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Clinical Reproduction & Urology > Pigmenturia > Flashcards

Pigmenturia Flashcards

1
Q

Endogenous pigmenturia likely

A

myoglobinuria, porphyria, haemoglobinuria, bilirubinuria, haematuria, melanuria

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2
Q

Exogenous pigmenturia

A

admin of numerous drugs/chemicals will result in discoloured urine

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3
Q

Normal urine coloured by

A
  • urochrome
  • urobilin
  • uroerythrin
  • uroporphyrins
  • trace amts of riboflavin
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4
Q

Urine colour should be analysed in relation to

A

USG

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5
Q

If there is abnormal colour to urine, consider these differentials

A
  • diet
  • medications
  • environment inborn error of metabolism
  • haemolysis
  • haematuria
  • rhabdomyolysis
  • metabolic effect
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6
Q

Physical appearance of Haematuria

A
  • contains clots or is red, red-brown, brown & cloudy
  • dvlp a deposit w/ time & clear w/ centrifugation
  • depends on oxidation of Hgb, more rusty over colour
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7
Q

Microscopic appearance of Haematuria

A
  • erythrocytes or ghosts in sediment
  • crenation if SG >1.020
  • spherocytes if SG <1.010
  • high protein
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8
Q

Occult haematuria

A

often incidental finding w/ other Sx of UT dz

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9
Q

Spurious haematuria

A

Genital tract incl prostate

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10
Q

Which is present on the left?

A

Haemaglobinuria

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11
Q

Haematuria in FUS

A
  • mainly blood in urine along w/ struvite crystals
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12
Q

Renal Haematuria

A
  • accounts for 15-30% of all haematurias
  • of glomerular origin, RBCs distorted
  • persistent or intermittent haematuria (hrs to days)
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13
Q

What are some causes of renal haematuria

A

renal trauma, renal calculi or crystals (oxalate monohydrate), ARF, haemorrhagic diathesis, acute pyelonephritis, acute glomerulonephritis, renal neoplasia, arteriovenous malformation, parasitism, renal cysts, renal infarcts/embolism, radiation, idiopathic, passive congestion

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14
Q

glomerular haemorrhage RBCs in renal haematuria have what appearance?

A

doughnut-like shape, membranous protrusions or blebs + target configuration

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15
Q

MB & Hb are partially reabsorbed by

A

renal tubular cells & haem iron reincorporated into ferritin & haemosiderin

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16
Q

spun urine for myoglobinuria is what colour?

A

orange-red to brown “mahogany brown”

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17
Q

spun urine for haemaglobinuria is

A

red to red-brown “port wine red”

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18
Q

Myoglobin has a greater susceptibility to oxidize leading to

A

a chocolate brown colour

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19
Q

Myoglobinuria has what colour serum when spun?

A

clear

20
Q

Haemoglobin spun serum is what colour

A

pink

21
Q

Mild myoglobinemia occurs w/

A

renal failure & active cardiac injury

22
Q

Gross pigmenturia can occur w/

A

rhabdomyolysis

23
Q

Myoglobinaemia peaks in & is cleared from…

A

about 12 hrs injury & is cleared from plasma in 1-2d

24
Q

Myoglobinuria (port wine) means

A
  • severe muscle damage & need to flush out kidneys to avoid renal damage –> can cause myoglobinuria renal necrosis
25
Q

Rhabdomyolysis in horse causes urine to become

A
  • reddish tinge if very fresh if haemoglobinuria
  • if there is a lot & has oxidized, it is black
26
Q

What are haemaglobin globules

A

globules of hgb found w/ extensive Haemglobinuria w/ colour dependent on stain

27
Q

IHA & intravascular haemolysis & haemoglobinuria can create

A

Haemoglobin globules bilirubin crystals

28
Q

Leaves that can cause haemolytic anaemia in horses

A

red maple (acer rubrum), esp wilted
Sugar maple, silver maple, Pistacia

29
Q

What Allium species cause haemolytic anaemia & in what species?

A

Onions - horse, cattle, dogs
Garlic, chives, leek

30
Q

What other things can cause haemolytic anaemia?

A

minerals/drugs
infectious
genetic

31
Q

Dipsticks are super sensitive to what molecule?

A

Haem

32
Q

What test is most sensitive for myoglobinuria?

A

RIA

33
Q

How do you differentiate Myoglobinuria, haemoglobinuria, and haematuria with the urine dipstick?

A

Greenish dot = haem
Free Hb/Mb = uniform colour (haem dissoleveD)
Mburia = appropriate clin situation, + dipstick, no red coloured serum, no RBCs in urine sediment

34
Q

Differentiating between myoglobinuria, haemoglobinuria, haematuria, otheruria

A
  • Dipstick test neg - likely porphyria or exogenous pigments
  • Microscopic analysis for rbcs & ghosts pos - likely haematuria
  • dipstick test & protein test pos & pink spun serum - hburia
  • Dipstick, protein, ammonium precipitation pos - mburia
35
Q

Porphyrin

A

tetra pyroles conjugated by double bonds giving light absorption & colour

36
Q

Porphyrin binds what metals?

A

Fe, Mg, Cu, Zn

37
Q

Haemoproteins contain..

A

oxidized Fe2+ at centre

38
Q

Roles of porphyrin

A
  • Hb/Mb carry oxygen
  • cytochromes transfer electrons for hepatic detox or mitochondrial respiration
  • antioxidants
  • gas sensors (CO, NO)
  • pigments
39
Q

Porphyria

A

purple pigment in urine

40
Q

what causes porphyria?

A

excessive production & excretion of porphyrins or their precursors due to haem biosynthetic pathway defect

41
Q

Porphyria is associated w/

A

cutaneous photosensitivity & neurologic abnormalities

42
Q

Bovine Congenital Erythropoietic Porphyria

A

Causes: red-brown discolouration & fluorescence of bones & teeth (erythrodontia), urine that is pink to deep burgundy, photosensitization, normochromic haemolytic anaemia, fluorescytes

42
Q

Bovine Congenital Erythropoietic porphyria is a genetic deficiency of

A

Uroporphyrinogen III cosynthetase

42
Q

What are the steps of porphyrin/ haem synthesis?

A
  1. gamma-aminolevulinate synthase
  2. gamma-aminolevulinate dehydrase = porphobilinogen synthase
  3. Uroporphyrinogen I synthase = porphobilinogen deaminase
    4. Uroporphyrinogen III cosynthase (CEP)
  4. Uroporphyrinogen decarboxylase
  5. Coproporphyringen III oxidase
  6. Protoporphyrinogen oxidase
  7. Ferrochelatase, Haem synthase (BEP)
43
Q

Uroporphyrin I accumulates in

A

urine in CEP & imparts red colour

44
Q

Bovine erythropoietic protoporphyria occurs in what species

A

Limousin cattle & humans

45
Q

When can melanuria a rare complication of dz?

A

metastatic malignant melanoma in grey horses

Clinical Reproduction & Urology (29 decks)

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