methods
A
  1. Pus is the accumulation of neutrophil granulocytes, some tissue cells, and microbes.
  2. Donne-test, microscopic evaluation of the sediment or using urine test-strip.
37
Q

Donne-test

  1. When is it used?
  2. Reagent used?
  3. Result?
  4. False test result?
A
  1. An orientative quick-test suitable for in-house evaluation.
  2. 10% NaOH
  3. Check the speed of the elevation of air bubbles in the sample. If there is pus in sample, the components are
    colliquated and the sample becomes more viscous (and so air bubbles elevate slower).
  4. Positive result may occur in males if sperm or seminal fluid is present and in horse-urine because of high mucin content.
38
Q

Microscopic evaluation of urine sediment

  1. Procedure
  2. When is it important?
A
  1. Urine samples are centrifuged, upper layer is removed by one quick movement and the sediment is rehomogenised in the remaining droplet of urine. One droplet of re-suspended sediment is poured out to a glass slide and covered with a cover-glass. Then observed using magnification 400x (native sample).
  2. In diagnosis of urinary tract tumors
39
Q

Causes of pyuria

A
  • Physiological in horses
  • Kidney pelvis inflammation
  • Cystitis (inflammation in the urine bladder)
  • Inflammation in the genital tract e.g. balanitis (inflammation of the glans penis) or prostatitis in males or vaginitis, endometritis in females
40
Q

Haematuria, haemoglobinuria and myoglobinuria

  1. What is haematuria?
  2. Whar is haemoglobinuria and myoglobinuria?
  3. Result of tests
  4. Methods
A
  1. Haematuria: the presence of blood (intact red blood cells) in the urine.
  2. Haemoglobinuria and myoglobinuria: the presence of free dissolved haemoglobin and myoglobin in urine.
  3. Result of tests:
    -If the presence of the above substances if visible for human eyes: use the preposition “macro-“
    -If the presence of the above substances is not visible, but can be detected by diagnostic methods, we use the
    preposition “micro-“
  4. Benzidine test, urinary test-strip or microscopic evaluation
41
Q

Benzidine test

  1. What kind of test is it?
  2. Sensitivity?
  3. Reagent used?
  4. Result?
  5. What is the reactivity of haemoglobin called? pseudoperoxidase activity.
A
  1. Qualitative quick-test to show the presence of blood, haemoglobin or myoglobin.
  2. Sensitivity: high sensitivity but low specificity since any of the above substances give a positive result.
  3. Reagent used: benzidine powder, H2O2 and acetic acid.
  4. Result: Red cells haemolyse in acetic acid and
    haemoglobin is freed from the cells. Haemoglobin reacts with H2O2, and the oxygen oxidizes benzidine to a deep green-blue colour complex. Myoglobin also causes colour change.
  5. The reactivity of haemoglobin is called pseudoperoxidase activity.
42
Q

Urine test strip - results

A

The reagents of the benzidine test are precipitated.

  • Speckled appearance is suggestive for haematuria
  • Diffuse colour indicates haemoglobin- or myoglobinuria.
  • Significant haematuria also causes diffuse colourchange.
43
Q

Urine sediment analysis - results

A

Red blood cells can be directly seen in microscopic evaluation of the urine sediment, which is the major method to differentiate haematuria from haemoglobinand
myoglobinuria.

44
Q

Causes of haematuria

A
  • Lower UTI
  • Trauma
  • Genital tract injury, tumor or inflammation
  • Infectious or non-infectious inflammatory process in the lower or higher urinary tract
  • Renal infarction
  • Thrombocytopenia, coagulopathy
45
Q

Causes of haemoglobinuria

A
  • Intravascular haemolysis

- Long term stasis of blood in the urine bladder

46
Q

Causes of myoglobinuria

A
  • Excessive muscle trauma or exercise
  • Ischaemia
  • Myositis
  • Burns
47
Q

Glucosuria

  1. How is glucose filtered?
  2. The renal threshold in dogs and cats?
  3. When can glucosuria be detected?
  4. Methods
  5. False test results
A
  1. Physiologically glucose is freely filtered in the glomeruli and completely reabsorbed in the proximal tubules, however reabsorption capacity is limited.
  2. Renal threshold in dogs; 10mmol/l, in cats; 14-17 mmol/l.
  3. Can be detected in cases of hyperglycaemia exceeding the renal threshold or in cases of renal tubular defects resulting in decreased reabsorption capacity.
  4. Methods: urine test-strips.
  5. False positive: in presence of chlorine bleach, cephalosporins, oxyglobin.
    False negative: in presence of formalin and if sample has low temperature.
48
Q

Ketonuria

  1. Physiologically
  2. Pathologically
  3. Methods
  4. False test results
A
  1. Physiologically: KBs are not present in the urine.
  2. Pathologically:
    -In case of increased KB production in the liver their presence can be showed in the urine.
    -Ru: primary and secondary ketosis
    -small animals: in diabetic ketoacidosis and may be observed in starvation.
  3. Methods: urine test-strips, where nitroprusside reagent is precipitated; semi-quantitative and can detect acetoacetate and with smaller sensitivity also acetone, not betahydroxybutyrate.
  4. False test results:
    False positive: in presence of very concentrated urine, sulphonamides and oxyglobin.
    False negative: long storage time
49
Q

Nitrite

  1. Methods
  2. Interpretation
  3. False test results
  4. Which animals is it not reliable for?
A
  1. Urine test-strips, since they react with α-naphthylamine (Griess-Ilosvay’s reagent).
  2. Interpretation:
    -positive test-result: can suspec tUTI.
  3. False positive: using not-fresh samples or after non-sterile urine collection.
    False negative: by vitamin C and antibiotics.
  4. In carnivores, as their urine does not contain nitrates as a substrate for bacterial reduction.
50
Q

Bilirubin, urobilinogen

  1. Physiologically
  2. Pathologically
  3. Methods
A
  1. Physiologically: Conjugated bilirubin can be present in the urine of healthy dogs. Urobilinogen is a normal constituent of urine.
  2. Pathologically: in other species bilirubinuria appears in jaundice (pre-hepatic, hepatic, post-hepatic). Urobilinogen cc. increases in pre-hepatic and hepatic jaundice and usually decreases in post-hepatic jaundice.
  3. Methods: Bilirubinuria can be tested by urinary test-strips (diazo-test) or the Gmelin-test (cc. nitric acid). Evaluation of urobilinogen is not especially helpful for clinical diagnosis in small animals.
51
Q

Urine sediment results

A

Organic sediments:
- Blood cells: red blood cells and white blood cells. Normal: <5 /hpf. Abnormal: haematuria: renal or urinary tract disease, obstruction, trauma, neoplasia, thrombocytopenia and coagulopathies, sometimes cystocentesis.
- Cells from the lower urogenital tract: urothelium cells,
renal tubular cells, prostatic acinar, ductal epithelial cells, squamous cells from the penis or vagina, sperm cells, tumour cells. Normal: 0-2/hpf. Abnormal: inflammation or infection of upper and/or lower urinary tract, inflammation of genital tract, neoplasm.
-Viral inclusion bodies
-Microbes: bacteria, parasites, fungi
-Mucin, fat droplets (normal in cats), starch and pollen grains - contaminants.
-Casts: when they accumulate cellular elements they become granular casts or lipid droplets – lipid casts. As they age they become waxy casts. Normal: small amount of hyaline or granular casts. Abnormal: increased number of casts – acute tubular disease or renal tubule damage, haemorrhage, inflammation
Inorganic sediments:
-A small amount of struvite or different calcium- crystals may be found in normal urine. Large number of crystals and persistent crystalluria may lead to stone formation.

52
Q

Different types of crystalluria

A

Mostly in alkaline urine:
-Struvite: presence of urease positive bacteria in UTI.
-Calcium-carbonate: hypercalcuria
-Amorphous phosphate: meat and grain diet – usually no clinical relevance, common in cc. urine.
-Ammonium-ureate/biurate: severe impairment of hepatic function, in Dalmatian dogs
Mostly in acidic urine:
-Calcium oxalate: monohydrate, dihydrate
-Uric acid: Dalmatians (congenital), or severe impairment of hepatic function (e.g. PSS)
-Cystine, tyrosine, leucine: metabolic disease, liver failure
or congenital defect in tubular resorption (Cystine: Bull Mastiff, English Bulldog, Dachshund, Chihuahua).
-Bilirubin crystals: in bilirubinuria e.g. prehepatic and hepatic jaundice
-Sulphonamides: sulphonamide therapy

Lab D (18 decks)

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