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Clinical Pathology > Lecture 21 - Urinalysis > Flashcards

Lecture 21 - Urinalysis Flashcards

1
Q

WATCH THIS LECTURE WHILE STUDYING

What are you evaluating when performing a urinalysis?

–> Evaluating what the kidney is _______ provides insight into:
1. ______ Function
2. _______ Disease
3. ________ Disease

A

–> Evaluating what the kidney is excreting provides insight into:
1. Renal Function
2. Metabolic Disease
3. Systemic Disease

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2
Q

What are the indications for a urinalysis?

A

–> Indications:
1. Health screening
2. Pre-anesthetic assessment
3. Key element to the minimum database

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3
Q

Performing a Urinalysis:
1. Cost?
2. ________ performed in-house
3. Requires _______ specialized equipment

A

Performing a Urinalysis:
1. Cost? Inexpensive
2. Easily performed in-house
3. Requires minimal specialized equipment

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4
Q

What is important about your urinalysis technique?

–> ________ of sample collection
- Early ________ → more concentrated
- Post- _______ → more alkaline
- After fluid or diuretic therapy → more ______
–> There are 3 options for collection:
1. _______ sample or “free ______”
2. Urinary _______
3. ___________

(1–>3 is least to most expensive)

A

–> Timing of sample collection
- Early morning → more concentrated
- Post- prandial → more alkaline
- After fluid or diuretic therapy → more dilute
–> There are 3 options for collection:
1. Voided sample or “free catch”
2. Urinary catheterization
3. Cystocentesis

(1–>3 is least to most expensive)

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5
Q

What is a voided sample?

  1. _________ sample
    * Catch ______-stream flow
    * __________ acceptable for urinalysis
    * Not suitable for _______
    - __________ contamination!
A
  1. Voided sample
    * Catch mid-stream flow
    * Generally acceptable for urinalysis
    * Not suitable for culture
    - Bacterial contamination!
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6
Q
  1. Urethral Catheterization
    * Acceptable for ________ and ______
    - May have _____ or ________ cell contamination
    * _________ invasive
    * Technically difficult, especially in ________
    Performed under ______ techniques
    Risk introducing _______ into the bladder
A
  1. Urethral Catheterization
    * Acceptable for urinalysis and culture
    - May have blood or epithelial cell contamination
    * Moderately invasive
    * Technically difficult, especially in females
    Performed under sterile techniques
    Risk introducing bacteria into the bladder
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7
Q
  1. Cystocentesis
    - Pass a needle _______ into the bladder
    • Often _______-guided
    • ______ technique
      - Acceptable for ________
    • ________ contamination
      Ideal for urine _________
A
  1. Cystocentesis
    - Pass a needle directly into the bladder
    • Often ultrasound-guided
    • Sterile technique
      - Acceptable for urinalysis
    • Blood contamination
      Ideal for urine culture
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8
Q

How are you supposed to handle a urine sample?

  1. Ideally analyze within ____ ________
    - Low USG can lead to _________ _____
    - May have urine crystals ______ or _________
  2. If longer time for analysis, refrigerate
    - Up to ____ _______
    - _______, _________, __________ container
    - _______ to _______ temperature prior to analysis
    - Be sure to gently _________ the sediment
A
  1. Ideally analyze within 30 minutes
    - Low USG can lead to cellular lysis
    - May have urine crystals dissolve or develop
  2. If longer time for analysis, refrigerate
    - Up to 12 hours
    - Sterile, opaque, airtight container
    - Warm to room temperature prior to analysis
    - Be sure to gently re-suspend the sediment
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9
Q

List the steps of a complete UA

A
  1. Gross inspection
  2. USG
  3. Chemical evaluation
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10
Q

List the probable causes for the following urine colors:

A

See below

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11
Q

List the levels of clarity of urine
What is cloudiness caused by?

A

See below

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12
Q

What does the USG evaluate?

A

Evaluates for dissolved molecules… “solutes”

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13
Q

What is important to remember in regards to the USG?

Remember:
Measure urine samples only at ______-temperature
- Cold fluids are more _____, falsely ______ USG

Remember: Significant INCREASES in (4?) in the urine can INCREASE the USG
–> Hypersthenuria (concentrated urine):
A. Dogs = ?
B. Cats = ?
C. Horses/ruminants/porcine = ?
–> Isosthenuric: USG = ?
- Kidney is not adjusting urine concentration (non _________ nor _______)
–> Range of minimal concentration (ROMC):
A. Dogs = ?
B. Cats = ?
C. Horses/ruminants/porcine = ?
–> Oliguric: ____ urine output
–> Azotemic: Increased ___ and/or ______

A

Remember:
Measure on room-temperature urine only
Cold fluids are more dense, falsely increases USG

Remember: Significant INCREASES in glucose, protein, sodium and/or urea in the urine can INCREASE the USG
Answer: 1.033 hypersthenuria (concentrated urine) in dogs, remember above 1.030, cats above 1.035, horses/ruminants/porcine above 1.025
Remember, 1)Isosthenuric: USG 1.008-1.012: Kidney is not adjusting urine
concentration (non concentrating nor diluting)
2) Range of minimal concentration (ROMC) : 1.013-1.030 Dog; 1.013-1.034
Cat; 1.013-1.024 Equine, Ruminants, Porcine
3)Oliguric: no urine output 4)azotemic: Increased BUN and/or Creatinine

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14
Q

Evaluate the image below

A

D

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15
Q

What type of measurement is the Dipstick test?

A

Semi-quantitative measurement

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16
Q

What scale is used for the Dipstick test?

A

Scale: neg → trace → 1+ → 2+ → 3+ → 4+

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17
Q

What does the dipstick measure? What does it not measure?

A

Measures:
Glucose, Bilirubin, Ketones, Heme, pH, Protein
Ignore: Leukocytes, USG, Nitrite, Urobilinogen

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18
Q

What is important about the dipstick test?

A

timing!

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19
Q
A
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20
Q

How are the Chemical constituents of urine measured?

A

Most often measured with a urine dipstick

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21
Q

A Urine dipstick is Semiquantitative: most analytes graded on
negative to 4+ scale

A
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22
Q

What dipstick tests are used in veterinary medicine?

A
  • Dipstick tests we use in veterinary medicine:
    – Glucose
    – Bilirubin
    – Ketones
    – Blood
    – pH
    – Protein
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23
Q

What dipstick tests do we NOT use in veterinary medicine?

A

– USG
– Leukocytes
– Nitrite
– Urobilinogen
– Ascorbic acid

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24
Q

Glucose:
_______ molecule
__________ filtered by the glomerulus
Usually completely reabsorbed in ______ tubules

A

Glucose:
Small molecule
Freely filtered by the glomerulus
Usually completely reabsorbed in proximal tubules

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25
Q

Glucosuria
Occurs when the __________ capacity is exceeded
Dog ___ mg/dL
Cat ____ mg/dL
Horse _____ mg/dL
Cattle _____ mg/dL

A

Glucosuria
Occurs when the reabsorption capacity is exceeded
Dog 220 mg/dL
Cat 280 mg/dL
Horse 180 mg/dL
Cattle 100 mg/dL

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26
Q

What are the common differentials for glucosuria?

A

Differentials for glucosuria: HAD Stress God Can Feel
Most common: Hyperglycemic glucosuria
Diabetes mellitus
Acute pancreatitis
Stress (corticosteroids) especially in cats
Glucose-containing fluids

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27
Q

What are the less common differentials for glucosuria?

A

Less common: Normoglycemic glucosuria
1. Acute kidney injury
- Reversible tubular damage: drugs, toxins, etc.
- Urethral obstruction in cats (unknown mechanism)
2. Fanconi syndrome (Basenjis, Labrador Retrievers)

Fanconi Syndrome: Proximal tubular defect that causes impaired tubular reabsorption of glucose, amino acids, and phosphate
– Results in proteinuria and glucosuria with normoglycemia • Can be congenital or acquired
– Congenital: Basenjis (30% of breed)
• Dogs are typically 3-4 years old when first diagnosed
– Acquired: chicken jerky treat recall, copper storage disease, heavy metal toxicity

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28
Q

Bilirubin is a product of erythrocyte ________ degradation (________ form) that becomes ________ in the liver

A

Bilirubin is a product of erythrocyte hemoglobin degradation (unconjugated form) that becomes conjugated in the liver

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29
Q

*Unconjugated bilirubin circulates bound to _______ and ________ pass through the glomerulus

A

*Unconjugated bilirubin circulates bound to albumin and cannot pass through the glomerulus

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30
Q

*____________ bilirubin passes through the glomerulus and is not _________ by the tubules

A

*Conjugated bilirubin passes through the glomerulus and is not reabsorbed by the tubules

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31
Q

*Bilirubinuria precedes _________ due to low renal threshold

A

bilirubinemia

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32
Q

*Usually normal to see trace to ____ __________ in dogs with concentrated urine

A

1+ bilirubinuria

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33
Q

*No _________ should be present in cats and is always ________

A

bilirubinuria, abnormal

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34
Q

*May or may not see concurrent bilirubin crystals in the urine

A
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35
Q

Bilirubinuria:
– Indicates _________ of ____ flow and regurgitation of ________ bilirubin into the ____

A

Bilirubinuria:
– Indicates obstruction of bile flow and regurgitation of conjugated bilirubin into the blood

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36
Q

Bilirubinia leads to an ________ tubular cell formation of bilirubin in cases of
hemoglobinuria
* Increased hepatic ________ of bilirubin in cases of intravascular __________
– _____
– ______ ____ leaf, _____, _______, ________ toxicity

A

Increased tubular cell formation of bilirubin in cases of
hemoglobinuria
* Increased hepatic conjugation of bilirubin in cases of intravascular
hemolysis
– IMHA
– Red maple leaf, onion, garlic, acetaminophen toxicity

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37
Q

In a case of bilirubinuria, – False _______ on the dipstick test can occur with ___________ sample processing or excessive _____ exposure

A

In a case of bilirubinuria, – False negative on the dipstick test can occur with delayed sample processing or excessive light exposure

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38
Q

Ketones (3?) are produced when energy production shifts from __________ to _____ metabolism. They are filtered by the ________, excreted in _______.

A

Ketones (β-hydroxybuterate, acetoacetate, acetone) are produced when energy production shifts from carbohydrate to lipid metabolism. They are filtered by the glomerulus, excreted in urine

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39
Q

What ketones do urine dipsticks detect?
Detects _________ and ______ (_____ ketones); does not detect ____________.
- _______ of ketonuria may be underestimated!

A

Detects acetoacetate and acetone (true ketones); does not detect β-hydroxybuterate
- Magnitude of ketonuria may be underestimated!

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40
Q

Ruminants produce mostly what type of ketone?

A

Ruminants produce mostly β-hydroxybuterate

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41
Q

Ketonuria
- ____________ _________ (_____) dogs and cats
- __________ energy balance (starvation)
- Diabetes ________ (Diabetic _________)
- _______ in cattle

A

Ketonuria
- Diabetic ketoacidosis (DKA) dogs and cats
- Negative energy balance (starvation)
- Diabetes mellitus (Diabetic ketoacidosis occurs in type 1 diabetes mellitus, less common in type 2)
- Ketosis in cattle

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42
Q

The dipstick heme/blood detects?

A

Intact red blood cells, hemoglobin, or myoglobin

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43
Q

List the DDx for Hematuria.

A

DDX Hematuria:
Inflammation,
Infection,
Trauma,
Coagulopathy,
etc.

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44
Q

What is the most common cause for finding intact rbc, hemoglobin, or myoglobin in blood?

A

Hematuria (RBCs)
The most common cause
Supernatant clears with centrifugation

Hematuria –> red, cloudy urine that clears after centrifugation: Should see RBC pellet in
centrifuged tube and usually RBCs on sediment exam

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45
Q

Define pigmenturia.

A

Pigmenturia (HGB, MGB)
Supernatant remains red with centrifugation

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46
Q
  1. Define hemoglobinuria. What should you look for?
  2. Hemoglobinuria –> ____ urine that _____ _____ ____ after centrifugation
    – Usually no RBC pellet in ________ tube
    – If hemoglobinuria is due to intravascular hemolysis, will also see _________ (red ______)
A

Hemoglobinuria = hemolysis
Look for anemia, pink/red serum

Hemoglobinuria –> red urine that does not clear after centrifugation
– Usually no RBC pellet in centrifuged tube
– If hemoglobinuria is due to intravascular hemolysis, will also see hemoglobinemia
(red plasma)

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47
Q
  1. Define myoglobinuria. What should you look for?
  2. Myoglobin –> _____-_____ urine that ______ _____ _____ after centrifugation
    – Clinical evidence of ______ disease
    – Usually elevated __________ _____ on chemistry panel
A

Myoglobinuria = muscle injury
Look for increased muscle enzymes (CK, AST)

Myoglobin –> red-brown urine that does not clear after centrifugation
– Clinical evidence of muscle disease
– Usually elevated Creatinine Kinase on chemistry panel

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48
Q

The Dipstick pH approximates?

A

urine pH.
It is not precise.

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49
Q

What is the normal urine pH in dogs and cats?

A

5.0-7.5

50
Q

Urine pH varies with?

Type of _____
Collection ____ (post-_____ vs. post-______)
Systemic ______-_____ status

A

Type of diet
Collection time (post-fasting vs. post-parandial)
Systemic acid-base status

51
Q

How does urine become acidic?

A

The Ph affects the types of casts and crystals, and uroliths
Paradoxical aciduria with alkalosis: acidic urine (aciduria) in the face of a metabolic alkalosis

52
Q

How does the urine become alkaline?

  1. ______ protein-based diet
  2. __________ alkaline tide
  3. ____ with _______-containing (______ producing) bacteria
  4. Urine sample exposed to ____ at _____ temperature
  5. Use of _______ agents
  6. _______ and _______ alkalosis
A
  1. Plant protein-based diet
  2. Postprandial alkaline tide
  3. UTI with urease-containing (ammonia producing) bacteria
  4. Urine sample exposed to air at room temperature
  5. Use of alkalinizing agents
  6. Metabolic and respiratory alkalosis
53
Q

The dipstick protein test primarily detects?

A

Primarily detects albumin (negative charge)

54
Q

Describe the sensitivity and specificity of the dipstick protein test.

A

Low sensitivity and low specificity

55
Q

Are false positives common in dipstick protein tests? If so, list the common reasons

A

False positives are common, especially in:
Alkaline urine
Cats due to an albumin-like protein, cauxin
Hypersthenuria

56
Q

What are the false negatives with a dipstick protein test?

Has a lower limit of ____-____ mg/dL of albumin
Insensitive to ____ and _______-_____ proteins

A

Has a lower limit of 20-30 mg/dL of albumin
Insensitive to globulins and Bence-Jones proteins

57
Q

What do you do if you see a positive protein reaction test in a dipstick protein test?

A

Positive protein reaction… FIRST:
1. r/o Hemorrhage
- Positive blood reaction
- Will see RBCs in sediment
2. r/o UTI / Cystitis
- Will see bacteria & WBCs on sediment
3. r/o Intravascular hemolysis- hemoglobinuria
- Hgb is a protein
- Animal will be anemic

58
Q

Proteinuria caused by renal disease:
1. Blood reaction will be _________ (usually)
2. Measure a ________

Proteinuria with nothing in the sediment is most often indicative of ?

A

Proteinuria caused by renal disease:
1. Blood reaction will be negative (usually)
2. Measure a UPCR

Proteinuria with nothing in the sediment is most often indicative of glomerular disease

59
Q

What is the Sulphosalicylic Acid Test (SSA) used for?

A

Used to confirm dipstick protein results

60
Q

The SSA test reacts with?

A

Reacts with albumin, and also…
Reacts adequately with globulins/Bence-Jones
proteins

61
Q

What will you need for the SSA test?
Urine ____________ + 5% ___________ acid
- _______ of sample is compared to standards

A

Urine supernatant + 5% sulphosalicylic acid
Turbidity of sample is compared to standards

62
Q

Proteinuria
* Interpret the ______ and ______ together
* Along with the _______ and _________ panel
* And don’t forget about the _____ and presenting clinical ______!

A

Proteinuria
* Interpret the dipstick and Sulphosalicylic Acid Test together
* Along with the USG and chemistry panel
* And don’t forget about the patient and presenting clinical signs!

63
Q

List the specific proteinuria disorders

A
  • Nephrotic syndrome
  • Fanconi syndrome
64
Q

Nephrotic syndrome
* Rare complication of _______–> abdominal ________/________
– Clinical syndrome characterized by:
* _________
* ______________
* Peripheral ______ or ______ spacing of fluid (ascites)
* _______________

A

Nephrotic syndrome
* Rare complication of protein-losing nephropathy (PLN) –> abdominal effusion/transudation
– Clinical syndrome characterized by:
* Proteinuria
* Hypoalbuminemia
* Peripheral edema or third spacing of fluid (ascites)
* Hypercholesterolemia

65
Q

Fanconi syndrome
* Proximal tubular defect that causes impaired tubular reabsorption of glucose, amino acids, and phosphate
– Results in proteinuria and glucosuria with normoglycemia
* Can be congenital or acquired
– Congenital: Basenjis (30% of breed)
* Dogs are typically 3-4 years old when first diagnosed
– Acquired: chicken jerky treat recall, copper storage disease, heavy metal toxicity

A
66
Q

Describe the microscopic examination of sediment procedure.

A

1) Centrifuge at low speed for 5 minutes
2) Decant urine without disrupting the sediment; leave a small amount of urine
(~500 uL) for resuspension
3) Re-suspend the pellet
4) Transfer a drop to a glass slide and place a coverslip
5) Lower the condenser on the microscope
6) Examine the entire coverslip, especially the edges

1st evaluate at 10x: epithelial cells, crystals, casts
2nd evaluate at 40x: RBC, WBC, fat, microorganisms

67
Q

What is the source of epithelial cells?

Squamous cells:?
Transitional cells:?
Caudate cells: renal ____ (RARE = ______)
Renal cells: renal ______ (RARE = renal ____ _____)

A

Squamous cells: distal urethra, vaginal tract, skin
Transitional cells: renal pelvis, ureter, bladder, proximal urethra
Caudate cells: renal pelvis (RARE = pyelonephritis)
Renal cells: renal tubules (RARE = renal tubular injury)

68
Q

Squamous epithelial cells
- ______ in size, _____ in terms of thickness, often _________, ______ or _____
- Significance:
- Seen in _____ catch urine
- Rarely _________
- Sertoli cell tumors causing squamous _________

A

Squamous epithelial cells
- Large, thin, often transparent, angular or folded
- Significance:
- Seen in free catch urine
- Rarely pathologic
- Sertoli cell tumors causing squamous metaplasia

69
Q
A

Squamous epithelial cells

70
Q

Describe the morphological characteristics of transitional epithelial cells.
What is its significance?

Transitional epithelial cells
- _______ in shape, ______ in size, found _________ and in ________
- Significance:
- __________ associated with inflammation
- Transitional cell tumors (_______ and _____)

A

Transitional epithelial cells
- Round, vary in size, found individually and in clusters
- Significance:
- Hyperplasia associated with inflammation
- Transitional cell tumors (benign and malignant)

71
Q
A

Transitional epithelial cells

72
Q

Urine Sediment: Neoplastic Cells:
- Expert diagnosis… send to your clinical pathologist!
- Transitional epithelial cells respond to inflammation with highly variable in ____ and ______
- Easy to mistake ______________ for neoplasia!!
- ____-dried sediment / __________ preparations
- Usually obtained with _______; unusual to see on ________ samples

A

Urine Sediment: Neoplastic Cells:
- Expert diagnosis… send to your clinical pathologist!
- Transitional epithelial cells respond to inflammation with highly variable in size and morphology
- Easy to mistake inflammation for neoplasia!!!
- Air-dried sediment / cytocentrifuged preparations
- Usually obtained with catheterization; unusual to see on cystocentesis samples

73
Q
A

Transitional cell carcinoma

74
Q
A

Red blood cells (RBCs) seen in the urine of a
monkey passing a kidney stone. Some of the RBCs
are crenated and there is one epithelial cell visible.
(Courtesy of Richard P. Usatine)

75
Q

Describe the morphological characteristics of RBCs on urine sediment. What is the significance.

________ in shape, often _______-tinged, may be __________
Significance: 2?
Remember: ______________ ___________ is expected on a cystocentesis sample

A

Red Blood Cells
Round, often yellow-tinged, may be crenated
Significance: Hemorrhage, Inflammation
Remember:Microscopic hematuria is expected on a cystocentesis sample

76
Q

Describe the morphological characteristics of WBCs on urine sediment. What is the significance.

  • ~___x larger than RBCs; cytoplasm looks _______
  • <5 WBCs/hpf is usually considered ______
  • > 5 WBCs/hpf = ______
  • General causes of pyuria:
    – _______ tract infection – _______ or lower _______ tract
    * Should ________ if UTI is suspected, even if no bacteria are _______!
    – Non-infectious _______ – ____ (e.g., from calculi)
    – ___________
    – ___________
A
  • ~2x larger than RBCs; cytoplasm looks granular
  • <5 WBCs/hpf is usually considered normal
  • > 5 WBCs/hpf = pyuria
  • General causes of pyuria:
    – Urinary tract infection – pyelonephritis or lower urinary tract
    * Should culture if UTI is suspected, even if no bacteria are visible!
    – Non-infectious inflammation – cystitis (e.g., from calculi)
    – Neoplasia
    – Prostatitis
77
Q
A

WBC on urine sediment

78
Q

How can you see bacteria on urine sediment?

A

> 10,000 rods/mL
100,000 cocci/mL

79
Q

What is the standard for detecting bacteria on urine sediment?

A

No standard method for reporting
- Few to many
- Present vs. Absent

80
Q

What do you expect to see in a urine sediment contains bacteria?

A

Neutrophils
- Unless immunosuppressed
- steroid therapy, Cushing’s,
diabetic, FIV cat, etc.

81
Q

Describe the culture selection for UTIs

  • _______ organisms
  • ___________ measurement
  • Sensitivity with _____
A
  • Aerobic organisms
  • Quanitative measurement
  • Sensitivity with MIC
82
Q
A

Urine sediment: bacteria

83
Q

What other infectious organisms can be seen on a urine sediment?

A

Significance? Are there clinical signs?
What was the method of collection?
- Voided (fecal contamination?)
Sample storage
- Where was the sample stored?
- How long was the sample stored?
I s the patient immunosuppressed?
Do other diagnostic findings support infection?

84
Q
A
85
Q
A
86
Q
A
87
Q

List the in vivo factors that Contribute to Urine Crystal Formation

  1. ________ and ________ of crystalline material
  2. Urine ____
  3. ______
  4. Excretion of ____ or _________ _______ agents
A
  1. Concentration and solubility of crystalline material
  2. Urine pH
  3. Diet
  4. Excretion of drugs or diagnostic imaging agents
88
Q

List the in vitro factors that Contribute to Urine Crystal Formation

Temperature - solubility _______ with decreased temperature
__________ - increases the solute concentration
Urine pH - changes with ________ urine and bacterial _________

A

Temperature - solubility decreases with decreased temperature
Evaporation - increases the solute concentration
Urine pH - changes with standing urine and bacterial overgrowth

89
Q

List the common crystals

A

“CCABS”
Amorphous
Bilirubin
Calcium carbonate
Calcium oxalate dihydrate
Struvite

90
Q

List the uncommon crystals

A

“CCADO”
Ammonium bitrate
Calcium oxalate monohydrate
Cysteine
Drug-associated
Other

91
Q

Describe the typical appearance of amorphous urinary crystals. Significance?

A

Typical appearance:
Yellow to yellow-brown
Aggregates of finely granular
material
No defining shape

Significance
None

92
Q

What can be seen in the image below?

A

Amorphous

93
Q

Describe the typical appearance of struvite urinary crystals. Significance?

Struvite (aka. triple ________ or _________ _________ phosphate)
Typical appearance:
- _______ in size, ______ in color, ______-like crystals (“______ lids”)
- Most common crystal in ____ and ____
- Formation is favored in ______ to _______ pH
–> Significance
- Can be found in clinically _______ patients
- Urease-_________ bacteria promote formation (↑urine pH)

A

Struvite (aka. triple phosphate or magnesium ammonium phosphate)
Typical appearance:
Large, colorless, prism-like crystals (“coffin lids”)
Most common crystal in dogs and cats
Formation is favored in neutral to alkaline pH
Significance
Can be found in clinical normal patients
Urease-positive bacteria promote formation (↑urine pH)

94
Q

What can be seen in the image below?

A

Struvite

95
Q

Describe the typical appearance of bilirubin urinary crystals. Significance?

Bilirubin
Typical appearance:
- ________ to _______ granules
- Usually present in small _______
Significance
- Dogs: low numbers in _____ concentrated urine is normal.
- _________ in all other species: _______
- pre-hepatic … hemolysis (EVH)
- hepatic/post-hepatic … hepatobiliary disease

A

Bilirubin
Typical appearance:
- Orange to copper granules
- Usually present in small bundles
Significance
- Dogs: low numbers in highly concentrated urine is normal.
- Abnormal in all other species: ICTERUS
- pre-hepatic … hemolysis (EVH)
- hepatic/post-hepatic … hepatobiliary disease

96
Q

What can be seen in the image below?

A

Bilirubin

97
Q

Describe the typical appearance of calcium carbonate urinary crystals. Significance?

Typical appearance:
- Large ______ with ______ striations
- _____-sized
- _______ to _____-_____ in color
Significance
- NORMAL in ?
- No reports in _______ or ______ urine

A

Typical appearance:
- Large spheres with radial striations
- Variably-sized
- Colorless to yellow-brown
Significance
- NORMAL in horses, rabbits, guinea pigs, and goats
- No reports in canine or feline urine

98
Q

What can be seen in the image below?

A

Calcium carbonate

99
Q

Describe the typical appearance of calcium oxalate dihydrate urinary crystals. Significance?

Calcium oxalate dihydrate
Typical appearance: “________”
- ______ squares connected by intersecting lines
- _____ in size

Significance
- _______ in domestic animals
- ________ artifact
Pathologic:
- ___________ _________ are predisposed
- __________ causing increased calcium excretion
- _______ renal failure

A

Calcium oxalate dihydrate
Typical appearance: “envelope”
- Colorless squares connected by intersecting lines
- Vary in size

Significance
- NORMAL in domestic animals
- Storage artifact
Pathologic:
- Miniature Schnauzers are predisposed
- Hypercalcemia causing increased calcium excretion
- Acute renal failure

100
Q

What image can be seen below?

A

Calcium oxalate dihydrate

101
Q

Describe the typical appearance of ammonium bitrate urinary crystals. Significance?

Typical appearance: “Thorn _______”
- ________ spheres
- _______ or _______-brown
Significance
- Normal finding in ______, _______ ________
- Pathologic: Suggests ______ disease; associated with ↓_____ , ↑ _____
- _______ Failure
- __________ or ________ shunts

A

Typical appearance: “Thorn apples”
- Spiked spheres
- Brown or yellow-brown
Significance
- Normal finding in Dalmations, English bulldogs
- Pathologic: Suggests liver disease; associated with ↓ B U N , ↑ N H 3
- Liver Failure
- Congenital or acquired shunts

102
Q

What image can be seen here?

A

Ammonium bitreate

103
Q

Describe the typical appearance of Calcium oxalate monohydrate urinary crystals. Significance?

Typical appearance:
- ______ (“____-____”), oval (“____ _____”) or dumbbell
- ____ in size: usually ____ and ____

Significance
- Can be seen in _______ animals, especially ______
- Pathologic:
- Oxalate urolithiasis
- Hypercalciuric or hyperoxaluric disorders
- Ehtylene glycol toxicosis (rare)

A

Typical appearance:
- Spindle (“picket-fence”), oval (“hemp seed”) or dumbbell
- Vary in size: usually small and colorless shaped

Significance
- Can be seen in healthy animals, especially horses
- Pathologic:
- Oxalate urolithiasis
- Hypercalciuric or hyperoxaluric disorders
- Ehtylene glycol toxicosis (rare)

104
Q
A

Calcium oxalate monohydrate

105
Q

Describe the typical appearance of cystine urinary crystals. Significance?

Typical appearance:
- ____ in terms of thickness, _________ in color ________ plates
- Often aggregate in _______
Significance
- Inherited disease: __________
- Defective renal tubular resorption of certain _______ ______
- Occurs almost exclusively in _____ dogs
- Many breeds affected
- Renal function is otherwise _______

A

Typical appearance:
- Flat colorless hexagonal plates
- Often aggregate in layers
Significance
- Inherited disease: Cystinuria
- Defective renal tubular resorption of certain amino acids
- Occurs almost exclusively in male dogs
- Many breeds affected
- Renal function is otherwise normal

106
Q
A

Cystine

107
Q

Describe the typical appearance of Drug-associated crystals. Significance?

A

Correlate with history!!!
Vary in appearance and size
- Frequently light to dark brown
- Commonly form needles arranged into sheaves, bundles, fans, and radiating spikes
Most drugs excreted in urine can form crystals
- Antibiotics: sulfa family drugs, ampicillin, ciprofloxacin, etc.
- Anticonvulsants: especially during poly therapy and in alkaline urine
- Allurinol administration
- Radiographic contrast media

108
Q

This material is FYI

A

FYI

109
Q

Casts are composed of_______-______ protein, a mucoprotein secreted by the tubular epithelium.

A

Tamm-Horsfall protein, a mucoprotein secreted by the tubular epithelium

110
Q

Casts are formed in what parts of the body?

A

– Formed in loops of Henle, distal tubules, and collecting ducts

111
Q

Casts are formed in ______ urine, may dissolve in _______ urine

A
  • Formed in acidic urine, may dissolve in alkaline urine
112
Q

The formation of casts is dependent on?

A
  • Formation is dependent on urine acidity, solute concentration, and flow rate
113
Q

Cats may be intermittently shed and may break down during urine sedimentation
* May indicate tubular damage and/or urine stasis within the tubules
* Increased numbers of casts in urine = cylindruria

A
114
Q

List the different types of casts.

– Hyaline casts
* >____ hyaline casts/10x objective is significant
– Cellular casts –> can be composed of ________ cells, _____, and/or ____
– ________ casts
– ______ casts –> indicate chronicity

A

– Hyaline casts
* >2 hyaline casts/10x objective is significant
– Cellular casts è can be composed of epithelial cells, RBCs, and/or WBCs
– Granular casts
– Waxy casts è indicate chronicity

115
Q
A
116
Q

Fat droplets
* Commonly seen (especially in ______ urine) and usually __________
* Result from degeneration of _________ cells
lining the urinary tract
* Can be differentiated from RBCs and
WBCs by being in a different _____ of
focus
– _________ in size but more uniformly ______
than cells

A

Fat droplets
* Commonly seen (especially in feline urine) and usually insignificant
* Result from degeneration of epithelial cells
lining the urinary tract
* Can be differentiated from RBCs and
WBCs by being in a different plane of
focus
– Variable in size but more uniformly round
than cells

117
Q
A

Fat droplets

118
Q

Mucus
* Commonly seen in ________ urine
* Can resemble _________ casts
– Mucus is more ________ shaped with _______ ends

A

Mucus
* Commonly seen in equine urine
* Can resemble hyaline casts
– Mucus is more irregularly shaped with tapered ends

119
Q
A

Mucus

120
Q
A

Contaminant fibers

121
Q

Contaminant fibers
* Cotton, plant, and paper fibers
* Can mimic parasite larvae or urinary casts

A
122
Q
A

Environmental fungi and pollen

Clinical Pathology (31 decks)

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