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3. Sys Path 2 > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

Complete Urinalysis involves what 3 components

A
  1. Gross visual assessment of urine & USG
  2. Chemical evaluation
  3. Microscopic examination of sediment
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2
Q

Urinalysis in General…
- timing
- temp

A
  • Ideal > within 30 min of collection
    > Refrigerate
    > Low USG can lead to cellular lysis
    <><><>
  • Refrigerate 12 h in sterile, opaque, airtight container > light breaks stuff in it down
    > Warm to room T for 20 min
    > Gently swish to remix
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3
Q

Gross visual assessment of urine & USG includes…

A

a. Physical properties
i. Colour – blood
ii. Turbidity – crystals, cells, bacteria, mucus, casts
iii. Odour – ketones, ammonia, UTI
b. USG–soluteconcentration

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4
Q

USG includes…
- temp? why?

A

Dissolved ions & molecules
* 3+-> 4+ glucose
* 4+ protein
<><><>
Room temperature urine only
* Cold fluids are more dense > FALSELY increased USG

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5
Q

USG - what makes things turbid

A

Turbid urine?
* Cells, casts & crystals are not dissolved > do not contribute to USG
* Light refraction makes line fuzzy
* Use supernatant

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6
Q

USG
- should be interpreted with what?
- values for common species
- isosthenuria?
- cats?

A
  • Interpret with hydration status
  • Dehydrated dog and cat should be at least 1.030 and 1.035, respectively
  • Horse and bovine 1.025
  • Isosthenuria 1.008-1.012
  • Cats maintain some concentrating ability in kidney disease
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6
Q

USG
- hyposthenuria
> what does this mean?

A
  • USG <1.008 – hyposthenuria
    <><><><>
    Active dilution, kidneys working… but…
  • Rarely see in kidney disease when electrolyte concentrations are decreased
  • Central / nephrogenic diabetes insipidus
  • Primary polydipsia
  • Insensitivity to ADH
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7
Q

ignore what dipstick values?

A
  1. Leukocytes
  2. USG
  3. Nitrite
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8
Q

Record what dipstick values?

A
  1. Glucose
  2. Bilirubin
  3. Ketones
  4. Blood
  5. pH
  6. Protein
    > timing of when you record each matters!
    > don’t let things leak onto other ones!
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9
Q

dipstick glucose
- when to read?
- when is it present?
- threshold for common species

A
  • read at 30s (yes, it matters)
    <><>
    Not present in healthy individuals except in certain situations
  • puppies up to 8 weeks of age – immature tubules
    <><>
    Kidney glucose threshold (mmol/L) [mg/dL]:
  • 6 cattle [100]
  • 10 dog [180]
  • 10 horse [180]
  • 15 cat [280]
  • 33 birds [594]
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10
Q

Conjugated bilirubin
- when measured on dipstick?
- species with low threshold?
> what will we see in them?
- what about other species?

A
  • Measure at 30s
    <><>
    Dog:
  • Low renal threshold
  • Expect bilirubinuria before bilirubinemia
  • Canine PCT can conjugate Hb & excrete bilirubin
  • More than 20% normal dogs > 1+ bilirubinuria
    <><>
  • Any other spp > bilirubinuria is ABNORMAL
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11
Q

DDx bilirubinuria:

A
  • Liver disease
  • Bile duct obstruction
  • Starvation
  • Hemolysis
  • Pyrexia
  • Horses off feed
  • 20% of cats with DM or hyperthyroidism
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12
Q

ketones on the dipstick
- when do we measure?
- what do they tell us? Ddx?
- what exactly does the dipstick detect?

A
  • measure at 40s
    <><>
    Excessive / defective lipid or carbohydrate metabolism
  • Ketonuria before ketonemia
  • DDx:
    > NEB
    > DKA
    > Insulinoma
    <><><><>
    Dipstick detects:
  • Acetoacetic acid & acetone – NOT β-OHB
  • β-OHB is predominant form in ruminants
  • Expect β-OHB in bovine ketosis & pregnancy toxemia in ewes
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13
Q

dipstick blood - what is the test detecting?

A
  • pad reacts to ‘iron’
  • Iron – peroxidase activity
  • RBCs lyse & release Hb
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14
Q

hematuria vs. Hemoglobinuria vs. Myoglobinuria
- how do we tell

A

Hematuria:
- PCV: WRI
- Plasma colour: colourless / straw
- Pre-spin urine colour: pink to red
- urine blood rxn: +
- RBCs in sediment: +
- AST & CK: WRI
<><><><>
Myoglobinuria
- PCV: WRI
- Plasma colour: colourless / straw
- Pre-spin urine colour: red/brown
- urine blood rxn: +
- RBCs in sediment:
- AST & CK: Increased
<><><><>
Hemoglobinuria
- PCV: Decreased
- Plasma colour: pink to red
- Pre-spin urine colour: pink to red
- urine blood rxn: +
- RBCs in sediment:
- AST & CK: WRI

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15
Q

dipstick ph
- what is normal
- what can mess this reading up?

A

Normal urine pH:
* Dog, cat, herbivore on milk: 5.5 – 7.5
* Herbivores: 7.0 – 8.5
<><>
* Protein pad leakage onto pH pad > false decreased pH
* Pigmenturia > stains pad
* Old sample > loss of CO2, urea converts to ammonia = increased pH

16
Q

Dipstick Alkaline pH
Caused by:

A
  • UTI (e.g., Proteus and Staph)
  • Low protein diets
  • Respiratory alkalosis
  • Metabolic alkalosis
  • Alkalinizing drugs
17
Q

Dipstick Acidic pH
- when we see this?

A

Carnivores, herbivores on milk, certain drugs
* increased Protein catabolism (diet, hyperthyroid, pyrexia, steroids, neoplasia)
* Furosemide
* Renal tubular acidosis
<><><>
* Metabolic acidoses
<><><>
Hypochloremic metabolic alkalosis
* Cow with displaced abomasum / other species upper GIT foreign body or intestinal ileus
> Low chloride and paradoxical aciduria

18
Q

dipstick protein
- primarily detects what?
- not as good for what? another test?
- SSA
- relation to USG

A

Primarily detects albumin – negative charge
* Insensitive to Bence-Jones proteins & globulins
* Confirm with sulfosalicylic acid turbidometric test
<><>
SSA – FP
* X-ray contrast media, penicillin, cephalosporins
* Cats
<><>
* 1,000 mg/dL protein increases USG ~0.003

19
Q

protein false positive
- how common, species

A

False positives – common:
* Random FP in cats > dogs

20
Q

dipstick protein false negatives

A
  • Low degree of albuminuria
  • Bence Jones proteinuria
21
Q

what can we do with the urine dipstick for protein to further investigate?

A
  • Measure directly on the biochemical analyzer
    > Urine protein:Urine creatinine ratio
  • Urine protein-electrophoresis
22
Q

Urobilinogen on the dipstick:
- what does it tell us? use?

A
  • Unobstructed biliary system
  • Fresh urine
  • Ignore
23
Q

Urine Sediment Preparation

A
  • Spin down urine
  • Pipette supernatant leaving 10% of starting
    volume and sediment
    ßFlick to resuspend
    ßOr gently pipette up and down
    Doing it this way makes it more standardized each time you look at a patient’s urine!
24
Q

Urine Sediment Examination
- what do we evaluate at 10x? 40x?
- how do we prep the slide?

A
  • Casts / LPF (10x)
  • WBC, RBC, epithelial cells, crystals, & bacteria / HPF (40x)
    <><>
  • Use Sedistain
  • Make thick air-dried prep and then stain with Diff-Quik or Wright’s
25
Q

RBC & WBC in Urine Sediment
- normal values? interpretation?

A

Normal <5 RBC and <5 WBC / HPF in well-concentrated urine
* Number should vary directly with amount of urine being produced
* Dilute and alkaline urine may lyse

26
Q

casts in urine sediment - what is normal? interpretation

A
  • <2 fine granular or hyaline casts / 10x field in well-concentrated urine
  • Absence of casts does not rule out kidney disease
27
Q

microscopic hematuria is associated with what on urine sediment exam?

A
  • Cystocentesis – microscopic hematuria
    > Especially cats & animals with bladder wall inflammation
    > Trace to 1+ on dipstick

3. Sys Path 2 (47 decks)

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