Oakley UTI

Question 1

Pollakiuria

Answer 1

increased urination frequency

Question 2

Stranguria

Answer 2

difficulty urinating

Question 3

case:
Oakley, 6 y old, FS Corgi
 Pollakiuria, hematuria, stranguria
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Differential diagnosis

Answer 3

 Urinary stones
 Bacterial cystitis
 Neoplasia

Question 4

dipstick analysis
- how do they work? how to use?
- reliable vs unreliable parameters?

Answer 4

 Dry reagent strips
> Chemical reactions → color change
> Color charts provided
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 Easy to use, inexpensive
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Several reliable parameters
 Protein, ketones, bilirubin, glucose, pH
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Unreliable (because made for humans)
 Leukocytes test (FN)
 Urobilinogen test
 Nitrite test (FN)
 Specific gravity

Question 5

what urine tests do we have? what are not useful for UTI vs useful?

Answer 5

NOT useful for UTI:
- Urine dipstick
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USEFUL for UTI:
 Urinalysis
 Sediment
 Urine culture

Question 6

how does bladder size relate to obstuction?

Answer 6

normal size = likely no obstruction

Question 7

urine pH - relates to what conditions? is it very reliable and why?

Answer 7

(alkaline versus acidic)
 Stone formation
 Alkaline pH and Bacteria
 Not really reliable because influenced by multiple
factors

Question 8

what conditions can increase USG? what do we need to take into account when interpreting this value

Answer 8

 Dehydration (USG ↑)
 Renal dysfunction (USG ↑)
 If dilute: takes more cells/bacteria/proteins to be significant

Question 9

what is pyuria? when might we see it?

Answer 9

White blood cells (WBC)
 >5 WBC/hpf= Pyuria
 Inflammation
 Contaminants (traumatic cystocentesis, catheterization)

Question 10

what sediment can we see in urine

Answer 10

• WBC
• RBC
• fat droplets (normal)
• epithelial cells

Question 11

what is true hematuria? cause?

Answer 11

Red blood cells
 >5 RBC/hpf
 True hematuria
 Contaminants (traumatic cystocentesis, catheterization)

Question 12

cause of epithelial cells in urine?

Answer 12

 Inflammation, neoplasia

Question 13

Origin of Pyuria

Answer 13

!!Inflammation!!
 UTI
 Uroliths
 Prostatitis
 Pyometra
 Neoplasms

Question 14

how does pyuria relate to urine culture results?

Answer 14

Increased WBC count in urine associated with increased odds of positive culture

Question 15

Causes of bacteriuria

Answer 15

 Urinary tract infection
 Sample contamination during collection or processing
 In vitro bacterial overgrowth

Question 16

Bacteriuria without ↑ WBC suggests what?

Answer 16

Bacteriuria without ↑ WBC = suggestive of bacterial contamination

Question 17

Pyuria (↑ leukocytes) + bacteriuria suggests what

Answer 17

 Active urinary tract inflammation + bacterial infection

Question 18

how does cytological detection of bacteria correspond to urine culture results

Answer 18

Poor agreement between cytological detection of bacteria and positive urine culture

Question 19

diagnosis of UTI

Answer 19

 Pyuria (↑ WBC/hpf)
 +/- Bacteruria
And clinical signs!

Question 20

should we treat a subclinical UTI?

Answer 20

NO - only treat if there are clinical signs!

Question 21

Does the absence of pyuria in a urine sediment rule out urinary tract infection?

Answer 21

NO
> eg. maybe urine is too dilute, or maybe a ‘silent UTI’

Question 22

Reasons for absence of pyuria in a urine sediment of patient with UTI

Answer 22

 Dilute urine
 Silent UTI (not eliciting an inflammatory
response)
> Hyperadrenocorticism
> Diabetes mellitus
> Immunosuppressed states (drug induced)

Question 23

if we have some combination of clinical signs, pyuria, baceruria - when is it likely UTI? vs not likley?

Answer 23

Likely UTI
 Clinical signs + pyuria + bacteruria
 Clinical signs + pyuria
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Unlikely UTI
 Bacteruria only
 No clinical signs

Question 24

UTI- DONTS:
can we rule out a UTI based on neg sediment?
can we diagnose a UTI based on bacteriuria?
do we need clinical signs?
- What are the exceptions?

Answer 24

 Don’t rule out a UTI based on neg sediment
 Don’t diagnose a UTI based on bacteriuria
 + YOU NEED CLINICAL SIGNS!!!
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Exception to the rule….
 Paralysed patients
> No clinical signs
> If fever and bacteruria, consider bacterial cystitis
 Fever of unknown origin
> Consider urine culture

Question 25

Do we need urine culture every time??

Answer 25

NO

Question 26

when should we do empirical treatment for UTI in cats?

Answer 26

CATS: not recommended because UTI rare
 Should do a urine culture before treating possible
infection

Question 27

when should we do empirical treatment for UTI in dogs? when is culture reccomended?

Answer 27

DOGS: yes BUT culture recommended if
 Recurrence of suspected UTI in dogs
 Multiple ATB treatments
 Multiple hospitalizations
 Raw food diet
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Empirical broad spectrum antibiotic OK

Question 28

Do we need urine culture?
Female dog
1st episode of urinary signs
UA: pyuria and bacteriuria

Answer 28

Empirical broad spectrum antibiotic OK

Question 29

Do we need urine culture?
Female dog- no clinical signs
Routine wellness recheck
UA: bacteriuria

Answer 29

No antibiotics
- no clinical signs

Question 30

Do we need urine culture?
Young female cat
1st episode of urinary signs
UA: pyuria and bacteriuria

Answer 30

No antibiotic
UTI extremely rare in cats

Question 31

Do we need urine culture?
Old cat (history of chronic kidney disease)
History of urinary signs
UA: pyuria and bacteriuria

Answer 31

Urine culture recommended
UTI more common in CKD cats

Question 32

Do we need urine culture?
Old male dog
Urinary signs
UA: pyuria and bacteriuria
Raw food diet

Answer 32

Urine culture And Imaging!

Question 33

Do we need urine culture?
Female dog
Urinary signs
UA: pyuria and bacteriuria
Multiple ATB treatments
Multiple hospitalizations

Answer 33

Urine culture

Question 34

Do you need imaging for urinary issues? when?

Answer 34

 Mostly in males (+/- intact)…(stones, prostatic diseases)
 Old patient and suspected obstruction (stranguria)
 Systemic signs (obstruction or pyelo?)