Lab Tech Exam 2 Flashcards
Total protein =
albumin + globulins
Albumin makes up __-__% of total plasma protein in most animals
35-50%
What organ is albumin produced by?
liver
This protein binds to & transports many substances
Albumin
Albumin accounts for about ___% of osmotic activity
75%
Too little albumin in the blood
hypoalbuminemia
What can cause hypoalbuminemia?
Hepatic disease, malnutrition, intestinal malabsorption, renal disease, blood/plasma loss
Too much albumin in the blood
Hyperalbuminemia
Hyperalbuminemia is _______; decreased plasma water content due to dehydration.
relative
All proteins other than albumin are collectively called ________. This includes fibrinogen.
globulins
What tube must you use to measure fibrinogen?
purple top
Globulins vary in size, structure, function & charge. Most are produced in the _____ and ____ tissue.
liver
lymphoid
Immunoglobulins aka
antibodies
Globulins are normally estimated by determining the difference between what?
total protein TP - ALB (albumin)
What are some causes of hypoglobulinemia?
liver disease, malnutrition, intestinal malabsorption, renal disease, blood/plasma loss, failure of passive transfer (from dam to neonate)
What are some causes of hyperglobulinemia?
Relative (decreased plasma water content due to dehydration); inflammation (infectious & noninfectious); lymphoid neoplasms; plasma cell myeloma
What does hepatobiliary refer to?
Liver enzymes and other substances made by the liver
Enzymes found _____ in the cytoplasm of the cell that leak out when the cell is injured.
free
The hepatocyte can be injured by what 2 broad categories?
Primary liver disease
Secondary
These are examples of what type of liver problem: toxins, medications; inflammatory reaction; direct trauma; cholestasis (due to toxicity of bile salts and bilirubin)
Primary liver disease
These are examples of what type of liver problem: leakage of pancreatic enzymes due to anatomical location; GI disease; hypoxia from anemia or poor circulation
Secondary liver disease
Magnitude of elevation of these leakage enzymes is dependent on the ______ of cells being affected, not on the ____ of the injury to these cells.
Number
Severity
Enzyme involved in biosynthesis of alanine.
Liver specific in dogs, cats & primates (major source is hepatocyte).
Alanine aminotransferase (ALT)
An increase in ALT is usually seen within ___ hours of hepatocyte damage.
Peak levels seen in __-___ hours.
Levels return to normal in a few weeks unless chronic insult is present.
12 hours
24-48 hours
Moderate increases in ALT can occur by overproduction produced by what 2 medications?
Glucocorticoids and anticonvulsants
This enzyme is involved in the synthesis of aspartate.
Not liver specific
Aspartate aminotransferase (AST)
This enzyme has a short half life in dogs and cats. There is no advantage over ALT in these species.
AST
AST has a longer half life in horses & cows. However, it is also a _____ enzyme so must be interpreted in light of _____ ______.
Muscle Creatine kinase (CK)
This enzyme is liver specific in large animals but is difficult to run because it is relatively unstable. Extremely short half life, may return to normal by time animal is presented.
Sorbitol Dehydrogenase (SDH)
This enzyme is found in high concentrations in hepatocytes of cattle, sheep, goats, and birds. No standardized test method has been developed for use in veterinary practice.
Glutamate Dehydrogenase (GLDH)
What are the Hepatocellular Leakage Enzymes? (4)
Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Sorbitol Dehydrogenase (SDH) Glutamate Dehydrogenase (GLDH)
This type of liver enzyme is present within the cell, bound to membranes, and does not leak out of cells when there is damage.
Inducible (Overproduction)
Elevations of inducible liver enzymes are induced by an ____ in the rate of synthesis. Some escape the cell into systemic circulation.
increase
A group of enzymes present in many tissues. Ex: Alkaline Phosphatase
Isoenzymes
High concentrations of this enzyme is found in the liver, bone, intestinal mucosa, kidney and placenta.
Alkaline Phosphatase
ALKP, ALP, AP
The half life of ALP in the intestines, kidneys and placenta is ____ (____) compared to bone and liver.
short (hours)
What drugs can cause an increase in ALP? This only occurs in dogs. Do not necessarily indicate liver pathology.
Glucocorticoids and anticonvulsants
Increased ALP can also be caused by ______. Accelerated production of ALP is induced by increased pressure in the bile ducts during blockage of bile flow.
Cholestasis
Cholestasis may be from ______ or _____ causes.
intrahepatic or extrahepatic
Intrahepatic cholestasis can occur secondary to a wide variety of conditions that affect the biliary tree in the liver, including:
inflammation or infection, hepatocyte swelling, and neoplasia
Extrahepatic cholestasis results from occlusion of the ______, which may be caused by similar conditions affecting the gall bladder, bile duct itselt, or the area of the duodenum where the bile duct empties.
common bile duct
Pancreatitis or pancreatic neoplasia may sometimes cause
extrahepatic bile duct obstruction
Cat’s livers are capable of less ALP production than dogs, consequently an increase of only - X the URL in cats in clinically significant
2-3X
ALP is considered an inducible enzyme, but mild increases (<5X URL) have been noted following _____ - probably because of release of membrane fragments containing ALP.
acute hepatic necrosis
Is it possible to differentiate the isoforms of ALP?
Yes: bone (BALP); corticosteriod-induced (CALP); liver cholestasis (LALP)
Increased osteoblastic activity of ALP can be due to what?
Young growing animals
Hyperparathyroidism
Fracture healing
Osteosarcoma
ALP is not use in what 2 species because there are wide fluctuations in normal blood ALP levels.
Cattle & Sheep
ALP increases are usually ____ with osteoblastic activity, fracture healing, etc.
mild
This enzyme is found in many tissues but the primary source is the liver. Blood ___ level is elevated with liver disease, especially w/obstructive liver disease.
Gamma glutamyltransferase (GGT)
Cattle, horses, sheep, goats, and birds have ___ (higher or lower) blood GGT activity than dogs and cats.
higher
This enzyme is synthesized in the highest amounts in the kidneys, pancreas & liver.
GGT
Why is the blood GGT specific to the liver?
GGT from renal tubules is excreted in urine.
GGT from the pancreas in excreted into the GI tract.
GGT present in the serum originates from the liver.
Increased GGT occurs with what pathologically?
Cholestasis
Biliary hyperplasia
Similar to ALP, GGT can be induced in dogs receiving what?
Corticosteriods and anticonvulsants
Because ALP is not very sensitive in large animals, what liver enzyme would you use to test for cholestasis?
GGT
Neonates of several species have markedly increased GGT due to ingestion of
colostrum
We can measure many substances that are taken up, modified, produced, and/or secreted by the liver - these are not enzymes. What are these tests called collectively?
Hepatocyte Function tests
2 general types of tests for what?
Those that test uptake, metabolism, and clearance of a substance from the blood.
Those that test the synthetic capabilities of the liver.
Hepatic Function tests
Bilirubin is a breakdown product of what?
hemoglobin
Aged RBCs are destroyed by macrophages in the
spleen
What portion of hemoglobin is converted to bilirubin?
Heme
The protein-bound (mainly albumin) bilirubin is called
unconjugated bilirubin
Inside the hepatocyte, bilirubine attaches first to a binding protein (ligandin), which helps keep it from refluxing back into the blood. Bilirubin is then ______ (usually to glucuronic acid), making it water soluble and excreted in the bile.
conjugated
Conjuaged bilirubin is also called
direct bilirubin
Some conjugated bilirubin may become protein-bound, termed
delta bilirubin
Protein-bound bilirubin, whether conjugated or unconjugated, does not pass through the normal glomerulus, and so is not usually present in
urine.
Conjugated bilirubin that is secreted in bile ends up in the intestine, where it is converted to ____ and excreted in feces.
Urobilinogen
In health, most serum bilirubin is ______, and a small amount is ______.
Most: unconjugated
small: conjugated
Conjugated bilirubin (which is _____ soluble) is excreted as a bile pigment into intestines.
Water
Conjugated bilirubin can be converted into urobilinogen by ______ in the intestines.
bacteria
Some urobilinogen is converted to stercobilinogen and excreted in stool as
stercobilin
Total bilirubin =
conjugated + unconjugated
When there is hyperbilirubinemia to a sufficient degree, the serum will be
icteric.
By the time the serum bilirubin reaches ___mg/dL, icterus can also be detected in the mucous membranes & sclera.
3 mg/dL
What are the three general causes of hyperbilirubinemia?
Pre-hepatic
Hepatic
Post-hepatic
Excess extravascular hemolysis red blood cell breakdown. One cause of hyperbilirubinemia.
Pre-hepatic
Liver disease that prevents liver from conjugating the normal amount of unconjugated bilirubin presented to it. One cause of hyperbilirubinemia.
Hepatic
Bile duct obstruction so that the conjugated bilirubin can’t be passed with bile into the intestines and backs up into the bloodstream and into the tissues. One cause of hyperbilirubinemia.
Post-hepatic
The enzymes induced by cholestasis (___ & ____) are generally more sensitive indicators of cholestasis than is increased serum bilirubin (particularly true in dogs & cattle, doesn’t always hold true for cats & horses).
ALP & GGT
The combination of increased induction enzymes (ALP & GGT) plus increased serum bilirubin supports
Cholestasis
Combination of regenerative anemia (typical of hemolysis) and increased serum bilirubin suggests a
pre-hepatic icterus
Leakage enzymes (ALT, AST) may be increased (indicating hepatocellular injury) from hepatic causes of icterus, but also from ______ because bile is an irritating substance that can solubilize membranes and cause hepatocyte injury.
post-hepatic causes
_____ and ______ causes of icterus cannot be reliably differentiated based on laboratory data. Additional diagnostic tests such as ultrasound, liver biopsy, or sx are usually required.
Hepatic and post-hepatic
Bilirubin in these 2 species is only elevated if significant liver disease is present.
Dog and cat
Increased bilirubin in this species can be seen in non-hepatic conditions such as anorexia.
Horse
Increased bilirubin in this species can be elevated in a variety of diseases. Increase due to liver disease is less than other species.
Cattle
Bile acids are synthesized by ______ from cholesterol.
hepatocytes
Bile acids are secreted in the ____ and stored in the _____.
bile
gallbladder
Bile acids are released into the ____ following a meal.
duodenum
Bile acids aid in ____ absorption.
fat
Bile acids get transported back to the _____ via portal circulation.
liver
Normally, there is a ____ level of bile acids in systemic circulation.
very low
What are 3 reasons for an elevation in bile acids?
Decreased hepatic function
Portosystemic shunt
Cholestatic disease
An elevation in bile acids because they are not effectively cleared from the blood is caused by what?
decreased hepatic function
When blood bypasses the liver and enters systemic circulation, this is called a
portosystemic shunt
Bile acids that get regurgitated to the liver and enter systemic circulation is caused by what?
cholestatic disease
These are techniques for what test: fast patient for 12 hours; draw blood sample; feed patient; draw blood sample 2 hours later; only fasting sample is taken in animals without a gallbladder.
Bile acids test
These 4 tests evaluate hepatic synthetic function.
Albumin, glucose, BUN, cholesterol
Albumin is synthesized in the ____, so hepatic insufficiency can result in hypoalbuminemia.
liver
Albumin has a long serum half-life (7-10 days), and so decreases are associated with ______ liver disease.
chronic
There are other causes besides chronic liver disease for hypoalbuminemia such as
urinary loss, blood loss, intestinal loss
The ____ is central to glucose metabolism, converting glucose to glycogen for storage, releasing stored glucose via glycogenolysis, and synthesizing glucose via gluconeogenesis.
Liver
Because of the liver’s reserve capacity, __-__% of hepatic function must be lost before glucose abnormalities and low albumin levels are seen.
60-80%
Typically, we think of hepatic insufficiency as causing hypoglycemia, but a prolonged ______ following a meal is also possible due to decreased glucose uptake by hepatocytes.
hyperglycemia
Urea is synthesized from ____ in the liver.
ammonia
Markedly decreased hepatic mass is result in ____ (increased or decreased) urea synthesis and therefore a _____ serum BUN, while blood ammonia levels increase.
decreased
decreased
Cholesterol is synthesized in the ____ and undergoes enterohepatic circulation via the bile.
liver
Cholesterol my be normal, decreased, or increased with liver disease, depending upon the balance between ____ and ____ ______.
cholestasis
hepatic insufficiency
What are 3 exocrine pancreatic enzymes?
Amylase, lipase & trypsin
What 2 pancreatic enzymes are measured directly?
amylase & lipase
_____ is an exocrine pancreatic enzyme that is measured using antibodies to detect it.
trypsin
What are the 2 endocrine pancreas tests?
Glucose
Fructosamine
Inflammation of the pancreas. The result of activation of the digestive enzymes (amylase, lipase & proteases) within the pancreas instead of activation in the intestine.
Pancreatitis
CSX of what disease?
vomiting, abdominal pain, systemic inflammation (leukocytosis, fever). Occurs in dogs and cats
Pancreatitis
The result of an absolute or relative lack of insulin production.
Diabetes mellitus (DM)
CSX of what disease?
polydipsia, polyuria, polyphagia & weight loss. Dogs: sudden blindness due to cataract formation can occur. Cats: decreased interaction, unkempt hair, rear limb weakness
Diabetes mellitus (DM)
____ and _____ are used to aid in the diagnosis of pancreatitis. Not useful for detection of pancreatic insufficiency because they are produced in other places.
Amylase and lipase
Pancreatitis occurs much more commonly in the ___ than other species.
dog
Pancreatitis occurs in ____ but is more difficult to diagnose.
cats
Pancreatitis is rarely diagnosed in ____ and ____.
horses & cattle
The primary source of ____ is the pancreas, but it is also produced in the salivary glands and small intestine.
Amylase
This enzyme breaks down starches and glycogen.
Amylase
Pancreatic duct ____ results in a backup of digestive enzymes into peripheral circulations.
inflammation
Amylase rises rapidly (w/in 12-48) with ____ and remains elevated for more than one ____.
pancreatitis
week
Normal amylase and lipase does not rule out _______
pancreatitis
Renal tubular cells normally degrade ______. Renal failure may cause elevations in _______.
Amylase
Some ____ and ____ diseases may cause elevations in amylase.
liver and intestinal
Manipulation of the ____ during sx may also cause elevations in amylase.
pancreas
In general, the higher the amylase, the more likely it is to indicate ______.
pancreatitis
The degree of amylase activity is not directly ____ to the severity of pancreatitis.
proportional
Nearly all serum lipase is derived from the ______.
pancreas
This enzyme breaks down the long-chain fatty acids of lipids.
Lipase
Interpretation of lipase is similar to that of ______
amylase
Lipase activity usually does not increase in ____ patients with pancreatitis and is not a reliable indicator.
feline
Lipase may be elevated in non-pancreatic disesases such as:
renal disease, hepatic disease, exploratory sx, corticosteroids (unlike amylase)
What test is species specific for an enzyme produced by the pancreas?
Species-specific pancreatic-lipase immunoreactivity (PLI)
Limited to the _____ cells (exocrine portion) of the pancreas, and thus is a specific marker indicating damage to the pancreas.
acinar
Abdominal ultrasonography is also a useful aid in the diagnosis of the canine _____
pancreatitis
This test uses antibodies to detect trypsin and trypsinogen. It is species specific. A 12 hour fasted serum sample is sent to a reference lab on gel ice pack
Serum trypsinlike immunoreactivity
This disease is hereditary in German Shepherds. It is secondary to reccurent bouts of pancreatitis.
Exocrine Pancreatic Insufficiency (EPI)
Which test is most often used to detect exocrine pancreatic insufficiency (EPI)?
Trypsin-like immunoreactivity (TLI)
This disease is a lack of digestive enzymes resulting in malassimilation of ingested food (food is not transformed to absorbable forms). Intestinal bacteria overgrowth often occurs in dogs. Secondary changes occur in intestinal mucosa.
Exocrine Pancreatic Insufficiency
Csx of what disease? Chronic diarrhea, weight loss or failure to gain weight, pica & coprophagia may occur.
EPI
These cells in the pancreas release glucagon in response to hypoglycemia.
Alpha cells
These cells in the pancreas release insulin in response to hyerpglycemia.
Beta cells
We can measure _____ to help assess the beta cell function of the pancreas.
glucose
Diabetes mellitus, stress, and glucocorticoids are causes of what?
Hyperglycemia
Insulinoma, fasting, liver disease, and artifact are causes of what?
hypoglycemia
This represents the irreversible reaction of glucose bound to protein, particularly albumin.
Fructosamine
When glucose is persistently elevated, fructosamine is ______
elevated
Half-life of albumin in dogs & cats is 1-2 weeks. Therefore, _____ provides an indication of the average serum glucose over that period.
fructosamine
Production of these hormones increases with exposure to cold and then increases metabolic rate to generate more heat.
thyroid hormones
These hormones affect metabolism of proteins, carbohydrates, and lipids much.
Thyroid hormones
These hormones encourage synthesis of proteins if there are adequate energy sources.
Thyroid hormones
Thyroid hormones ____(encourage or discourage) the breakdown of lipids for energy
encourage
Thyroid hormones ______ (encourage or discourage) using carbs as energy source.
discourage
Deficiency of thyroid hormone
hypothyroidism
Lethargy, weight gain, cold intolerance, alopecia are clinical signs of
hypothyroidism
Diagnostic tests for hypothyroidsim
Free T4 by ED, T4, TSH
Tx for hypothyroidism
thyroid hormone supplement
Excessive thyroid hormone
hyperthyroidism
Etiology for what disease? lymphocytic throiditis & idiopathic atrophy of the thyroid gland
Hypothyroidism
Etiology for what disease? hyperplasia or neoplasia of thyroid gland typically in middle aged to older cats
Hyperthyroidism
Clinical signs of what diease? PU/PD, polyphagia, weight loss, v/d, tachycardia, hyperactive
Hyperthyroidism
Diagnostic tests for hyperthyroidism
T4, free T4 by ED
TX for hyperthyroidism
antithyroid drugs, sx, radioactive iodine
This thyroid assay monitors hypothyroid & hyperthyroid patients; aids in diagnosis of hyper & hypothyroidism
Total T4
___% of T4 is protein bound
99
Total T4 thyroid assay is affected by (2 things). “Euthyroid-sick”
Drugs and non-thyroid illnesses
This thyroid assay is more accurate than T4. It measures unbound, biologically active T4.
Free T4 by Equilibrium Dialysis
Free T4 by ED should be interpreted in conjunction with (2 things)
TSH & clinical signs
This thyroid assay differentiates primary hypothyroidism from secondary/tertiary.
TSH
TSH should be interpreted in conjunction with
T4 or free T4 and clinical signs
Total T4 should be interpreted in conjunction with (3 things)
TSH, free T4 by ED & clinical signs.
Total T4 assay uses what?
serum or plasma
If monitoring total T4, draw sample - hours post pill.
4-6
Can Total T4 be sent out or run in house?
Both
Can Free T4 by ED be sent out or run in house?
Sent out
Can TSH be sent out or run in house?
sent out
When should a UA be performed? (time of day)
morning
increased urine production
Polyuria
frequent urination
pollakiuria
decrease in daily urine output
oliguria
absence of urine
anuria
painful urination
dysuria
High WBC count in urine
pyuria
RBC in urine
hematuria
hemoglobin in urine
hemogloinuria
4 methods of urine collection
free-catch, manual expression, cystocentesis, catheterization
What collection method? Urine collected in clean container free of disinfectants. Mid-stream sample preferred.
Free-catch
Disadvantages of free catch method?
WBC, bacteria & protein can be added as contaminants from distal urethra, genital tract & external skin
Free catch samples that are negative for WBC, bacteria & protein are ____ results.
valid
Free catch samples that are positive for WBC, bacteria, protein will necessitate sampling via
cystocentesis
This method of urine collection is cleaner than samples collected by free catch, but urine sample may still contain contaminants.
Catheterization
What should be done before cathing an animal for a UA?
External area is generally cleaned w/a surgical skin method
When cathing, there is the possibility of causing an ____ UTI.
iatrogenic (secondary)
This method of urine collection is likely to add RBC’s & transitional cells to the urine sample. This is due to mild trauma to the urethra.
Catheterization
This is the preferred method of urine collection when evaluating the significance of cells or bacteria in the urine.
Cystocentesis
Which method of collection should be used when obtaining urine for culture?
Cystocentesis
Mild blood contamination may be seen in ____ obtained sample.
cystocentesis
What are the 4 UA assays?
Gross examination
Specific gravity (USG)
Chemical analysis
Sediment
Analyzing urine sample should be done in what time frame?
15-30 min
Why should urine be analyzed within 30 min?
Dissolution of casts & deterioration of cells present in urine.
Increase in urine pH due to loss of CO2
Formation of dissolution of crystals depending on type.
Bacteria will overgrow
Urine samples sent to an outside lab for cytologic exam are sent in a ____ tube.
EDTA
If urine cannot be examined w/in 30 min, it can be refrigerated & sealed to slow rate of artifactual changes. It will be valid for about ___ hours
6
Horse urine is normally what turbidity?
cloudy
Normal USG for dogs is what if hydration status is normal
1.025
Normal USG for cats is what if hydration status is normal
1.030
This UA assay indicates renal function in maintaining hydration; can kidneys concentrate urine?
Urine specific gravity
No normal results for USG, only appropriate values for a given _____ state.
hydration
In health, the pH of urine is dependent on
diet.
Diets high in animal protein produce a ____ urine pH.
lower (more acidic)
Diets that are plant/vegetable based result in ___ urine pH.
Higher (alkaline)
Carnivores/omnivores have more ___ urine.
acidic
Herbivores have more ___ urine
alkaline
In illness, the urine pH can be affected by the ____ status of the patient.
acid/base
An animal with academia should have more ___ urine as the kidneys excrete excess ____.
Acidic
H+
An animal with alkalemia should have more ____ urine as the kidneys retain ____.
basic
H+
UTI’s, with urease positive bacteria (which convert urea to ammonia) may result in an ____ in pH.
increase
Increase in urine pH/alkaline urine, WBC & bacteria in urine sediment are indications of
Urinary tract infections
The most common cause of an increase in urine pH in small animals is
artifactual, letting it set out for too long
Protein is normally present in ___ quantities in the urine.
low
The protein pad on the urine stick is influenced by the ___ of the urine
pH
Positive protein readings should be re-checked by a separate method, such as
Sulfosalicylic acid turbidity (SSA)
This type of urine can occur with stress, temp extremes (envir or fever) or strenuous exercise.
Proteinuria
The more common proteinuria is
renal proteinuria
____ is normally not present in the urine in quantities detectable on dipsticks. The dipstick pad detects this using the enzyme glucose oxidase.
Glucose
This enzyme activity on the urine dipstick glucose pad is limited and outdated strips may give false neg reactions & temp can affect enzyme activity (refrigerated samples should be warmed to room temp before testing).
glucose oxidase
_____ will occur with any condition that causes blood glucose levels to exceed the renal threshold for re-absorption.
Glucosuria
____ is a common cause of glucosuria due to excessive blood glucose concentrations.
Diabetes mellitus
____ are formed during fat metabolism. ____ indicate an excessive shift from carb metabolism to fat metabolism.
Ketones
Ketonuria
The occult blood reagent on the urine dipstick measures what 2 things?
myoglobin or hemoglobin
Positive occult blood reading is most commonly associated with ____ rather than hemoglobinuria.
Hematuria
____ may occur after rhabdomyolysis. Animals will usually have elevations in muscle enzymes & signs of muscle pain.
rhabdomyolysis
____ is a breakdown product of hemoglobin.
Bilirubin
Which tests on the dipstick are not reliable for animals?
USG, urobilinogen, nitrites, WBCs
What should be used to measure USG?
refractometer
What should be observed at 40X for microscopic exam of urine sedimentation?
epithelial cells, RBC, WBC, bacteria
What should be observed at 10X for microscopic exam of urine sedimentation?
casts, crystals
What misc findings can be on the microscopic exam of urine sedimentation?
mucus, fat, sperm, parasites
What are the five main types of casts?
Hyaline, cellular, granular, waxy, fatty
What are the 2 types of Calcium oxalate crystals and what do they look like?
Monohydrate: picket fence
Dihydrate: square w/x or back of an envelope
Factors that may increase urine pH
sample sits out, UTI, high-fiber diets, certain drugs, alkalosis, urine rentention
Factors that may decrease urine pH
high-protein diet, fever, starvation, acidosis, excessive muscular activity, certain drugs
What type of bilirubin cannot pass through the glomerulus?
unconjugated, because it is usually bound to albumin
Only ____ bilirubin will be excreted in the urine.
conjugated
Bilirubinuria & hyperbilirubinemia are caused by the same 3 diseases which are
hemolytic disease
hepatic insufficiency
cholestasis
Bilirubinuria should prompt you to look for other evidence of (2 things)
liver disease or hemolysis
Dogs, especially males, have a ___ renal threshold for bilirubin.
lower
Many normal cattle have ___ amounts of bilirubin in their urine.
small
Any amount of ___ in cats, pigs, sheep & horses is significant.
bilirubinuria
This type of cast is clear, colorless, and somewhat transparent structures composed only of protein.
Hyaline
Increased numbers of this type of cast indicate the mildest form of renal irritation. There numbers are also increased with fever, poor renal perfusion, strenuous exercise, or general anesthesia.
Hyaline
This type of cast is a hyaline cast containing granules. It is the most common type of cast seen in animals.
Granular casts
This type of cast is seen in large numbers with acute nephritis and indicate more severe kidney damage than do hyaline casts.
Granular casts
This type of cast consists of epithelial cells from the renal tubules imbedded in a hyaline matrix
Epithelial casts
This type of cast is seen in acute nephritis or other conditions that cause degeneration of the renal tubular epithelium
Epithelial casts
This type of cast contains WBC, mostly neutrophils, which indicates inflammation in the renal tubules.
Leukocyte casts
This type of cast is deep yellow to orange in color. RBC membranes may or may not be visible.
Erythrocyte casts
This type of cast indicates renal bleeding.
Erythrocyte casts
This type of cast resembles hyaline casts but are usually wider, with square ends rather than rounded ends and a dull, homogenous, waxy appearance
Waxy casts
This type of cast indicates chronic, severe degeneration of the renal tubules.
Waxy casts
This type of cast contains many small droplets of fat that appear as refractive bodies.
Fatty casts
This type of cast is seen in cats with renal disease, occasionally in dogs with diabetes mellitus. A large number of these casts suggest degeneration of the renal tubules.
Fatty casts
This type of crystal is a 6-8 sided prism with tapering sides and ends. Typically described as coffin lids, occasionally they may be fern-leaf shaped.
Struvite crystals
This type of crystal is found in alkaline to slightly acidic urine
Struvite
This type of crystal is common in alkaline urine and appear as a granular precipitate.
Amorphous phosphate
This type of crystal is commonly seen in urine of horses and rabbits. They are round, with many lines radiating from their centers, or appear as large granular masses. They may also have a dumbbell shape. They have no clinical significance.
Calcium carbonate.
This type of crystal is similar to Amorphous phosphate crystals in that they appear as granular precipitate. Unlike amorphous phosphate, they are found in acidic urine.
Amorphous urates
This type of crystal is found in acidic, neutral, or alkaline urine. They are brown in color and round with long, irregular spicules (thorn apple shaped)
Ammonium biurate
This type of crystal is most common is animals with severe liver disease, such as portocaval shunts.
Ammonium biurate
Calcium oxalate crystals come in what 2 types?
Dihydrate and monohydrate.
This type of crystal generally appears as small squares, containing an X across the the crystal, resembling the back of an envelope.
Calcium oxalate dihydrate
This type of crystal may be small and dumbbell shaped or elongated and pointed at each end (picket fence).
Calcium oxalate monohydrate
This type of calm oxalate crystal is found in acidic and neutral urine. It is commonly seen in small numbers in dogs and horses
Calcium dihydrate
The urine of animals poisoned with ethylene glycol (antifreeze), often contains large numbers of ………, especially which one?
Calcium oxalate crystals
Monohydrate
Animals with oxalate urolithiasis may have large numbers of ………. …….. Crystals in their urine, and large numbers of these crystals may indicate predisposition to oxalate urolithiasis.
Calcium oxalate
This type of crystal is seen in animals being treated with sulfonamides.
Sulfonamide crystals
This type of crystal is round, usually dark, with individual crystals radiating from the center. They are less likely to be seen in alkaline urine.
Sulfonamide crystals
This type of crystal takes on a variety of shapes but are usually diamond or rhomboid. They appear yellow or yellow-brown and are not commonly found in dog or cat urine except Dalmatians
Uris acid crystals
This type of crystal is wheel or pincushion shaped and are yellow or brown in color. Animals with liver disease may have this type of crystal in their urine.
Leucine
This type of crystal is dark, with needlelike projections, and are highly refractive. They are often found in small clusters. They are not a common finding in dog and cat urine. Animals with liver disease may have these in their urine.
Tyrosine
This type of crystal appears flat and is 6-sided (hexagon) colorless and thin. They can be associated with renal tubular dysfunction or cystine urolithiasis.
Cystine
The bladder worm of dogs and cats
Capillaria plica
Kidney worm of dogs
Dioctophyma renale
What may be seen in the urine sediment of dogs with adult heartworms?
Microfilaria
Occurrence of uroliths in the urinary tract
Urolithiasis
What are the primary serum chemistry tests for kidney function?
Blood urea nitrogen (BUN)
Creatinine (CREA)
Increased concentrations of BUN and/or CREA are referred to as
azotemia
During protein catabolism, ____ is formed.
ammonia
The liver converts ammonia to
urea
Urea is soluble in plasma and is freely filtered through the glomerulus. Some urea is normally reabsorbed through the tubules. There, ___ amount of BUN is maintained.
some
Serum creatinine is produced from the breakdown of
phosphocreatine
Protein in muscle tissue is referred to as
phosphocreatine
The day to day rate of creatinine production is relatively constant in any animal and is dependent on
muscle mass
Creatinine is cleared primarily by the
kidney
Creatinine is ____ reabsorbed through the tubules.
minimally
Even though ___ is the result of breakdown of muscle protein, alterations in muscle metabolism rarely affect it enough to cause elevations above normal.
creatinine
What are 2 general causes of azotemia?
Decreased glomerular filtration of blood. (glomerular filtration rate GFR)
Increased rate of protein catabolism
This is a characteristic of what cause of azotemia? Decreased number of functioning nephrons.
Decreased GFR (glomerular filtration rate)
This is a characteristic of what cause of azotemia? Shut down of filtration due to obstruction causing backpressure into the ureter and kidneys.
Decreased GFR
This is a characteristic of what cause of azotemia? Decreased blood flow to the kidneys: 1) reduced blood volume from dehydration, hypotension, 2) reduced circulating volume due to cardiac insufficiency.
Decreased GFR
These are characteristics of what cause of azotemia? High protein diet. Increased muscle breakdown.
Increased rate of protein catabolism
This is a characteristic of what cause of azotemia? Bleeding in the GI tract (results in digestion of serum proteins).
Increased rate of protein catabolism
Pre-renal azotemia can result from the rate of formation of nitrogenous waste _____ and _____ renal clearance.
increases and exceeds
Pre-renal azotemia can result from ___ blood flow to the kidneys.
decreased
The kidneys are normal but there is reduced blood flow to the kidneys resulting in reduced clearance of waste products. This results in ____ azotemia.
pre-renal
With decreased blood flow to the kidneys, the degree of azotemia may be
very high
You cannot ever rule out pre-renal azotemia due to poor perfusion simply based on the magnitude of the
azotemia
Decreased GFR due to lack of functioning renal tissue (reduced number of functioning nephrons) will result in ____ azotemia.
renal
Because of the excess reserve capacity of the kidney, renal azotemia does not occur until approximately __% of the nephrons are nonfuncitonal.
75%
Decreased GFR secondary to urinary obstruction is related to
postrenal azotemia
Blockage of urine flow eventually causes enough backpressure into the ureters and kidneys to shut down
renal filtration
If you can rule out post-renal azotemia based on clincal exam, then ___ can be used to differentiate pre-renal from renal azotemia.
USG
If the urine is adequately concentrated, the animal has a ____ azotemia.
pre-renal
The ability to concentrate urine is lost when __% of the nephrons are non-functional.
66%
