Oakley UTI Flashcards
Pollakiuria
increased urination frequency
Stranguria
difficulty urinating
case:
Oakley, 6 y old, FS Corgi
Pollakiuria, hematuria, stranguria
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Differential diagnosis
Urinary stones
Bacterial cystitis
Neoplasia
dipstick analysis
- how do they work? how to use?
- reliable vs unreliable parameters?
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
what urine tests do we have? what are not useful for UTI vs useful?
NOT useful for UTI:
- Urine dipstick
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USEFUL for UTI:
Urinalysis
Sediment
Urine culture
how does bladder size relate to obstuction?
normal size = likely no obstruction
urine pH - relates to what conditions? is it very reliable and why?
(alkaline versus acidic)
Stone formation
Alkaline pH and Bacteria
Not really reliable because influenced by multiple
factors
what conditions can increase USG? what do we need to take into account when interpreting this value
Dehydration (USG ↑)
Renal dysfunction (USG ↑)
If dilute: takes more cells/bacteria/proteins to be significant
what is pyuria? when might we see it?
White blood cells (WBC)
>5 WBC/hpf= Pyuria
Inflammation
Contaminants (traumatic cystocentesis, catheterization)
what sediment can we see in urine
- WBC
- RBC
- fat droplets (normal)
- epithelial cells
what is true hematuria? cause?
Red blood cells
>5 RBC/hpf
True hematuria
Contaminants (traumatic cystocentesis, catheterization)
cause of epithelial cells in urine?
Inflammation, neoplasia
Origin of Pyuria
!!Inflammation!!
UTI
Uroliths
Prostatitis
Pyometra
Neoplasms
how does pyuria relate to urine culture results?
Increased WBC count in urine associated with increased odds of positive culture
Causes of bacteriuria
Urinary tract infection
Sample contamination during collection or processing
In vitro bacterial overgrowth
Bacteriuria without ↑ WBC suggests what?
Bacteriuria without ↑ WBC = suggestive of bacterial contamination
Pyuria (↑ leukocytes) + bacteriuria suggests what
Active urinary tract inflammation + bacterial infection
how does cytological detection of bacteria correspond to urine culture results
Poor agreement between cytological detection of bacteria and positive urine culture
diagnosis of UTI
Pyuria (↑ WBC/hpf)
+/- Bacteruria
And clinical signs!
should we treat a subclinical UTI?
NO - only treat if there are clinical signs!
Does the absence of pyuria in a urine sediment rule out urinary tract infection?
NO
> eg. maybe urine is too dilute, or maybe a ‘silent UTI’
Reasons for absence of pyuria in a urine sediment of patient with UTI
Dilute urine
Silent UTI (not eliciting an inflammatory
response)
> Hyperadrenocorticism
> Diabetes mellitus
> Immunosuppressed states (drug induced)
if we have some combination of clinical signs, pyuria, baceruria - when is it likely UTI? vs not likley?
Likely UTI
Clinical signs + pyuria + bacteruria
Clinical signs + pyuria
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Unlikely UTI
Bacteruria only
No clinical signs
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?
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
Do we need urine culture every time??
NO
when should we do empirical treatment for UTI in cats?
CATS: not recommended because UTI rare
Should do a urine culture before treating possible
infection
when should we do empirical treatment for UTI in dogs? when is culture reccomended?
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
Do we need urine culture?
Female dog
1st episode of urinary signs
UA: pyuria and bacteriuria
Empirical broad spectrum antibiotic OK
Do we need urine culture?
Female dog- no clinical signs
Routine wellness recheck
UA: bacteriuria
No antibiotics
- no clinical signs
Do we need urine culture?
Young female cat
1st episode of urinary signs
UA: pyuria and bacteriuria
No antibiotic
UTI extremely rare in cats
Do we need urine culture?
Old cat (history of chronic kidney disease)
History of urinary signs
UA: pyuria and bacteriuria
Urine culture recommended
UTI more common in CKD cats
Do we need urine culture?
Old male dog
Urinary signs
UA: pyuria and bacteriuria
Raw food diet
Urine culture And Imaging!
Do we need urine culture?
Female dog
Urinary signs
UA: pyuria and bacteriuria
Multiple ATB treatments
Multiple hospitalizations
Urine culture
Do you need imaging for urinary issues? when?
Mostly in males (+/- intact)…(stones, prostatic diseases)
Old patient and suspected obstruction (stranguria)
Systemic signs (obstruction or pyelo?)
