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Clinical Pathology > UNIT 2 - Lecture 3: Urinalysis > Flashcards

UNIT 2 - Lecture 3: Urinalysis Flashcards

1
Q

What are 5 instances where a UA is indicated?

A
  1. New patient (est. baseline)
  2. Sick patient
  3. Along with bloodwork
  4. Monitoring
  5. Prior to administration of IVF or other treatments
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2
Q

What are the 3 methods for urine collection?

A

Free catch/voided, catheterization, cystocentesis

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3
Q

What are 3 advantages to a free catch?

A
  1. Can be easy
  2. Non-invasive
  3. Collection during normal voiding poses no risk to patient
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4
Q

What are 3 disadvantages to a free catch?

A
  1. Lower urinary tract contamination
  2. Manual expression –> discomfort to patient or reflux infected urine into other structures
  3. Sample not ideal for culture
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5
Q

What are 3 advantages to a catheterization?

A
  1. UB does not need to be distended to obtain sample
  2. Collection does not depend on patient’s willingness to urinate
  3. Catheter may be maintained for patient cleanliness, to measure production, or maintain patency in animals with obstruction issues
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6
Q

What are 5 disadvantages to catheterization?

A
  1. Sedation may be necessary
  2. Difficult to perform with females
  3. Potential to introduce pathogens
  4. Urine may be contaminated with cells/bacteria from the urethra
  5. Small risk of perforation
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7
Q

What are 3 advantages of cystocentesis?

A
  1. Sedation often not necessary
  2. Preferred sample collection method for culture
  3. Low risk for iatrogenic infection
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8
Q

What are 4 disadvantages of cystocentesis?

A
  1. Potential for iatrogenic blood contamination
  2. Potential for inadvertent sampling of other organs
  3. Small risk of bladder laceration or urine leakage
  4. Risk of seeding neoplastic cells along needle track from patient with TCC
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9
Q

How long should urine be evaluated in house if not refrigerated?

A

Within one hour

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10
Q

What can happen if urine is not evaluated within one hour if it is not refrigerated?

A

Cells and casts can decay rapidly and/or crystals may form in vitro

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11
Q

What 3 precautions should be taken when sending urine to an outside lab?

A
  1. Refrigerate/keep cool (don’t freeze)
  2. Ship fast (overnight or courier)
  3. Protect from sunlight (bilirubin will break down when exposed to light)
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12
Q

What types of tubes should be used to send out a urine sample?

A

Red top (no additive) = chemical analysis, culture

EDTA = cellular examination

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13
Q

When would you send out a urine cytology and what sample types should be sent?

A

For evaluation by pathologist to ID bacteria or abnormal cells;

Send both direct and concentrated (sediment) air-dried slides

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14
Q

What are the 4 components of a urinalysis?

A
  1. Gross evaluation (color, clarity, odor)
  2. USG
  3. Dipstick (pH, protein, glucose, ketones, blood, bilirubin)
  4. Sediment analysis
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15
Q

How much urine is preferred for a complete analysis?

A

At least 5 ml

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16
Q

Normal urine is _____ to _____ in color.

A

Yellow, amber

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17
Q

What determines shade and intensity of urine color?

A

Concentration and endogenous pigments (urochromes or urobilin)

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18
Q

What does a red urine color mean?

A

RBCs, free Hgb, myoglobin

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19
Q

What does a red-brown urine mean?

A

Hematuria, hemoglobinuria, myoglobinuria, methemoglobin

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20
Q

What does brown to black urine mean?

A

Methemoglobin from hemoglobin or myoglobin

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21
Q

What does yellow-orange urine mean?

A

Bilirubin

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22
Q

What does yellow-green or yellow-brown urine mean?

A

Bilirubin or biliverdin

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23
Q

What is often the clarity of horse urine and why?

A

Cloudy - calcium carbonate crystals and mucus

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24
Q

What does cloudy urine indicate?

A

Presence of cells, crystals, bacteria, casts, sperm, contaminants, and lipid droplets

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25
Q

What affects urine odor?

A

Concentration, diet, meds, bacteria, inflammation, certain medical conditions (i.e. DM)

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26
Q

What is USG used for?

A

To assess kidney’s concentrating ability

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27
Q

USG is the ratio of a solution’s _____ to the _____ of an equal volume of _____.

A

weight, weight, water

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28
Q

What instrument is used to evaluate a USG?

A

refractometer

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29
Q

Why should USG be analyzed at room temperature?

A

Cold urine can cause false increase in USG

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30
Q

USG is determined primarily by # of _____.

A

solute particles

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31
Q

What electrolytes do urine solutes include?

A

Na, K, Cl, Ca, P, ammonia

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32
Q

What metabolic wastes does USG include?

A

urea and creatinine

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33
Q

Marked proteinuria or glucosuria will very slightly _____ USG.

A

increase

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34
Q

What is the “adequate” USG for a dog in the face of azotemia?

A

>1.030

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35
Q

What is the “adequate” USG for a cat in the face of azotemia?

A

>1.040

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36
Q

What is the “adequate” USG for large animals in the face of azotemia?

A

>1.025

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37
Q

What does adequate USG suggest?

A

That there are sufficient nephrons to adequately concentrate urine

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38
Q

What does inadequate USG in an azotemic animal suggest?

A

There is a problem that interferes with urine concentrating ability

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39
Q

What are 5 problems that can lead to inadequate USG?

A
  1. Insufficient functioning nephrons (kidney disease)
  2. Osmotic diuresis
  3. Loss of medullary [] gradient
  4. Reduced ADH release
  5. Impaired response to ADH
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40
Q

What tests are unreliable on a dipstick in animals?

A

USG, leukocytes, urobilinogen, nitrite

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41
Q

What tests are useful to evaluate on a dipstick for animals?

A

Protein, pH, blood, ketones, bilirubin, glucose

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42
Q

What is the primary protein detected on a dipstick?

A

albumin

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43
Q

What can cause a false (+) for protein on a dipstick?

A

Very alkaline urine OR contamination by some cleaning agents

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44
Q

Trace to 1+ protein can be found in animals with a _____ urine.

A

concentrated

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45
Q

Urine protein must be interpreted in context with _____ and _____.

A

USG, pH

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46
Q

What is sulfosalicyclic acid precipitation (SSA)?

A

Alternative urine protein assay that can detect Bence Jones proteins

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47
Q

How does SSA work?

A

5% SSA is combined with urine –> proteins denature –> cloudy precipitate

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48
Q

What are causes for pre-renal (overload) proteinuria?

A

Hemoglobinuria, myoglobinuria

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49
Q

What are causes for renal proteinuria?

A

Glomerular and/or tubular disease

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50
Q

What are causes for post-renal proteinuria?

A

Hemorrhage, inflammation, trauma, or neoplasia in urinary tract

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51
Q

What test is used to assess significance/severity of proteinuria?

A

UPC (urine protein to creatinine ratio)

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52
Q

In health, urine pH is primarily determined by _____.

A

diet

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53
Q

Carnivores have _____ protein catabolism –> more _____ urine (pH???)

A

increased, acidic, <7.0

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54
Q

Herbivores have _____ protein catabolism –> more _____ urine (pH???)

A

decreased, alkaline, >7.0

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55
Q

One would expect a more _____ urine with metabolic acidosis.

A

acidic

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56
Q

One would expect a more _____ urine with metabolic alkalosis.

A

alkaline

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57
Q

What ia paradoxical aciduria?

A

Metabolic alkalosis with acidic urine

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58
Q

Urine is more alkaline with infection with _____.

A

urease-producing bacteria

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59
Q

What can lead to a (+) heme/blood reaction in a UA?

A

Hematuria, hemoglobinuria, myoglobinuria

60
Q

What should a (+) heme result be interpreted with?

A

urine sediment

61
Q

Free Hgb and myoblobin are _____toxic.

A

nephrotoxic

62
Q

When might RBCs not be seen on urine sediment when there is hematuria?

A

They may lyse in very alkaline or dilute urine

63
Q

With hematuria, supernantant should be _____ with an _____ pellet after centrifugation.

A

clear, RBC

64
Q

Hemoglobinuria is “spill-over” from excess free Hgb in _____.

A

plasma

65
Q

When is the only time hemoglobinuria occurs?

A

With extravascular hemolysis

66
Q

What erythrogram finding should you expect with hemoglobinuria? What should the plasma look like?

A

Anemia with red plasma

67
Q

What are some medical causes for hemoglobinuria?

A
  1. IMHA
  2. Oxidative damage
  3. RBC parasites
  4. Severe hypophosphatemia
68
Q

How can you differentiate hematuria from hemoglobinuria on urine sediment?

A

Hemoglobinura = no RBCs noted on sediment

69
Q

When is myoglobin released into the plasma?

A

When where is severe skeletal muscle injury

70
Q

What colors can be expected in urine with myoglobinuria?

A

Orange, red, or brown

71
Q

How can myoglobinuria be differentiated from hematuria on erythrogram and urine sediment?

A

No anemia; No RBCs present on sediment

72
Q

With myoglobinuria, a very high _____ activity is expected (leaked enzyme released from injured myocytes).

A

creatine kinase

73
Q

What are some DDx for myoglobinuria?

A
  1. Severe muscle injury
  2. Exertional rhabdomyolysis (horses)
  3. Inherited myopathies
74
Q

What ketone bodies can be released into the urine?

A

Acetone, acetoacetate, and ß-hydroxybutyrate

75
Q

What are 2 general situations in which ketone bodies are produced?

A
  1. Starvation
  2. Inability to utilize carbs as an alternate energy source
76
Q

What are some diseases in which ketones may be present in the urine?

A
  1. Unregulated DM in dogs and cats
  2. Pregnancy toxemia in sheep and camelids
  3. Ketosis in cattle
77
Q

Ketonuria precedes _____.

A

ketonemia

78
Q

When is a false (+) for ketonuria possible?

A

With highly pigmented urine

79
Q

What are the 4 steps to ketone production?

A
  1. Energy production shifts from utilization of carbs to lipids due to DM, starvation, or hypoglycemic disorders
  2. Excessive β-oxidation of fatty acids in hepatocytes –> more acetyl-coA than needed for gluconeogenesis and triglyceride synthesis
  3. Excess acetyl-coA stimulates ketogenesis by liver –> increased formation of ketoacids –> ketonemia
  4. Ketones in blood excreted in urine –> ketonuria
80
Q

Ketogenesis is stimulated by _____ and repressed by _____.

A

glucagon, insulin

81
Q

What is ketosis?

A

Pathologic state caused by excessive ketogenesis

82
Q

What is ketoacidosis?

A

Ketosis with concurrent acidemia

83
Q

Prolonged ketonuria may result in depletion of _____ or _____ since renal excretion of ketones (anions) obligates excretion of _____.

A

sodium, potassium, cations

84
Q

T/F: Ketonuria is an indicator of kidney disease

A

False: It indicates a systemic problem, NOT kidney disease

85
Q

What does a (+) bilirubin reaction indicate?

A

Presence of conjugated bilirubin in urine (soluble form)

86
Q

Bilirubinuria occurs secondary to _____ from _____ disease or _____ disease.

A

hyperbilirubinemia, liver, hemolytic

87
Q

Bilirubin should not be detected in urine other than in what 2 situations?

A

concentrated canine and ferret urine (low renal threshold)

88
Q

What values on a dipstick mean urine is (-) for glucose?

A

<100 mg/dL

89
Q

What is the renal threshold for glucose in dogs? Cats? Horses? Cows?

A

Dogs = 180 mg/dL

Cats = 280 mg/dL

Horses = 160 mg/dL

Cow = 100 mg/dL

90
Q

What is the most common cause of glucosuria?

A

Hyperglycemic glucosuria

91
Q

What are reasons for persistent hyperglycemic glycosuria?

A

DM, Cushings, acromegaly, pheochromocytoma

92
Q

What is a reason for transient hyperglucemic glucosuria?

A

Stress/excitement (esp in cats)

93
Q

What are reasons for normoglycemic glycosuria?

A

Renal tubular defects - acquired or inherited damage to tubular epithelium

94
Q

What are examples of acquired renal tubular defects that lead to normoglycemic glucosuria?

A

Gentamycin toxicity, leptospirosis

95
Q

How is urine sediment prepared?

A
  1. Centrifuge urine
  2. Remove most of supernatent
  3. Gently re-suspend the sediment in the remaining supernatent
  4. Examine a wet mount without stain
  5. Lower microscope condenser for optimal viewing
  6. Report # cells or crystals per low or high power field
96
Q

What do RBCs look like on a wet mount?

A

Lack internal structure

97
Q

How many RBCs can be seen in urine of healthy animals?

A

<5 RBCs/hpf

98
Q

What do WBCs look like on a urine wet mount?

A

Round, granular cells with internal structure (1.5 to 2x diameter of RBCs)

*arrowheads in pic*

99
Q

How many WBCs can be seen in urine in health?

A

<5 WBCs/hpf

100
Q

What is the term for increased #s of WBCs in urine?

A

pyuria

101
Q

What epithelial cells can be seen in urine?

A

Transitional, squamous, renal tubular, neoplastic

102
Q

When are epithelial cells in the urine a concern?

A

When they are atypical or in casts

103
Q

_____ epis are common in voided urine - are _____ for lower urogenital tract.

A

Squamous, contaminants

104
Q

What sample type should not have bacteria in the urine?

A

cysto

105
Q

What are casts?

A

Cylindrical aggregates of materials that collect in the renal tubules and collecting ducts;

Are named and classified according to composition

106
Q

What does appearance of casts depend on?

A

Length of time in tubule

107
Q

What do hyaline casts contain and what #s are seen in healthy patients?

A

Contain Tamm-Horsfall mucoprotein +/- other proteins;

<2/lpf

108
Q

When are hyaline casts seen in increased #s?

A

Fever, exercise, passive congestion, protein-losing glomerular disease

109
Q

What is a cellular cast the result of?

A

Ischemia, infarction, or nephrotoxicity –> degeneration or necrosis of tubular epithelial cells

110
Q

Presence of cellular casts indicates _____, but not _____ or _____.

A

acute tubular injury, extent, reversibility

111
Q

What are granular casts?

A

Degenerated cellular casts

112
Q

T/F: Granular casts can be present in low #s in animals without apparent tubular injury.

A

True

113
Q

When do RBC casts form?

A

When there is intra-renal hemorrhage.

114
Q

What is a waxy cast and what does it indicate?

A

Final stage of cast degeneration; indicates tubular injury.

115
Q

When is presence of a waxy cast of pathological significance?

A

Always

116
Q

How are waxy casts differentiated from hyaline casts?

A

Waxy casts have squared off ends

117
Q

Lack of crystalluria does not exclude the possibility of _____.

A

urolithiasis

118
Q

Presence of crystalluria does not mean there is _____.

A

urolithiasis

119
Q

What are the 5 common crystals?

A
  1. Struvite
  2. Bilirubin
  3. Calcium carbonate
  4. Amorphous
  5. Calcium oxalate dihydrate
120
Q

What are the 4 uncommon crystals?

A
  1. Calcium oxalate monohydrate
  2. Ammonium biurate
  3. Cystine
  4. Drug-associated
121
Q

What are two other names for struvite crystals?

A

Magnesium ammonium phosphate

OR

Triple phosphate

122
Q

What do struvite crystals look like?

A

Have “coffin lid” or “prism” appearance

123
Q

Struvite is the most common type of crystal in _____ and _____.

A

dogs, cats

124
Q

What type of urine do struvite crystals favor?

A

alkaline

125
Q

Struvite crystals are often associated with _____ with _____ bacteria by _____ pH and increasing _____.

A

cystitis, urease-producing, raising, free amonia

126
Q

What do bilirubin crystals look like?

A

Needle-like to granular, yellow, often small crystals

127
Q

What spp are bilirubin crystals common in and what is the clinical significance?

A

Dogs; no clinical significance

128
Q

What do calcium carbonate crystals look like?

A

Variably-sized, frequently appear as large spheroids with radial striations.

129
Q

What color can the urine be when there are high #s of calcium carbonate crystals present?

A

Can have a brownish tinge

130
Q

What spp are calcium carbonate crystals normally found in (in the urine)?

A

Horses, rabbits, guinea pigs, goats

131
Q

What can make up amorphous crystals?

A

Urates, phosphates, xanthine

132
Q

What color and pH can amorphous urates make the urine? Amorphous phosphates?

A

Urates = yellow or yellow-brown; acidic

Phosphates = lack color; alkaline

133
Q

Can specific clinical interpretations be made based on the finding of amorphous crystals?

A

No

134
Q

What do calcium oxalate dihydrate crystals look like?

A

Colorless squares with “X” of variable size

135
Q

What pH does calcium oxalate dihydrate crystals favor?

A

Any

136
Q

What do calcium oxalate monohydrate crystals look like and what do they indicate?

A

Vary in size, may have a spindle, oval, or dumbbell shape;

Indicate supersaturation of urine with calcium and oxalate

137
Q

What spp commonly has calcium oxalate monohydrate crystals in their urine in health?

A

Horses

138
Q

What is presence of calcium oxalate monohydrate crystals associated with in dogs and cats?

A

Ethylene glycol intoxication

139
Q

What do ammonium biurate crystals look like and what type of urine do they favor?

A

Brown or yellow-brown spherical bodies with irregular protrusions;

Favor neutral to acidic urine

140
Q

What conditions are ammonium biurate crystals commonly seen with?

A

In dogs and cats with congenital or acquired portal vascular anomalies (i.e. PSS), +/- ammonium urate uroliths

141
Q

What breeds are predisposed to urate urolithiasis?

A

Dalmatians and Bulldogs

142
Q

What do cystine crystals look like and what type of urine do they favor?

A

Flat colorless plates, hexagonal shape with equal or unequal sides;

Favor acidic urine

143
Q

What does cystinuria result from?

A

Inborn error of metabolism involving defective renal tubular reabsorption of certain amino acids including cysteine.

144
Q

Cystine crystals are almost exclusively found in _____.

A

male dogs

145
Q

Other than crystals and blood, etc., what are some etiologic agents that can be found in urine sediment?

A

Fungal hyphae, parasites, bacteria, TCC

Clinical Pathology (22 decks)

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