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Hematology > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What is the purpose of urinalysis?

A

The purpose of urinalysis is to diagnose and manage renal or urinary tract disease, and to detect metabolic or systemic diseases not related to the kidney.

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2
Q

Why is a morning sample best when collecting urine via normal micturation?

A

A morning sample is best because it is more concentrated and is free from influences such as feeding or exercise.

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3
Q

Why should you avoid the initial stream when collecting urine via normal micturation?

A

The initial stream may contain cells or debris from the urethra or genital tract.

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4
Q

When must sterile containers be used to collect urine samples via normal micturation?

A

Sterile containers should be used when making a bacterial culture?

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5
Q

What methods can be used to collect a urine sample for urinalysis?

A

Collection via normal micturation (voided), manual compression of the urinary bladder, catheterization, or cystocentesis.

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6
Q

What are the advantages of urine collection via catheterization?

A

Catheterization provides an immediate sample that is practically free from contamination.

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7
Q

Is bacteria present in normal urine?

A

no

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8
Q

What is a disadvantage of urine collection via catheterization?

A

Catheter trauma may increase number of RBCs and epithelial cells.

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9
Q

When is cystocentesis most commonly used?

A

Cystocentesis is most commonly used to collect urine from small animals.

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10
Q

Why should urine samples be fresh when analyzed?

A

Samples should be fresh when analyzed because bacteria in a sample may multiply, cells break down, casts may dissolve in alkaline urine, and some bacteria may increase pH.

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11
Q

What should you do if you are unable to perform urinalysis within one hour of collection?

A

refrigerate the sample

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12
Q

What effect does refrigeration have on a urine sample?

A

The specific gravity is slightly increased.

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13
Q

What effect does freezing have on a urine sample?

A

It alters the sediment, however it is an acceptable preservation for chemistry analysis.

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14
Q

What effect does formalin have on a urine sample?

A

One drop of formalin preserves formed elements, but alters the chemistry of the urine.

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15
Q

What are the components of a complete urinalysis?

A

A complete urinalysis consists of examining the physical characteristics of the urine, measuring the specific gravity (concentration of solids), running routine chemistries, a microscopic sediment examination all using routine protocol and as soon after collection as possible.

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16
Q

What are the physical characteristics of normal urine?

A

Normal urine is amber/yellow due to urochrome pigment. Its intensity of color depends on concentration. Clear is normal except in horses and rabbits.

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17
Q

What are causes of abnormally colored urine?

A

hemorrhage (red), hemoglobinuria (red), bilirubinuria (dark yellow/orange/brown w. colored foam upon agitation) and myoglobinuria (brown)

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18
Q

Define hemoglobinuria.

A

the presence of hemoglobin in the urine, causing it to turn red in color

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19
Q

Define bilirubinuria.

A

the presence of bilirubin in the urine, causing it to turn dark yellow/orange/brown in color and colored foam upon agitation

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20
Q

Define myoglobinuria.

A

the presence of myoglobin in the urine, causing it to turn brown in color

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21
Q

What are possible causes of turbidity in urine?

A

Mucus, crystals, cells, semen, bacteria, lipids, and casts are all possible causes of turbidity in urine.

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22
Q

Define floculent.

A

loosely clumped in texture

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23
Q

What is urine volume related to?

A

Urine volume is related to fluid intake, exercise and the size of the animal.

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24
Q

Define polyuria.

A

abnormally excessive urination

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25
Q

What are some physiologic causes of polyuria?

A

Increased water consumption, supplemental fluids, steroid administration, and diuretic administration are all possible physiologic causes of polyuria.

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26
Q

What are some pathologic causes of polyuria?

A

Chronic renal disease, diabetes mellitus, diabetes insipidus, hyperadrenocorticism, psychogenic polydipsia, and renal glycosuria are all possible pathologic causes of polyuria.

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27
Q

Define oliguria.

A

abnormally low urination

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28
Q

What are some physiologic causes of oliguria?

A

Decreased water intake, dehydration, and exercise are all possible physiologic causes of oliguira.

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29
Q

What are some pathologic causes of oliguria?

A

Acute renal failure, urinary tract obstruction, terminal chronic renal failure, and shock are all possible pathologic causes of oliguria.

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30
Q

What does urine with an ammonia odor indicate?

A

retained urine

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31
Q

What does urine with a fetid odor indicate?

A

protein breakdown

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32
Q

What does urine with an acetone odor indicate?

A

ketosis

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33
Q

Define urine specific gravity.

A

Specific gravity is a measure of the total solids in the urine as compared to water. It indicates the concentrating and diluting abilities of the kidneys.

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34
Q

What are some possible causes of variations in urine specific gravity?

A

Diet, fluid intake, climate and activity are all potential causes of variations in urine specific gravity.

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35
Q

What methods can be used to measure urine specific gravity?

A

A urinometer or refractometer is used to measure urine specific gravity.

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36
Q

How much urine is required to measure urine specific gravity using a urinometer?

A

10-15ml

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37
Q

How does a standard refractometer differ from a veterinary refractometer?

A

A standard refractometer measures up to 1.035-1.050. A veterinary refractometer measures up to 1.060 and has seperate scales for cats and dogs/large animals.

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38
Q

Define hematouria.

A

urine containing blood, turning it red

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39
Q

How is urine specific gravity interpreted?

A

Urine specific gravity can range from 1.000 (water) to >1.060. It is usually inversely related to volume.

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40
Q

Define isothenuria.

A

continued excretion of urine at the SG of glomerular filtrate (1.008-1.012)

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41
Q

What may isothenuria indicate?

A

Isothenuria may be a chance finding of normal kidneys, or it may indicate a complete lack of concentrating ability of nephron tubules (at least 2/3 of nephrons nonfunctional).

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42
Q

How may a lack of concentrating ability of the nephron tubules of the kidneys be confirmed?

A

Lack of concentration ability may be confirmed by demonstrating dehydration and/or azotemia.

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43
Q

How are the chemical characteristics of urine analyzed?

A

Chemical characteristics are analyzed by use of reagent strips.

44
Q

What is the procedure for analyzing urine using reagent strips?

A

Immerse the dipstick in well mixed, unspun urine, blot excess urine and visually compare the test areas.

45
Q

What does urine pH indicate?

A

Urine pH is a crude index of the body’s acid-base balance.

46
Q

What is the normal range of urine pH?

A

5-8.5

47
Q

What factors may affect urine pH?

A

Urine pH depends somewhat on diet and metabolism, and becomes alkaline when kept at room temprature.

48
Q

What values are associated with urinary cystitis?

A

Alkaline values are often associated with urinary cystitis because of the bacterial catabolism of urea to ammonia.

49
Q

Define proteinuria

A

presence of protein in the urine

50
Q

What are possible causes of proteinuria?

A

Glomerular or tubular disease, hemorrhage, and inflammatin are all possible causes of proteinuria.

51
Q

What are possible sources of protein in the urine?

A

plasma, urinary tract, sometimes the genital tract

52
Q

When are small amounts of protein in urine significant?

A

Small amounts of protein are significant in dilute urine.

53
Q

What are the normal glucose levels in urine?

A

Glucose is not normally present in urine - no color change on the reagent strip is normal. Glucose is normally filtered by the glomerulus and reabsorbed by the proximal tubules.

54
Q

Define glycosuria.

A

glucose in the urine exceeding the renal threshold

55
Q

What are some possible causes of glycosuria?

A

Stress, especially in cats, diabetes mellitus, and primary renal glycosuria are all possible causes of glycosuria.

56
Q

Define ketonuria.

A

presence of ketones in the urine

57
Q

When does ketonuria occur?

A

Ketonuria occurs when excessive amounts of fatty acids are metabolized, accumulate in the blood and then are excreted in the urine.

58
Q

What is the most important cause of ketonuria>

A

Diabetes mellitus is the most important cause of ketonuria.

59
Q

When may a false positive for ketonuria occur?

A

False positives may occur with highly pigmented urine.

60
Q

What are some possible causes of ketonuria other then diabetes melletus?

A

Fevers, anorexia, pregnancy, starvation, ketosis (in cattle)

61
Q

What may cause a false negative for bilirubin?

A

Excessive delay in reading

62
Q

What are some causes of bilirubinuria?

A

hepatocellular disease, obstructive biliary tract disease, hemolyis, may also be present in normal dogs

63
Q

How is hematuria identified?

A

Hematuria causes red, cloudy urine with RBCs after being spun down for sedimentation.

64
Q

How is hemoglobinuria identified?

A

Hemoglobinuria causes red to brown urine with absence of RBCs in the urine sedimentation.

65
Q

How is myoglobinuria identified?

A

Hemoglobinuria causes brownish urine, with an absence of RBCS in the urine sedimentation. There is also absence of evidence of hemolysis.

66
Q

What does myoglobinuria idicate?

A

muscle disease

67
Q

What is the normal reading for urobilinogen?

A

negative in many normal animals, not a very valuable test

68
Q

What does a positive urobilinogen test indicate?

A

A positive test indicates patent bile duct, and increased concentrations are seen in cases of hemolysis and decreased functional hepatic mass.

69
Q

What is the procedure for urine sedimentation examination?

A

The urine is centerfuged for 5 minutes at a low rate of speed (1000-3000 RPM). The supernate is poured off, and the remaining sediment and supernate is mixed gently. Pipette 1 drop to the slide, add coverslip, and examine with microscope. One drop of Sedi-stain may be added to the remaining sediment and 1 drop added to the same slide with a coverslip.

70
Q

How is a urine sedimentation examined using a microscope?

A

Scan the sample under the 10x objective and with low light, noting the presence of casts. Report types and average numbers/LPF. Examine at least 10 fields with the 40x objective, estimating the average numbers of RBCs, WBCs, and epithelial cells/fiend. Report relative quantities of bacteria, amorphous and other crystals, and fat droplets as few/moderate/many. Note the presence of sperm, mucus, yeast, etc.

71
Q

How are squamous epithelial cells identified in a sediment examination?

A

Squamous epithelial cells are the largest cells seen in a sediment examination. They have an irregular outline with angular margins and a small, round nucleus. They occur singly or in sheets, and originate from the urethra and/or the vagina/prepuce.

72
Q

How are transitional epithelial cells identified in a sediment examination?

A

Transitional epithelial cells are between squamous and renal epithelial cells in size. Shapes may vary - round, oval, spindled and caudate shapes are seen. They may be in clusters or single, and are of little diagnostic importance unless they are neoplastic. A few will normally have two nuclei. They originate from the renal pelvis, ureter, urinary bladder, or the proximl urethra.

73
Q

How are renal epithelial cells identified on a sediment examination?

A

Renal epithelial cells are small, round, and slightly larger then RBCs. They usually degenerate and are difficult to identify. They originate in the renal tubules.

74
Q

How are erythrocytes identified on a sediment examination?

A

Erythrocytes as seen on a urine sediment examination are round, slightly light refractile, and range from colorless to pale orange. They may crenate in concentrate urine or balloon/lyse in dilute urine.

75
Q

What does a presence of erythrocytes > 4-5/HPV indicate?

A

a hemorrhage at some point in the urinary tract, possibly due to a needle puncture or catheter trauma depending on the method of collection

76
Q

How are leukocytes identified on a sediment exam?

A

Leukocytes as seen on a urine sediment exam are large, granular cells with a nucleus that is frequently degenerate. They are larger then RBCs but smaller then epithelial cells.

77
Q

Define pyuria.

A

pus (neutrophils) in the urine

78
Q

What is a possible cause of pyuria?

A

inflammation of the genitourinary tract due to cystitis, pyelonephritis, etc.

79
Q

What condition is pyuria frequently associated with?

A

Pyuria is frequently associated with bactiuria.

80
Q

Define bacturia.

A

presence of bacteria in the urine

81
Q

What do casts in a sedimentation exam indicate?

A

renal irritation, renal inflammation, or renal degeneration

82
Q

What condition is often associated with the presence of casts on a sedimentation exam?

A

proteinuria

83
Q

How are hyaline casts identified on a sediment exam?

A

Hyaline casts are made of protein alone, and are colorless, semitransparent, and cylindrical with rounded ends. A few may be present in normal urine, but they may also indicate the mildest form of renal irritation.

84
Q

How are granular casts identified on a sedimentation exam?

A

Granular casts are the most common type of cast seen. They are hyaline casts containing granules, and are primarily derived from the disentigration of the tubular epithelial cells. They indicate more severe renal disease then hyaline casts.

85
Q

How are waxy casts identified on a sedimentation exam?

A

Waxy casts are broader then hyaline casts, highly refractive and brittle, and usually have broken off square ends. They are yellow or dull waxy in appearance. Waxy casts indicate severe nephritis and renal degeneration.

86
Q

How are fatty casts identified on a sedimentation exam?

A

Fatty casts contain many fat globules that are very refractive.

87
Q

Where are fatty casts commonly seen?

A

Fatty casts are commonly seen in cats with renal disease due to the increased lipid content of urine.

88
Q

How are RBC casts identified on a sedimentation exam?

A

RBC casts are deep yellow or orange in color, and consist of RBCs incorperated in a hyaline matrix. They indicate hemorrhage has occurred within the nephron of the kidney.

89
Q

How are WBC casts identified on a sedimentation exam?

A

White blood cell casts consist of intact leukocytes incorperated in the hyaline matrix. They indicate renal inflammation i.e. pyelonephritis

90
Q

How is bacteria identified on a urine sedimentation exam?

A

Bacterial rods occur singly or in chains. Cocci may be more difficult to ID if seen singly; staining may help.

91
Q

What is the significance of bacteria seen on a urine sedimentation exam?

A

Normal urine is sterile until it reaches mid-urethra. Bacteria may be normal in samples collected via catheter or voiding, but is not normal in urine collected via cystocentesis.

92
Q

How are fat droplets identified on a urine sediment exam?

A

Fat droplets are round, highly refractile, and vary in size. They float to the undersurface of the coverslip. Fat droplets are present in most cats. They indicate fat metamorphosis of the renal tubules, obesity, high fat diets, hypothyroidism, and diabetes mellitus.

93
Q

How is mucus identified on a urine sediment exam?

A

Mucus as seen on a urine sediment exam appears as narrow, twisted, ribbon like strands. It can be caused by urethral irritation or genital secretions.

94
Q

In what species is mucus a normal finding on a urine sediment exam?

A

the horse

95
Q

When is sperm seen in a urine sediment exam?

A

Sperm is commonly seen in U/A of intact male animals, and may be seen in voided or catheterized samples of female animals post breeding.

96
Q

What factors contribute to crystal formation in urine?

A

Crystal formation depends on pH, solubility, the concentration of the crystalloid, and the administration of drugs.

97
Q

What is the significance of crystals in a urine sediment exam?

A

They can be seen in cases of urolithiasis and in a few metabolic disturbances but are otherwise of little importance

98
Q

How are struvite/magnesium ammonium phosphate crystals identified?

A

they appear as “coffin lids” or envelopes and are presennt in alkaline, neutral and slightly acid urine

99
Q

How are calcium carbonate crystals identified?

A

they appear as spheres/ovals/dumbbells and are formed in alkaline urine. they are common in horses

100
Q

How are calcium oxalate dihydrate crystals identified?

A

they appear as small colorless envelopes, and are formed in acid, slightly neutral and alkaline urine

101
Q

How are calcium oxalate monohydrate crystals formed?

A

they are colorless and rectangular with blunt points (“picket fences”) and are formed in acid, neutral and slightly alkaline urine. they indicate ethelyne glycol toxicity

102
Q

How are ammonium biurate crystals identified?

A

they are yellow, opaque, or brown in color and appear as “thorn apple” spheres. they are often covered with spicules, dumbbells, or sheaves of needles and are formed in alkaline urine. commonly seen in dalmations, and may be seen with portal caval shunt or liver disease

103
Q

How are bilirubin crystals identified?

A

Bilirubin crystals appear as yellow to reddish brown needle-like structures in bundles, and form in acid urine.

104
Q

How are cystine crystals identified?

A

they appear as flat, colorless, hexagonal plates with well defined edges that occur singly or in clusters. they indicate altered protein metabolism; congenital cystinuria in dogs

105
Q

When are sulfonamide crystals seen?

A

with exessive treatment (with sulfa drugs)

106
Q

When are tyrosine crystals seen?

A

rarely seen with liver disease

107
Q

What are some possible artifacts seen on a sediment exam?

A

pollen grains/spores, glass particles, fecal material, fragments of cotton or other fabric, starch granules from glove powder, etc

Hematology (11 decks)

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