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Clin Path > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What are indications for performing a urinalysis?

A
  • aid to search for diagnosis of disease
  • screen patients for asymptomatic diseases
  • monitor biologic behavior of disease
  • monitor effectiveness and safety of therapy
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2
Q

What are the disorders of the urinary system?

A
  • renal disease/failure
  • bacterial infection
  • hematuria
  • neoplasia
  • crystalluria
  • urolithiasis
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3
Q

What is Uremia?

A

abnormal concentration of urine constituents in blood caused by generalized renal disease;marked by polysystemic toxic syndrome which occurs as a result of both kidneys being impaired. Uremic crises may result from disorders such as CHF, acute pancreatitis or endocrine crisis

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4
Q

What is Bacteriuria?

A

bacteria in the urine

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5
Q

What is Pyuria?

A

WBC’s in the urine

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6
Q

What is Hematuria?

A

blood in urine

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7
Q

What is Crystalluria?

A

crystals in urine

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8
Q

What are Uroliths?

A

stones in urine

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9
Q

What are the Non-Urinary Disorders?

A
  • diabetes mellitus
  • diabetes insipidus
  • hepatic failure
  • severe hemolytic disease
  • pre renal azotemia
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10
Q

What conditions are associated with Diabetes Mellitus?

A
  • hyperglycemia
  • glucosuria
  • ketonuria
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11
Q

What condition is associated with Hepatic Failure?

A

bilirubinuria

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12
Q

What is Pre-Renal Azotemia?

A

abnormal concentration of urea, creatinine and other nitrogenous substances in the blood; can be caused by an increased rate of production or decreased rate of removal in urine or both

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13
Q

What can the value of urinalysis be influenced by?

A
  • diet being consumed
  • condition of patient at time of sample collection
  • method of sample collection
  • sample handling and preservation
  • testing methods
  • medications
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14
Q

What is Micturition?

A

act of passing urine, voiding, “peeing”, etc.

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15
Q

What are the methods of sample collection?

A
  • voided
  • bladder expression
  • catheterization
  • cystocentesis
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16
Q

When should a sample be collected?

A

prior to beginning therapy (fluid or drug) in order to ensure accurate results

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17
Q

What type of sample is most concentrated and least affected by dietary factors?

A

early morning, pre prandial

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18
Q

What is the easiest method of sample collection?

A

voided

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19
Q

What can easily contaminate Voided samples?

A

bacteria in distal urethral (vulva/prepuce) secretions

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20
Q

Why can the WBC count be elevated in Voided samples?

A

due to inflammation of genital tract

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21
Q

What type of voided sample is least contaminated?

A

midstream sample

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22
Q

What can affect results of Table Top collected samples?

A
  • cleanliness of table

- chemical agents/disinfectants

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23
Q

What can happen if too much pressure is applied during a Bladder Expression?

A

injure or rupture bladder

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24
Q

What kind of animals should you never use a Bladder Expression on?

A

animal’s with fragile bladder wall or with urethral obstruction

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25
Q

What may become increased due to pressure of a Bladder Expression?

A

RBC’s in sample

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26
Q

What is Catheterization?

A

polyproylene or rubber catheter is inserted into urethra to obtain urine sample

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27
Q

What may be seen due to trauma of urinary tract from a Catheter?

A
  • RBC’s

- epithelial cells

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28
Q

Catheterization is an acceptable method of collection for?

A

culture and sensitivity testing when cytocentesis can’t be performed

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29
Q

When should a sample be collected by Cytocentesis?

A

when the bladder is distended (can be palpated or observed on ultrasound)

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30
Q

What needle and syringe size is used for a Cytocentesis?

A

20-22 gauge, 1 or 1/2 inch needle, 10ml syringe

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31
Q

What position should the animal be during a Cytocentesis?

A
  • standing
  • lateral recumbancy
  • dorsal recumbancy
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32
Q

Where is the needle inserted during a Cytocentesis?

A

caudal abdomen on midline (side of penis in males)

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33
Q

What is commonly seen due to trauma of bladder wall via needle puncture?

A

RBC’s

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34
Q

What are predictable changes that happen to urine when left at room temperature for long periods of time?

A
  • decrease glucose and bilirubin
  • alkaline pH
  • crystal formation
  • increased turbidity
  • breakdown of casts and RBC’s
  • bacterial proliferation
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35
Q

How long does refridgeration preserve most urine constituents?

A

6-12 hours

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36
Q

What can form (or degrade) when sample is refidgerated then brought to room temp?

A

crystals

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37
Q

When must a preservative be added to the urine sample?

A
  • when sending samples to outside lab

- sample must be held for longer than 12 hours

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38
Q

What is the preservative of choice?

A

1 drop of 40% formalin per 1oz of urine

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39
Q

What are other less common preservatives?

A
  • thymol crystal
  • 5% phenol
  • toluene
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40
Q

What should a urinalysis report include?

A
  • patient information
  • collection technique
  • date and time of collection
  • method of preservation (if used)
  • complete results
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41
Q

What is done to maintain Quality Assurance?

A
  • keep reagent strips and tablets in tightly sealed bottles
  • replace outdated reagents with fresh reagents
  • use controls to monitor results
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42
Q

What is a Control?

A

biologic solution of known values, used for verification of accuracy and precision of test results

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43
Q

What are the 3 categories of findings?

A
  • physical findings
  • chemical findings
  • microscopic findings
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44
Q

What is recorded under Physical findings?

A
  • color
  • transparency
  • odor
  • volume
  • USG
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45
Q

What is recorded under Microscopic findings?

A

crystals, casts, bacteria, yeast, aritfacts, WBC’s, RBC’s, epithelial cells, fungi,

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46
Q

What are the Physical Properties of Urine?

A
  • volume
  • color
  • odor
  • specific gravity
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47
Q

What factors affect Urine Volume that are unrelated to disease?

A
  • fluid intake
  • external losses (sensible, insensible, contemporary)
  • environmental temperature and humidity
  • amount and type of food fed
  • level of physical activity
  • species and size of animal
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48
Q

What is the ideal way to deterimine Urine Volume?

A

24 hour urine volume collection

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49
Q

What is the normal daily output of dogs and cats?

A

20-40ml/kg

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50
Q

What is Polyuria?

A

increase in daily output of urine

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51
Q

What conditions/diseases is Polyuria seen?

A
  • steroids
  • diabetes mellitus/insipidus
  • nephritis
  • diuretics
  • fluid admin
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52
Q

What is Pollakiuria?

A

increased frequency of urination

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53
Q

What conditions/diseaes is Pollakiuria seen?

A

marking

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54
Q

What is Oliguria?

A

decreased daily urine output

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55
Q

What conditions/diseases is Oliguria seen?

A
  • dehydration
  • decreased fluid intake
  • vomiting
  • diarrhea
  • increased body temp
  • fever
  • shock
  • heart disease
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56
Q

What is Anuria?

A

no urine output

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57
Q

What conditions/diseases is Anuria seen?

A
  • complete blockage
  • trauma
  • ruptured bladder
  • shut down kidneys
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58
Q

What is Stranguria?

A

straining to urinate

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59
Q

What conditions/diseases is Stranguria seen?

A
  • UTI
  • blocked tom
  • prostatits
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60
Q

What is Polydipsia?

A

increased fluid intake

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61
Q

What conditions/diesease is Polydipsia seen?

A
  • seen with polyuria

- diabetes…etc..

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62
Q

What is the normal color of urine?

A

light yellow to amber due to presence of urochromes (urobilinogen)

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63
Q

Colorless urine

A
  • low USG

- associated with polyuria

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64
Q

Dark yellow to yellow brown urine

A
  • high USG

- associated with oliguria

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65
Q

Yellow-brown, green or greenish yellow; foamy urine

A

contains bile pigments

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66
Q

Red or red-brown urine

A

idicates hematuria or hemoglobinuria

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67
Q

Brown urine

A

contains myoglobin

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68
Q

What kind of odor does male cats, goats and pigs have?

A

strong

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69
Q

What kind of odor may occur with cystitis?

A

amonia

caused by bacteria that produce urease

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70
Q

What can happen to samples left standing at room temp (odor)?

A

ammonia odor from bacterial ingrowth

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71
Q

What does a sweet or fruity odor urine indicate?

A

ketones

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72
Q

What are Ketones in the urine associated with?

A
  • diabetes mellitus
  • ketosis in cows
  • pregnancy disease in sheep (postparturent ketosis, eclampsia)
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73
Q

What is Specific Gravity?

A

weight (density) of a quantity of liquid compared with that of an equal amount of distilled water

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74
Q

What is the most common way to determine Specific Gravity?

A

refractometer

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75
Q

What does interpretation of Specific Gravity yield?

A

info on hydration status and the ability of kidneys to concentrate or dilute urine

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76
Q

What does the USG of normal urine depend on?

A
  • eating and drinking habits
  • environmental temperature
  • time of sample collection
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77
Q

What urine samples tend to be the most concentrated?

A

early morning, mid urination

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78
Q

What is the normal USG range for dogs?

A

1.001-1.060 (1.025)

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79
Q

What is the normal USG range for cats?

A

1.001-1,080 (1.030)

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80
Q

Increased USG is seen with what?

A
  • decreased water intake
  • increased fluid loss through sources other than urination (sweating, panting, diarrhea)
  • increased excretion of urine solutes
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81
Q

Decreased USG is seen with what?

A
  • diseases in which the kidneys cannot reabsorb water

- increased fluid intake such as polydipsia or excessive fluid admin

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82
Q

What is Isosthenuria?

A

USG is equal to specific gravity of plasma

1.008-1.012

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83
Q

In what conditions is Isosthenuria seen?

A
  • chronic renal disease; the closer the USG is to glomerular filtrate, the greater amount of kidney function thats been lost
  • normal renal function that have no need to concentrate urine
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84
Q

What is Hyposthenuria?

A

USG is lower than normal

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85
Q

What is the ability to concentrate urine depend on?

A

ADH and sufficient number of function nephrons and tubules of both kidneys

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86
Q

What is Hypersthenuria?

A

USG is higher than normal

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87
Q

What is the Dehydration range of USG in dogs?

A

1.050-1.070

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88
Q

What is the Dehydration range of USG in cats?

A

1.050-1.085

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89
Q

What is the SG of plasma (glomerular filtrate)?

A

1.010

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90
Q

What are the Chemical Properties of Urine?

A
  • pH
  • protein
  • glucose
  • ketones
  • bilirubin
  • urobilinogen
  • nitrite
  • blood
  • leukocytes
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91
Q

What % of water and solutes does urine consist of?

A
  • 95% water

- 5% solutes (urea, sodium, potassium, phosphate, sulfate, creatinine, uric acid, hormones)

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92
Q

What are the most common chemical properties tested in Vet Med?

A
  • pH
  • protein
  • glucose
  • ketones
  • urobilinogen
  • bilirubin
  • blood/hemoglobin
  • leukocytes
93
Q

What is pH?

A

measurement of hydrogen ions concentration

94
Q

What is urine pH a function of?

A

kidney’s ability to regulate H+ and bicarbonate concentration within the blood

95
Q

What is the normal pH of cats and dogs?

A

6.0-7.0

96
Q

What happens if the urine is too acidic or alkaline?

A

specific crystals or uroliths can form

97
Q

What happens to the pH of samples left standing at room temp?

A

pH increases due to loss of carbon dioxide

98
Q

What does the pH of urine depend on?

A

diet

99
Q

What urine pH does a carnivore have?

A

acidic

100
Q

What are causes of Acidic Urine?

A
  • metabolic or respiratory acidosis
  • vomiting
  • severe diarrhea
  • fever
  • starvation
  • prolonged exercise
  • urinary acidifiers
101
Q

What are causes of Alkaline Urine?

A
  • metabolic or respiratory alkalosis
  • bacterial infections
  • renal tubular acidosis
102
Q

Is protein usually present or absent in urine?

A

absent

103
Q

What causes trace amounts of protein to be present in urine?

A

samples obtained via catheterization, cystocentesis or bladder expression due to trauma (RBC’s)

104
Q

Why is there Protein in the urine from Voided Samples or Bladder Expression?

A

secretions that contaminate urine during passage along genital tract

105
Q

What do Reagent Strips primarily detect?

A

albumin

106
Q

What can cause false positives when using Reagent Strips?

A

occur in alkaline urine depending on diet, UTI or urine retention due to urethral obstruction

107
Q

How is the Urine Protein/Creatinine Ratio obtained?

A

dividing protein concentration by creatinine concentration

108
Q

What are Reagent Strips a screening tool for?

A

proteinuria

109
Q

What is Urine Protein/Creatinine Ratio used to confirm?

A

proteinuria findings on dipstick

110
Q

When should you not perform a Urine Protein/Creatinine Ratio?

A

when there is bacteria in the urine

111
Q

What can yield false negative results in a Urine Protein/Creatinine Ratio?

A

very dilute urine, concentration may be below the sensitivity of testing method used

112
Q

What does Transient Proteinuria result from?

A

temporary increase in glomerular permeability, allowing excess protein to enter filtrate

113
Q

What are causes of Temporary Proteinuria?

A

muscle exertion, stress, convulsions, after partuition, during first few days of life, during estrus

114
Q

What does Proteinuria indicate?

A

in many cases, indicates disease of urinary tract, especially kidneys

115
Q

What is Glycosuria?

A

presence of glucose in urine

116
Q

Is glucose normal or abnormal in urine?

A

abnormal

117
Q

When does Glucosuria occur?

A

when blood glucose level exceeds the renal threshold

118
Q

What can cause False Positives in Glucose testing?

A

various drugs: vitamin C, morphine, asprin, penicillin, and other antibiotics

119
Q

What may lead to blood glucose levels exceeding renal threshold?

A

high carb meal

120
Q

Fear, excitement or restraint in cats can cause what?

A

hyperglycemia and glucosuria as a result of epinephrine release

121
Q

What disease is commonly seen with Glucosuria?

A
  • diabetes mellitus
  • cushing’s
  • pancreatitis
122
Q

What are Ketones?

A

chemical compounds normally produced during fat metabolism

123
Q

Ketones include:

A
  • acetone
  • acetoacetic acid
  • beta-hydroxybutyric acid
124
Q

What Ketones are Reagent Strips most sensitive to?

A

acetoacetic acid

125
Q

What Ketone do Reagent Strips not detect?

A

beta-hydroxybutyric acid

126
Q

What Ketone is primarily responsible for producing acidosis?

A

beta-hydroxybutyric acid

127
Q

Are Ketones normally found in the urine?

A

no

128
Q

Conditions characterized by altered metabolism may result in what?

A

excessive amount of fat catabolism to provide energy

129
Q

What problems develop with excessive Ketones?

A
  • CNS depression

- ketoacidosis

130
Q

What is Ketonuria associated with?

A

diabetes mellitus

131
Q

Ketonemia with ketonuria occurs with?

A
  • high fat diets
  • starvation
  • fasting
  • long term anorexia
  • persistant fever
  • impaired liver function
132
Q

What are causes of Bilirubinuria?

A
  • fever
  • starvation
  • intravascular or extravascular hemolysis (hemolytic disease)
  • intrahepatic or extrahepatic biliary obstruction
133
Q

Is Urobilinogen normal in urine?

A

yes

134
Q

What are true reasons for increased values of Urobilinogen?

A
  • liver dysfunction
  • hepatic infection
  • excessive hemolysis
  • increased urobilinogen production
  • re absorption
  • poisioning
135
Q

What are reasons for true absence or very low values of Urobilinogen?

A
  • failure of bile production

- obstruction of bile passage

136
Q

Why do Nitrates occur in urine?

A

bacterial infections

137
Q

What must occur in order to achieve a positive result of Nitrate?

A

urine must be retained in bladder atleast 4 hour

138
Q

A positive Nitrate test indicates what?

A

bacterial infections, gram negative rods

139
Q

What do tests for blood in urine detect?

A
  • hematuria
  • hemoglobinuria
  • myoglobinuria
140
Q

What is Hematuria?

A

whole blood in urine

141
Q

What is Hematuria usually a sign of?

A

disease that has caused bleeding somewhere in the urogenital tract

142
Q

What is Hemoglobinuria?

A

lysed RBC’s in urine

143
Q

What is Hemoglobinuria a result of?

A

intravascular hemolysis (IMHA, incompatable blood transfusions, leptospirosis, babesiosis, poisionous plants, water intoxication in cattle)

144
Q

What does Myoglobinuria result from?

A

severe muscle damage causing myoglobin to leak from muscle cells into blood

145
Q

How do you distinguish myoglobinuria from hemoglobinuria?

A

look at history and c/s

146
Q

What causes false negatives in Leukocyte testing?

A
  • especially in dogs
  • glucosuria
  • elevated USG
  • certain antibiotics (tetracycline)
147
Q

What causes false positives in Leukocyte testing?

A
  • occurs in ALL cats
  • old samples, fecal contamination
  • epinephrine release (neutrophilia)
  • certain drugs or food
  • microscopic eval. necessary to confirm positive result
148
Q

Microscopic evaluation is important especially for:

A

recognizing diseases of the urinary tract

149
Q

What animals have normal sediment in their urine?

A

horses and rabbits

150
Q

What is the collection method of choice for microscopic examination?

A

cystocentesis

151
Q

What are the constituents of urine sediment?

A
  • WBC’s
  • RBC’s
  • epithelial cells
  • casts
  • crystals
  • microorganisms
  • parasites
  • ova
  • miscellaneous
152
Q

What do RBC’s look like in fresh urine?

A
  • small
  • round
  • smooth edges
  • refractile
  • yellow or orange
  • may be colorless if hemoglobin has diffused during standing
153
Q

What do RBC’s look like in concentrated urine?

A

shrink and crenate

154
Q

What do RBC’s look like in dilute or alkaline urine?

A

swell and may lyse

155
Q

What do WBC’s look like in urine?

A

dull gray or greenish-yellow

156
Q

What happens to WBC’s in concentrated urine?

A

shrink

157
Q

What happens to WBC’s in dilute urine?

A

swell

158
Q

What findings of WBC’s indicate inflammatory process in urinary or gential tracts?

A

2-3 / hpf

159
Q

What is Pyuria?

A

excess of WBC’s in urine

160
Q

Are epithelial cells normal in urine?

A

yes

161
Q

What are the 3 types of epithelial cells found in urinary sediment?

A
  • squamous
  • transitional
  • renal
162
Q

Where do squamous epithelial cells come from?

A
  • distal urethra
  • vagina
  • vulva
  • prepuce
  • presence is normal
163
Q

Where do Transitional Epithelial Cells come from?

A
  • bladder
  • uterus
  • renal pelvis
  • proximal urethra
164
Q

What do increased numbers of transitional epithelial cells suggest?

A
  • cystitis

- pyelonephritis

165
Q

What are the smallest epithelial cells seen in urine?

A

renal epithelial cells

166
Q

What do increased numbers of transitional epithelial cells suggest?

A

parenchyma

167
Q

Where do casts come from?

A

renal tubules

secreted protein precipitates in ACIDIC conditions

168
Q

How are casts classified?

A
  • hyaline
  • epithelial
  • cellular
  • granular
  • waxy
  • fatty
  • mixed
169
Q

What does cast type depend on?

A
  • how quickly filtrate is moving through the tubules

- how much tubular damage is present

170
Q

Casts dissolve in what kind of urine?

A

alkaline

171
Q

What can disrupt casts?

A

high speed centrifugation

172
Q

What do Hyaline casts look like?

A

colorless and transparent

rounded edges

173
Q

What are Hyaline casts composed of?

A

only protein

174
Q

What do Hyaline casts indicate?

A
  • mildest forms of renal irritation
  • fever
  • poor renal perfusion
  • strenous exercise
  • general anesthesia
175
Q

Where do Epithelial cells originate from?

A

renal

176
Q

What do Epithelial cells most commonly result from?

A

when ischemia, infarction or nephrotoxicity cause degeneration and necrosis of tubular epithelial cells

177
Q

What do Leukocyte casts contain?

A
  • WBC’s

- primarily neutrophils

178
Q

What does the presence of Leukocyte casts indicate?

A

inflammation of renal tubules

179
Q

What do Erythrocyte casts look like?

A

deep yellow to orange in color (membranes may or may not be visible)

180
Q

When do Erythrocyte casts occur?

A

when RBC’s aggregate within the lumen of the tubule

181
Q

What do Erythrocyte casts indicate?

A

renal bleeding (hemorrhage resulting from trauma or bleeding disorders or as part of inflammatory response)

182
Q

Where do Granular casts come from?

A

tubular epithelial cells, RBC’s or WBC’s that became incoporated into cast and then degenerate

183
Q

When are Granular casts seen?

A

acute nephritis and indicate more severe kidney damage than do hyaline casts

184
Q

Where are Fatty casts commonly seen?

A

cats with renal disease

diabetic dogs

185
Q

What do Waxy casts look like?

A
  • resemble hyaline casts, but wider and with square ends

- waxy appearance, colorless or gray and highly refractile

186
Q

What do Waxy casts represent?

A

latter stages of cast development/degeneration

187
Q

What do Waxy casts indicate?

A

severe chronic degeneration of tubules

188
Q

What is Crystalluria?

A

presence of crystals in urine

189
Q

What does the type of casts formed depend on?

A

pH (diet)

concentration, temperature, solubility of elements

190
Q

What are the only definitive methods of identifying crystals?

A
  • optical crystallography
  • x ray diffraction
  • chemical analysis
191
Q

What are the most common type of crystals in cats and dogs?

A

struvite

192
Q

What promotes Struvite Crystalluria?

A

UTI with urease-posititve bacteria, by raising urine pH and increasing free ammonia

193
Q

What do Struvite Crystals look like?

A

coffin lids or prisms

194
Q

How many sides do Struvite crystals have?

A

6-8

195
Q

What are Struvite crystals commonly referred to as?

A
  • triple phosphate

- magnesium ammonium phosphate

196
Q

In what kind of urine are Struvite crystals found?

A

alkaline to slightly acidic

197
Q

Where do Amorphous Phosphate crystals form?

A

alkaline urine

198
Q

How do Calcium Carbonate crystals appear?

A
  • rounded with many lines radiating from the center
  • large granular masses
  • dumb bell shaped
199
Q

Where are Calcium Carbonate crystals found?

A

neutral to alkaline urine

200
Q

Calcium Carbonate crystals are normal findings in:

A

horses and rabbits

201
Q

Where do Amorphous urates form in?

A

acidic urine

202
Q

Where do Uric Acid crystals commonly occur?

A

dalmations, bulldogs

cant process purines

203
Q

Where do Urates and Uric Acid Crystals form?

A

acidic acid

204
Q

Ammonium Biurate Crystals are also known as:

A

thorn apples

205
Q

Where do Ammonium Biurate Crystals form?

A

neutral to alkaline urine

206
Q

What disesae are Ammonium Biurate Crystals seen with?

A

severe liver disease

207
Q

Where are Calcium Oxalate crystals formed?

A

acidic and neutral urine

208
Q

Where are Calcium Oxalate crystals commonly seen?

A

small numbers in dogs and horses

209
Q

When are Calcium Oxalate Monohydrate crystals seen in large amounts?

A

antifreeze poisioning

210
Q

Where do Tyrosine Crystals formed?

A

acidic urine

211
Q

What are Tyrosine crystals associated with?

A

liver disease

212
Q

Where do Cystine Crystals form?

A

acidic urine

213
Q

What are Cystine crystals associated with?

A

renal tubular dysfunction or canine urolithiasis

214
Q

Where are Bilirubin crystals seen?

A

canine urine, especially in high concentrated specimens

215
Q

What microorganisms are seen in urine?

A

bacteria
parasite ova and microfilaria
yeast and fungi

216
Q

How are Bacteria in urine identified?

A

high power magnification

217
Q

Why may bacteria appear to be quivering?

A

brownian movement

218
Q

What does a large number of bacteria accompanied by WBC’s suggest?

A

infection and inflammation of urinary tract or genital/reproductive tract

219
Q

What are the parasites of the Urinary Tract?

A

dioctohyma renale

capillaria plica

220
Q

What is Yeast commonly confused with?

A

RBC’s or lipid droplets

221
Q

What are the Miscellaneous Components of Urine?

A
  • mucus threads
  • spermatozoa
  • fat droplets
  • artifacts
222
Q

What are Mucus threads commonly confused for?

A

casts

223
Q

What are Mucus threads indicative of?

A

urethral irritation or contamination of sample with genital secretions

224
Q

Where are large amounts of Mucus threads normally present?

A

urine of horses

225
Q

Where is Spermatozoa occasionaly seen?

A

sediment of intact males

recently bred females

226
Q

What is Lipiduria seen with?

A

obesity
diabetes mellitus
hypothyroidism
rarely, after a high fat meal

227
Q

When do Artifacts enter samples?

A

during collection, transportation or examination

228
Q

What are examples of Artifacts?

A

air bubbles, oil droplets, starch granules, hair, fecal material, plant spores, pollen, cotton fiber, dust, glass particles or chips, bacteria and fungi

Clin Path (8 decks)

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