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RUSVM Clin Path > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

T/F cystocentesis is an invasive procedure

A

true

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2
Q

when is a cysto contraindicated

A

Local pyoderma, coagulopathy, neoplasia (risk of seeding)

Insufficient volume of urine in the urinary bladder

Patient resists restraint and abdominal palpation

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3
Q

what is the recommended technique for urine culture

A

Cystocentesis

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4
Q

Voided urine

A

mid stream flow

generally acceptable for U/A, sediment exam

not suitable for culture

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5
Q

Catheterization can result in

A

Blood or epithelial cell contamination

Trauma

Technically difficult, especially in females

Track materials into bladder and cause bladder infection

Perform re-check UA to check for UTI after catheterization

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6
Q

urine should ideally be evaluated within

A

30 min
– Refrigerate
– Low USG can lead to cellar lysis – analyze soon!

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7
Q

how long can you refrigerate urine for

A

up to 12 h in sterile, opaque, airtight container
– Warm to room temp for 20 min
– Gently swish to remix and resuspend sediment

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8
Q

T/F exposure to light can turn urine a darker yellow

A

true

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9
Q

yellow-orange urine

A

bilirubin

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10
Q

yellow-green/yellow-brown urine

A

bilirubin and biliverdin

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11
Q

red urine

A

RBCs, HgB, and MgB

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12
Q

red-brown urine

A

RBCs, Hb, Mgb, MetHgb

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13
Q

brown to black urine

A

MetHgB

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14
Q

how to differentiate to between RBCs, Hb, Mgb, and MetHgb

A

– Hemoglobin: serum will also be red/pink

– Myoglobin: doesn’t accumulate in serum,

– MetHgb: serum is brown/black serum will not be discolored

– RBCs will settle to the bottom after centrifugation

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15
Q

miscellaneous color changes

A

Drugs - especially drugs with dyes

Horse urine with storage or on snow can turn reddish
– this is not evidence of hematuria

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16
Q

clarity:

A

Clear -> slightly cloudy -> cloudy -> opaque -> flocculent (chunky)

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17
Q

T/F horses tend to have turbid/ cloudy urine

A

true: contains mucous (looks like beer-think budwiser clydesdales)

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18
Q

what is cloudiness or turbidity caused by

A

– “formed elements”

– Cells, crystals, bacteria, casts, and lipid droplets (some lipid normal in cats)

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19
Q

read the SpGr off of the

A

supernatant

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20
Q

why is it important to use room temp urine for SpGrq

A

Cold fluids are more dense, FALSELY increases SpGr

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21
Q

what do you interpret USG with

A
  1. Serum [BUN] & [CREA]
  2. Amount of urine
  3. Hydration status
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22
Q

T/F each species has a normal USG value

A

False: there is no “normal” USG; indicative of adequate [ ] ability

  • Dog >1.030
  • Cat >1.035
  • Horse & Cattle >1.025
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23
Q

what are the “big 6” on a dipstick

A

glucose

bilirubin

ketones

blood

pH

protein

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24
Q

T/F glucose can be present in urine in health puppies

A

true

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25
Q

T/F cold urine falsely elevates glucose

A

false: decreases it

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26
Q

renal threshold for dogs -glucose

A

180 mg/dL

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27
Q

renal threshold for cats - glucose

A

280 mg/dL

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28
Q

renal threshold for horses - glucose

A

180 mg/dL

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29
Q

renal threshold for cattle - glucose

A

100 mg/dL

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30
Q

5 main causes of hyperglycemic glucosuria

A

Diabetes mellitus – glucose

Hyperadrenocorticism – cortisol

Drugs – dextrose, glucocorticoids, progesterone

Postprandial (P just ate)

Acute pancreatitis

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31
Q

3 main causes of normoglycemic glucosuria

A

Transient stress

Reversible tubular damage: drugs, hypoxia, infection, toxins

Cats with urethral obstruction

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32
Q

T/F more than 20% of normal dogs have 1+ bilirubin

A

true:
– Has low renal threshold
– Canine PCT can conjugate Hgb & excrete bilirubin

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33
Q

T/F Expect bilirubinuria before bilirubinemia

A

true:
– 2+ bilirubin & USG 1.020 – more concerned
– 2+ bilirubin & USG 1.040 – less concerned

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34
Q

in any species other than dogs bilirubinuria is

A

ABNORMAL

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35
Q

bilirubinuria can be indicative of

A

liver disease

bile duct onstruction

hemolysis

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36
Q

what causes false negatives [bilirubin}

A

Old sample

Light exposure

Nitrites

Ascorbic acid

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37
Q

what are they true ketones

A

acetoacetic acid and acetone

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38
Q

T/F ketones are present in normal animals

A

False

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39
Q

Question, what kind of bear is best?

A

black bear

40
Q

Fact, bears eat beets

A

Bears, beets, “Battlestar Galactica.”

41
Q

which ketones are detected on dipstick

A

Acetoacetic acid & acetone – NOT β-hydroxybuterate

42
Q

what it the predominant form of ketones in ruminants

A

β-hydroxybuterate

– Expect β-OHB in bovine ketosis & pregnancy toxemia in ewes

43
Q

when do you get ketonuria

A

Negative energy balance

DKA

Insulinoma

44
Q

what can blood on the dipstick indicate

A

Hgb, Mgb or RBCs
– RBCs lyse & release Hb
– Bleach causes a F(+) reaction

45
Q

if blood on the dipstick is due to hematuria:

A

Clears with centrifugation

Speckled pattern if low-grade

46
Q

causes of hematuria

A

Trauma, infection, inflammation, infarction, calculi, neoplasia, coagulopathy

47
Q

if blood on the dipstick is due to hemoglobinuria

A
  1. Urine supernatant NOT clear after centrifugation
    – still red colored
  2. No RBCs found in sediment
48
Q

causes of hemoglobinuria

A

intravascular hemolysis
– Serum will be pink/red
– Patient will be anemic

49
Q

T/F myoglobinemia is visible

A

false

50
Q

what leads to the release of myoglobin

A

Myocyte damage
– ↑ AST & CK – muscle-origin on biochemical profile
– Urine supernatant red

51
Q

normal urine pH of Dogs and Cats

A

6.5 – 7.5 * carnivores/omnivores

52
Q

normal urine pH of Horses and Cattle

A

7.5 – 8.5 * herbivores

53
Q

renal tubular dysfunction leads to…

A

paradoxically alkaline urine

54
Q

alkaline pH caused by

A

Urinary Tract Infections (UTI) - urea splitting bacteria

Low protein diets

Respiratory alkalosis, Metabolic alkalosis

Alkalinizing drugs

55
Q

what hinders interpretation of urine pH

A

pigmenturia

56
Q

examples of urea splitting bacteria

A

Proteus

Pseudomonas

Staphylococcus

57
Q

causes of acidic pH

A

High protein diets: Carnivores/omnivores; herbivores on milk

Respiratory and Metabolic Acidoses

Hypochloremic metabolic alkalosis + severe dehydration

Hypokalemia (K/H exchanger)

Furosemide

58
Q

which protein is primarily detected on dipstick

A

albumin

59
Q

which proteins is the dipstick insensitive to

A

Bence Jones proteins

Globulins

60
Q

causes of proteinuria

A

‒ Pre-renal: Fever, hypertension, seizures, IV

‒ Renal: Glomerulonephritis, renal tubular injury

‒ Post-renal: Hemorrhage, infection

61
Q

what should be ruled out with a positive protein reaction

A

hemorrhage (RBCs in sediment)

UTI/Cystitis (BacT and WBCs on sediment)

Intravascular hemolysis-hemoglobinurea (animal will be anemic)

62
Q

proteinuria caused by renal disease

A
  1. Blood reaction will be negative (usually)
  2. Sediment will likely have casts
  3. Measure a UPCR

Proteinuria with nothing in the sediment is most often indicative of glomerular disease

63
Q

T/F trace to 1+ protein is a normal finding in concentrated urine for dogs

A

true (remember 1+ bilirubin is also normal in dogs)

64
Q

T/F proteinuria with dilute urine is a problem

A

true

65
Q

Sulphosalicylic Acid Test (SSA)

A

Used to confirm dipstick protein results

Reacts with albumin, and also reacts adequately with globulins / Bence-Jones proteins

66
Q

what does a discrepancy between SSA and dipstick indicate

A

there is protein other than albumin in the urine

See glob and BJ proteins with certain neoplasms- multiple myeloma and B cell tumors

67
Q

urine sediment preparation

A
  1. Mix urine and transfer a standarized volume to a conical test tube
  2. Centrifuge at low speed for 5 minutes
  3. Decant urine without disrupting the sediment;

leave a small amount of urine for sediment resuspension

  1. Gently agitate the vial to resuspend the sediment
  2. Transfer a drop to a glass slide and place a coverslip
  3. Lower the condenser on your microscope
  4. Examine the entire coverslip, especially the edges
68
Q

source of caudate cells

A

renal pelvis

69
Q

renal cells

A

renal tubules

70
Q

squamous epithelial cells

A

‒ Largest

‒ Thin

‒ Often transparent

‒ Angular or folded

71
Q

significance of squamous epithelial cells

A

Seen in free catch urine

Rarely pathologic

72
Q

transitional epithelial cells

A

‒ Round

‒ Vary in size

‒ Found individually or in clusters

73
Q

significance of transitional epithelial cells

A

Seen with hyperplasia associated with inflammation

Seen in transitional cell tumors (benign and malignant)

74
Q

caudate cells

A

cone-shaped

significance: pyelonephritis

75
Q

renal cells

A

‒ Small

‒ Cuboidal to round

‒ Basal to central nuclei

‒ Found individually and in small groups or rows

‒ Seen with renal tubular injury: infectious, toxic, and ischemic injury

76
Q

what are crenated RBCs

A

they are the pissed off cats of the RBC world- when urine has been stored or USG >1.025 (unhappy environment)

77
Q

when do you see RBC lysis

A

USG

78
Q

significance of RBCs in sediment

A

hemorrhage, inflammation

79
Q

WBCs on sediment

A

1.5-2x larger than RBCs

Light gray, granular texture

Often visualize nucleus

Cannot easily differentiate in unstained preps

80
Q

significance of WBCs

A

inflammation (infectious and noninfectious-stones)

81
Q

when can you see start to see bacteria on sediment

A

‒ >10,000 rods/ mL

‒ >100,000 cocci/ mL

82
Q

T/F air-dired wright stained is a better detector of bacteria

A

true

83
Q

T/F there is no standard method for reporting bacteria

A

true

84
Q

T/F bacteria spin down with centrifugation

A

false

85
Q

other infectious agents include

A

dioctophyma renale

capillaria ovum

yeast and fungal hyphae (immunosuppressed)
- candida spp

Dirofilaria immitis

86
Q

transitional cell carcinoma

A

Extremely difficult to diagnose and differentiate from inflammation- send it to a clinical pathologist!!!!

Normal transitional epithelial cells can be very variable in size

87
Q

T/F free lipid droplets are common in cats

A

true

88
Q

when can lipid presence have pathologic significance

A

renal tubular injury

89
Q

Struvite crystals

A

Most common crystal in dogs and cats

Formation is favored in neutral to alkaline pH

90
Q

significance of struvites

A

Can be found in clinical normal patients

Urease-positive bacteria promote formation (↑urine pH)

91
Q

bilirubin crystals

A

Orange to copper granules

Usually present in small bundles

92
Q

significance of bilirubin crystals

A

dogs: low number in highly concentrated urine is normal

Abnormal in all other species: ICTERUS

  • r/o pre-hepatic - hemolysis (EVH)
  • r/o hepatic/ post-hepatic - hepatobiliary disease
93
Q

calcium carbonate

A

‒ Large spheres with radial striations

‒ Variably sized

‒ Colorless to yellow-brown (can cause brown-tinged urine in ↑↑↑ #s)

94
Q

significance of calcium carbonate

A

NORMAL in horses, rabbits, guinea pigs, and goats

No reports in canine or feline urine.

95
Q

calcium oxalate dihydrate

A

NORMAL in domestic animals

Storage artifact

Pathologic:

  • Miniature Schnauzers are predisposed to calcium oxalate urolithiasis
  • Increased calcium excretion due to hypercalcemia (e.g. hyperparathyroidism)
  • Acute renal fialure
96
Q

calcium oxalate monhydrate

A

Can be seen in healthy animals (esp horses)

Can be seen in animals with:
‒ Oxalate urolithiasis
‒ Hypercalciuric or hyperoxaluric disorders
‒ ETHYLENE GLYCOL TOXICOSIS (RARE)

RUSVM Clin Path (11 decks)

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