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FA2 Clinical Pathology > Lecture 11 9/24/24 > Flashcards

Lecture 11 9/24/24 Flashcards

1
Q

What are the four factors that affect urine composition?

A

-quantity and composition of plasma
-glomerular filtration
-tubular function
-method of urine collection/sampling conditions/sample handling

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2
Q

What are the four components of a urinalysis?

A

-physical inspection
-USG
-biochemical analysis/dipstick
-microscopic sediment exam

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3
Q

What are the three urine collection methods?

A

-cystocentesis
-urinary catheter
-free catch

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4
Q

What steps should be taken during sample handling to avoid pre-analytical error?

A

-use clean sample container
-refrigerate if analysis cannot occur within 30-60 minutes
-try to get a mid-stream sample that is not contaminated with bacteria, dirt, or chemicals

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5
Q

What are the potential sample storage artifacts?

A

-bacteria multiply
-pH can increase
-cells and casts can degrade
-crystals may form

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6
Q

What are the normal findings on physical inspection?

A

-yellow color
-clear clarity
-ammonia-like odor

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7
Q

What type of sample is wanted for the urine dipstick test?

A

well-mixed aliquot of urine (uncentrifuged)

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8
Q

Which dipstick pads are not typically considered in a urinalysis and why?

A

-leukocytes: better information from sediment
-nitrite: not diagnostically useful
-urobilinogen: not diagnostically useful
-USG: better information from refractometer

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9
Q

What should be avoided when running a dipstick?

A

-reading pads at wrong time point
-letting urine from one pad run onto another
-using outdated dipsticks
-storing dipsticks improperly/with lid off

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10
Q

What are the characteristics of HGB and bilirubin in the urine?

A

-discolor urine, making pads harder to read
-can be interferents in urine testing

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11
Q

When should a dipstick control solution be used?

A

-opening a new shipment or lot number
-worried about dipstick integrity
-result make no sense and technique had no obvious errors

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12
Q

What can cause a falsely low pH on dipstick?

A

contamination with urine from neighboring protein pad

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13
Q

What can cause a falsely high pH on dipstick?

A

-prolonged sample storage
-contamination with detergent/disinfectant

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14
Q

What can cause a falsely high heme on dipstick?

A

hydrogen peroxide or bleach contamination

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15
Q

What can cause a falsely low bilirubin on dipstick?

A

-prolonged sample storage
-exposure of sample to sunlight

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16
Q

What can cause a falsely low glucose on dipstick?

A

-cold sample
-marked ketonuria or bilirubinuria

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17
Q

What can cause a falsely high glucose on dipstick?

A

hydrogen peroxide or bleach contamination

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18
Q

What are the characteristics of glucose on dipstick?

A

-negative in health
-freely filtered, then reabsorbed
-glucosuria seen when resorption mechanism is overwhelmed or there is tubular damage/defect

19
Q

What are the differential diagnoses for glucosuria?

A

associated with hyperglycemia:
-stress
-dextrose admin.
-diabetes mellitus
associated with euglycemia:
-renal tubular dysfunction/damage

20
Q

What is the consequence of prolonged glucosuria?

A

osmotic diuresis; primary PU, secondary PD, and low USG

21
Q

What are the characteristics of bilirubin on dipstick?

A

-negative in health
-conjugated bilirubin is detected
-dogs may have mild positive if urine is concentrated
-positive result expected if patient has hyperbilirubinemia

22
Q

What are the characteristics of ketones on dipstick?

A

-negative in health
-shift from using carbs for energy to fats results in ketonemia and ketonuria
-detects acetone and acetoacetate; not beta-hydroxybutyrate

23
Q

What are the differential diagnoses for ketonuria?

A

-untreated/poorly controlled diabetes mellitus
-negative energy balance

24
Q

What are the characteristics of hemoglobinuria?

A

-red urine appearance
-urine remains red upon centrifugation
-serum/plasma appearance is pink or red
-patient may also have hyperbilirubinemia, bilirubinuria, and/or anemia

25
Q

What are the characteristics of myoglobinuria?

A

-red urine appearance
-urine remains red upon centrifugation
-serum/plasma appearance is clear
-patient may also have increased CK on chem.

26
Q

What are the characteristics of hematuria?

A

-red, cloudy urine appearance
-red button forms and supernatant is clear upon centrifugation
-serum/plasma appearance is clear
-patient may have RBCs in sediment

27
Q

What are the characteristics of pH on dipstick?

A

-carnivores typically have more acidic pH
-result is a crude estimate that may be an overestimate
-crucial measurements should be done with a pH meter

28
Q

What are the characteristics of protein on dipstick?

A

-predominantly detects albumin
-positive result expected in samples with an “active” sediment (hematuria and/or pyuria)
-critical evaluation should be done with quantitative measurement

29
Q

What are the characteristics of urine protein-to-creatinine ratio?

A

-done on chem. analyzer
-test urine with “inactive” sediment only
-creatinine filtration is relatively constant and therefore a good reference for protein

30
Q

When is a urine protein-to-creatinine ratio indicated?

A

-done to evaluate and quantify pathological renal proteinuria
-most commonly done when patients have or are suspected to have CKD

31
Q

What are the characteristics of UP:C interpretation?

A

-considered persistent proteinuria if documented in 3+ urine samples obtained 2+ weeks apart
-ratio greater than 2 in dogs or 1 in cats indicates glomerular disease
-increased ratio is associated with poor prognosis in animals with AKI/CKD

32
Q

What are the steps of a urine sediment exam?

A

-use fresh specimen
-centrifuge
-decant majority of supernatant
-re-suspend button in small amount of supernatant
-place on slide with coverslip
-evaluate on 10x for casts
-evaluate on 40x for cells, crystals, and microorganisms

33
Q

What are the different cast types made of?

A

-cellular: intact cells
-granular: partially disintegrated cells
-waxy: totally disintegrated cells
-hyaline: tamm-horsfall mucoprotein

34
Q

What do hyaline and granular casts suggest?

A

-hyaline: glomerular proteinuria
-granular: renal tubular disease/damage

35
Q

What are the characteristics of RBC and WBC presence on sediment?

A

-can be collection artifact
-0-5 cells per field on a 40x objective is normal
-TNTC if there are many cells
-increased RBCs is hematuria
-increased WBCs is pyuria

36
Q

What are the characteristics of epithelial cells on sediment?

A

-can be collection artifact
-low #s of transitional and squamous cells expected
-increased transitional cells with abnormal morphology may indicate carcinoma

37
Q

What are the characteristics of crystals on sediment?

A

-significance depends on # and type seen
-may or may not be associated with urolithiasis
-definitive analysis only done in specialized labs

38
Q

What are the characteristics of bacteria on sediment?

A

-may be collection artifact
-may indicate UTI
-can have UTI in the absence of bacteria
-other microbes such as fungi and parasites are rare

39
Q

What are the characteristics of struvite crystals?

A

-normal and common in dogs and cats
-especially occur in alkalinuria

40
Q

What are the characteristics of calcium oxalate dihydrate crystals?

A

-normal and common
-can be seen in disease

41
Q

What are the characteristics of calcium oxalate monohydrate crystals?

A

indicate ethylene glycol toxicity

42
Q

What are the characteristics of calcium carbonate crystals?

A

normal in herbivores, especially horses

43
Q

What are the characteristics of ammonium biurate crystals?

A

-rarely seen in health
-common in Dalmatians and english bulldogs
-typically associated with portosystemic shunt in other dogs and cats

FA2 Clinical Pathology (21 decks)

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