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Urinalysis Flashcards

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1
Q

what is urinalysis?

A

analysis of urine by physical, chemical or microscopic means to aid in the diagnosis and management of underlying disease

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2
Q

what are the 5 key reasons to perform urinalysis?

A

rapid
cheap
basic equipment required
can be a critical diagnostic technique
supportive for renal, bladder and prostate pathologies
can allow more accurate interpretation of other tests

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3
Q

what pathologies is urinalysis supportive for?

A

renal, bladder and prostate

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4
Q

what are the 3 parts of urinalysis?

A

physical exam
chemical analysis
sediment analysis

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5
Q

what 4th part of urinalysis is sometimes included?

A

uroculture

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6
Q

what are the equipment requirements for urinalysis?

A

microscope with 100x and 400x magnification capacity
centrifuge capable of approx 1500rpm
conical centrifuge tube (capped)
sediment stain
standard graticule grid (or slides and slide covers)
+/- cytological stain

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7
Q

why should the centrifuge tube be capped?

A

some infectious bacteria that can be passed in urine is zoonotic

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8
Q

what effect can method of collection have on the urine sample?

A

can cause massive variation in results particularly sediment and culture

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9
Q

why does collection method affect results?

A

depending on where in the urinary tract the sample has been gained from there will be different types of bacteria
more invasive sampling can result in blood in the sample

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10
Q

what are the 6 main methods of urine collection?

A 
off floor
clean container
free catch
bladder squeeze
catheterisation
cystocentesis
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11
Q

what is cystocentesis?

A

removal of urine from bladder through the abdominal wall via a needle

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12
Q

what are the advantages of free catch collection?

A

easy to collect

can be collected at home

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13
Q

what are the disadvantages of free catch collection?

A

may not be sterile so not as good for culture

may contain cells from distal urinary/reproductive tract

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14
Q

what are the advantages of catheter collection?

A

should be sterile

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15
Q

what are the disadvantages of catheter collection?

A

difficult in females
may be traumatic leading to blood and increased epithelial cells in urine
requires sedation

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16
Q

what are the advantages of cystocentesis collection?

A

sterile - best for culture

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17
Q

what are the disadvantages of cystocentesis collection?

A

more invasive
may cause blood to be present
may require sedation

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18
Q

how much urine should be collected?

A

at least 5ml

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19
Q

what should urine be collected into?

A

sterile universal container to ensure no bacterial contamination

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20
Q

what can be done when using a free catch sample for culture?

A

use of a boric acid tube

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21
Q

what is the role of boric acid in storage of free catch for culture?

A

stops the growth of contaminant bacteria so levels should remain the same as they were when sampled

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22
Q

what must happen when using boric acid tubes?

A

must fill to the line to ensure that sample is not altered by acid

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23
Q

what tubes should be used for cytology?

A

EDTA

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24
Q

where should urine be stored if sampling is delayed more than 30 mins?

A

in the fridge

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25
Q

what effect can leaving urine in direct sunlight have?

A

degradation of bilirubin leading to a false negative

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26
Q

within what time frame is urinalysis best performed?

A

ASAP - within an hour of collection

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27
Q

what is the effect of refrigeration on urine samples?

A

preserves physical and chemical properties of urine, slows bacterial overgrowth and maintains cellular elements

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28
Q

if a sample has been refrigerated what must happen before proceeding with analysis?

A

allow sample to return to room temperature

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29
Q

what effect can storage have on urine samples?

A

formation of urate crystals

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30
Q

how should samples for uroculture be stored?

A

sterile or boric acid

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31
Q

should boric acid be used in cysto samples?

A

no

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32
Q

what must be remembered if cytology is required on urine?

A

collect some into EDTA and make fresh sediment smears

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33
Q

before the test what must be considered?

A

pre-analytical factors

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34
Q

what are the main pre-analytical factors during urinalysis?

A

collection methods
medication that may influence results (antibiotics/steroids)
diet/time post meal

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35
Q

what is the effect of a meal on urine pH?

A

makes it more alkaline

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36
Q

what 3 elements of urine appearance should be recorded?

A

turbidity
colour
any odour

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37
Q

does normal appearance of urine vary between species?

A

yes

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38
Q

what is the usual colour range of urine?

A

pale yellow to amber depending on urochrome pigments

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39
Q

in what species can urine be turbid?

A

horses and rabbits

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40
Q

what colour may urine be in rabbits?

A

tinged red/brown

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41
Q

what effect will time after sampling have on urine colour?

A

will make it darker

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42
Q

what is altered urine colour at sampling usually due to?

A

haematuria
haemoglobinuria
myoglobinuria
bilirubinuria

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43
Q

what colour will urine with haematuria or haemoglobinuria be?

A

red

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44
Q

what colour will urine with myoglobinuria be?

A

brown/black

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45
Q

what colour will urine with bilirubinuria be?

A

orange

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46
Q

what is myoglobinuria due to?

A

muscle damage

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47
Q

what part of urinalysis is specific gravity part of?

A

physical exam

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48
Q

what is specific gravity measured with?

A

refractometer

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49
Q

what is a method for quality control of refractometers?

A

measuring specific gravity of distilled water

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50
Q

what is the specific gravity of distilled water?

A

0.0

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51
Q

at what temperature should specific gravity be measured?

A

room temp

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52
Q

should specific gravity be measured with a dipstick?

A

no

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53
Q

why may specific gravity vary normally?

A

hydration levels

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54
Q

what is hypersthenuria?

A

concentrated urine of normal healthy animals

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55
Q

what is the specific gravity of hypersthenuria (normal urine)?

A

> 1.012-1.015

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56
Q

what is isosthenuria?

A

urine is neither concentrated or dilute and equal to plasma filtrate

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57
Q

what is the specific gravity of isosthenuria (normal urine)?

A

1.007 - 1.012

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58
Q

what does isosthenuria suggest?

A

fluid has moved through kidney and remained exactly the same

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59
Q

what is hyposthenuria?

A

urine more dilute than plasma

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60
Q

what is the specific gravity of hyposthenuria?

A

<1.007

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61
Q

what does persistent isosthenuria and hyposthenuria warrant?

A

further investigation

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62
Q

when should urea be concentrated?

A

in a dehydrated animal

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63
Q

what are specific gravity readings for dehydrated cats and dogs?

A

Dogs - 1.025 - 1.030

Cats - 1.030 - 1.035

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64
Q

what are the 3 main benefits of urine dipstick analysis?

A

simple
cheap
quick

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65
Q

what is crucial about reading results from a urine strip chart?

A

readings are taken at the correct time after test begins

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66
Q

what are the reliable readings on a urine dipstick in animals?

A 
pH
protein
glucose
ketones
bilirubin
blood
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67
Q

what is measured by a urine dipstick looking at blood?

A

anything containing haem

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68
Q

what are the unreliable readings on a urine dipstick in animals?

A

urine specific gravity
urobilinogen
nitrate
leukocytes

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69
Q

what is the issue with urine dipstick tests of nitrites?

A

more specific than sensitive, many non-nitrate producing UTI’s exist

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70
Q

what would positive nitrates on a dipstick suggest?

A

UTI

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71
Q

what would negative nitrates on a dipstick suggest?

A

may still be a UTI from bacteria that don’t produce nitrates!

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72
Q

what is pH of a sample rapidly affected by?

A

storage of the sample

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73
Q

what is the normal urine pH in herbivores?

A

alkaline >7

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74
Q

what is the normal urine pH in carnivores?

A

acidic 5.5-7.5

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75
Q

what forms at different pH levels?

A

different urine stones

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76
Q

what protein is most often measured on dipstick tests?

A

albumin

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77
Q

when may dipsticks give false negatives for protein?

A

in alkaline urine or in presence of detergents

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78
Q

what must the amount of protein be considered in relation to?

A

urine concentration

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79
Q

what is normal in highly concentrated samples?

A

trace or 1+ proteinuria

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80
Q

what should proteinuria in dilute samples or >1+ in concentrated samples be checked with?

A

urine protein to creatinine ratio (UPC)

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81
Q

what is the role of the protein:creatinine ratio?

A

removes the influence of concentration of urine on assessment of the amount of protein

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82
Q

what can influence UPC?

A

haematuria

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83
Q

what UPC in non-azotemic animals is considered normal?

A

<0.5

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84
Q

what UPC in non-azotemic animals should be rechecked?

A

0.5-1

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85
Q

what UPC in non-azotemic animals suggests glomerular disease?

A

> 2

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86
Q

how does azotemia affect proteinuria significance?

A

smaller limits - >0.4 is considered proteinuric

87
Q

what causes pre renal proteinuria?

A 
hyperproteinaemia
hyperthermia
intense exercise
seizures
venous congestion secondary to cardiac disease
88
Q

what causes renal proteinuria?

A

glomerular

tubular

89
Q

what causes post renal proteinuria?

A

inflammation

hematuria from after renal pelvis or extra-urinary sources (genital tract)

90
Q

can a urine dipstick differentiate between intact RBC, haemoglobin and myoglobin?

A

no - microscopy required

91
Q

is the glucose test on a dipstick accurate for animals?

A

yes

92
Q

is glucose normally found in the urine of healthy animals?

A

no

93
Q

what causes glycosuria?

A

persistent hyperglycaemia
transient hyperglycaemia
renal tubular disorders (glucose leaking from blood)
false positives

94
Q

what causes persistent hyperglycaemia?

A

diabetes mellitus

95
Q

what causes transient hyperglycaemia?

A

stress in cats
drugs
IV fluids containing glucose
convulsion

96
Q

what causes false positive for glucose?

A

bleach
hydrogen peroxide
sample collection pot!

97
Q

is the ketone test on a dipstick accurate for animals?

A

yes

98
Q

what does ketone test on a dipstick not detect?

A

beta-hydroxybutiric acid which is one of the first ketones to rise

99
Q

are ketones normally found in the urine of healthy animals?

A

no (traces in rabbits)

100
Q

what are the causes of ketonuria?

A

diabetes mellitus in diabetic ketoacidosis
starvation
ketosis

101
Q

what level of bilirubin is normal in dogs if urine is concentrated?

A

trace to +

102
Q

is there any bilirubin present in the urine of healthy animals apart from dogs?

A

no

103
Q

what are the causes of bilirubinaemia?

A

liver/biliary disease

haemolytic anaemia

104
Q

what are the normal findings on a urine strip?

A

majority negative
pH varies between species (carnivore/herbivore)
dogs can have 1+ for bilirubin if urine is concentrated
cats can have 1+ for protein if urine is concentrated

105
Q

what should be done to the urine sample immediately before centrifugation for analysis?

A

sample should be mixed well

106
Q

once urine has been mixed where should it be transferred to?

A

conical tipped, capped centrifuge tube

107
Q

how much urine should be transferred the centrifuge tube?

A

standard volume (usually 5ml but doesn’t matter as long as it is always the same)

108
Q

what rpm should the centrifuge be set on and for how long?

A

1500 rpm

5 mins

109
Q

what should be done once the urine is removed from the centrifuge?

A

supernatant decanted with a pipette leaving a small amount for resuspension

110
Q

how much supernatant should be left in the pipette for resuspension?

A

0.5ml

111
Q

how much stain should be added to the sample if used?

A

equal volume to sediment

112
Q

how can the sediment be resuspended?

A

flicking tube gently until well mixed

113
Q

what are the main 2 methods for analysis of sediment?

A

using commercial graticule or single drop under a standard square coverslip

114
Q

describe the process of sediment examination

A

sediment is remixed with a drop of supernatant and then pipetted onto a clean glass slide.
it is covered with a coverslip and then examined under low light

115
Q

how do you examine under low light with a microscope?

A

lowering condenser and closing the aperture of the diaphragm

116
Q

what is the benefit of viewing sediment crystals in low light?

A

makes the crystals easy to see

117
Q

what can been seen during the low power (10x objective) view of sediment?

A

scanning overview and initial quantification of elements (casts, crystals, cells)

118
Q

what objective is the low power lens?

A

10x

119
Q

what objective is the high power lens?

A

40x

120
Q

what can been seen during the high power (40x objective) view of sediment?

A

identification of morphology, bacteria and quantification of RBC and WBC

121
Q

how may a sample be scored?

A 
numerical scores per high power field
subjective count (low, medium, high)
122
Q

what sort of prep is used for sediment analysis?

A

wet prep

123
Q

are sediment analysis slides usually stained?

A

no

124
Q

what is the main aim of sediment analysis?

A

identifies categories of cells/objects present

125
Q

what is mainly viewed in sediment analysis?

A

crystals and casts

126
Q

what sort of prep is used for cytology slides?

A

dry prep - as with blood smear

127
Q

are cytology slides stained?

A

yes - diff quick or Wrights

128
Q

what is the main aim of cytology?

A

attempts to determine if cells are cancerous or not as well as presence of bacteria/infection

129
Q

what is mainly viewed during cytology?

A

bacteria and cells

130
Q

how many erythrocytes are usually seen per 400x field?

A

less than 5

131
Q

what may affect levels of erythrocytes in specimen?

A

type of collection - free catch should have very little whereas cystocyntesis will produce more due to trauma

132
Q

what can happen to erythrocytes in low specific gravity urine?

A

heamolysis

133
Q

how will erythrocytes appear under the microscope?

A

biconcave disks - may be crenated or swollen

134
Q

how will ruptured erythrocytes appear?

A

membrane only - ghost cells

135
Q

what can the presence of erythrocytes in sediment analysis indicate?

A

trauma, oestrus, infection/inflammation

136
Q

how many leucocytes are usually seen per 400x field?

A

less than 5

137
Q

what does presence of leukocytes in sediment analysis suggest?

A

inflammatory process

138
Q

what size are leucocytes compared to RBC?

A

1.5 to 2x larger

139
Q

what do leucocytes look like under the microscope?

A

granular cytoplasm

lobed or segmented nuclei

140
Q

what can be done to aid differentiation between leucocytes and epithelial cells?

A

air dried sample and Giemsa stain

141
Q

visually what information about infection cannot be gained from viewing lecocytes in sediment analysis?

A

whether it is septic or sterile (eg. in response to uroliths)

142
Q

why is using an air dried smear important when looking at leucocytes?

A

helps guide antimicrobial use and so aids stewardship

143
Q

in what sort of collection method are squamous epithelial cells seen most often?

A

free catch

144
Q

where do squamous epithelial cells originate from?

A

externally or distal urethra

145
Q

how do squamous epithelial cells appear under the microscope?

A

large/flattened cell, usually anucleated

may be folded or rolled

146
Q

what may be attached to squamous epithelial cells if the are external in origin?

A

bacteria

147
Q

what sort of epithelial cells are often seen in urine samples?

A

transitional epithelial cells

148
Q

how large are transitional epithelial cells?

A

up to 40 um

149
Q

what must be done to diagnose transitional cell carcinoma?

A

nuclear staining - air dried cytology

150
Q

what can changes in transitional epithelium morphology be caused by?

A

exposure to urine

151
Q

what sort of sampling techniques most often delivers transitional epithelium in clusters?

A

traumatic (e.g. catheterisation)

152
Q

what are the most common/important crystals found in urine?

A 
struvite
calcium oxalate (dihydrate and monohydrate)
ammonium biurate
bilirubin
calcium carbonate (rabbits and horses)
153
Q

what is formation of crystals influenced by?

A

urine pH

temperature

154
Q

what are the 2 types of calcium oxalate crystals?

A

dihydrate and monohydrate

155
Q

what are struvite crystals also known as?

A

magnesium ammonium phosphate

156
Q

what do struvite crystals look like?

A

usually rectangular
‘roof tops or casket lids’
line through the centre is key feature

157
Q

what pH are struvite crystals found at?

A

alkaline

158
Q

in what animals are struvite crystals seen?

A

normal animals
those with uroliths of any type
urinary tract disease
UTI

159
Q

what happens to struvite crystals if acidified?

A

dissolve

160
Q

how can some struvite crystals be resolved?

A

feeding acidifying diets

161
Q

what do calcium oxalate crystals look like?

A

squares with intersecting lines from each corner - a ‘tick box’
may occur singularly or conglomerate structures

162
Q

can calcium oxalate dihydrate crystals be seen with or without calcium oxalate uroliths?

A

both with and without

163
Q

why can calcium oxalate uroliths be seen on x-ray?

A

presence of calcium

164
Q

what pH of urine are calcium oxalate crystals seen?

A

any

165
Q

what do calcium oxalate monohydrate crystals look like?

A

‘oval dingys’

very shiny

166
Q

what conditions lead to calcium oxalate monohydrate crystals forming?

A

hypercalcaemia and excessive oxaluria

ethylene glycerol toxicity

167
Q

what is ethylene glycerol toxicity?

A

anti-freeze poisoning

168
Q

are calcium oxalate monohydrate crystals seen with calcium oxalate dihydrate crystals?

A

yes but can be seen alone as well

169
Q

what do ammonium biurate crystals look like?

A

‘thorn apple’ - brownish with spikes

170
Q

what conditions are indicated by ammonium biurate crystals?

A

liver function compromise particularly portosystemic shunt

171
Q

what breeds have increased incidence of ammonium biurate crystals?

A

dalmatians and english bulldogs

172
Q

what pH are ammonium biurate crystals seen at?

A

acidic and neutral

173
Q

how do amorphus urates appear?

A

no defined shape - granular material

174
Q

when are amorphus urates seen?

A

simular circumstances to ammonium biurate crystals

175
Q

when may bilirubin crystals be normal?

A

concentrated urine in dogs

176
Q

in what animal is any bilirubin abnormal?

A

cats

177
Q

when are increased amounts of bilirubin crystals seen?

A

pre-hepatic, hepatic and post hepatic origin jaundice

178
Q

what do bilirubin crystals look like?

A

golden yellow ‘winter trees’

179
Q

what pH urine are calcium carbonate crystals seen in?

A

alkaline

180
Q

what animals are calcium carbonate crystals common in?

A

horses and rabbits

181
Q

what do calcium carbonate crystals look like?

A

brown/golden with concentric and radial striations

182
Q

what do cystine crystals look like?

A

flat/hexagonal crystals

183
Q

what do drug related crystals look like?

A

spiky with no colour

184
Q

where are urinary casts formed?

A

nephron

185
Q

what can form a hyaline (protein) cast?

A

Tamm-Horsfall mucoprotein secreted in loop of Henle, distal tubule and collecting duct

186
Q

how are granular casts formed?

A

cells become snared on mucoprotein which then degenerate as it continues down tubule/duct

187
Q

what are the 4 main types of cast?

A

hyaline
granular
waxy
cellular

188
Q

which are the most common casts?

A

granular

189
Q

what are the 3 types of cellular cast?

A

RBC
WBC
epithelial

190
Q

what number and type of cast is normal in concentrated urine?

A

low level granular and hyaline

191
Q

what do high numbers of casts suggest?

A

renal insult: hypoxia, ischemia

192
Q

how are cast quantified for reporting?

A

number seen per low power field and classified by type

193
Q

what is the appearance of granular casts?

A

textured - fine to course

194
Q

what is the appearance of hyaline casts?

A

smooth

195
Q

how are cellular casts formed?

A

with renal tubular injury epithelial cells slough into lumen of the renal tubules and are caught within hyaline cast (mucoprotein)

196
Q

how are coarsely and finely granular casts formed?

A

degeneration of epithelial cells so they can no longer be recognised as cells within hyaline matrix. Coarsely granular are formed followed by finely granular

197
Q

what is the final step in formation of casts?

A

waxy cast

198
Q

what do waxy casts indicate?

A

chronic tubular disease

199
Q

how can epithelial cell casts be differentiated from leukocyte casts?

A

cytology

200
Q

what do epithelial cell casts imply?

A

renal damage by disease processes (e.g. ischemia or necrosis of tubular epithelial cells)

201
Q

what may be seen alongside leukocyte cast?

A

lower UTI

202
Q

what must leukocyte casts have to mold the cells into cylinders?

A

tubular molding through renal involvement

203
Q

what colour are erythrocyte casts?

A

red

204
Q

what does an erythrocyte cast denote?

A

renal bleeding - idiopathic renal haematuria or trauma

205
Q

what is visible in the hyaline material of an erythrocyte cast?

A

individual erythrocytes

206
Q

in what animals is lipid in urine normal?

A

cats

207
Q

what is lipid presence in urine the result of ?

A

normal tubular degeneration

208
Q

is there direct relationship between lipidaemia and lipiduria?

A

no

209
Q

when may yeast or fungi in urine be pathological?

A

immunocompromised animals on chronic antibiotics

210
Q

what should be suspected if presence of yeast/fungi with no inflammation (WBC)?

A

contamination and overgrowth

211
Q

what are the common parasites seen in urine?

A

Capillaria plica or Capillaria felis cati - lemon shaped

Dioctophyme renale and Dirofiliria microfilaria

212
Q

what other things may potentially be seen during sediment analysis?

A

spermatozoa

contaminants - particularly from free catch

213
Q

what are 4 examples of common contaminants?

A

fungi
textile fibres
pollen
mites

X Pre Clinical Science (17 decks)

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