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Clinical Urology > Urinalysis > Flashcards

Urinalysis Flashcards

1
Q

What does the colour indicate in a urine sample?

A

Concentration and possible pathologies (blood, myoglobin)

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2
Q

What does the smell indicate in a urine sample?

A

Possible pathologies

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3
Q

What does the turbidity indicate in a urine sample?

A

Reflects suspended substances (crystals or cells)

Graded from 0 to 4+

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4
Q

Is horse urine naturally turbid? if so, why?

A

Yes, due to the natural Calcium carbonate crystals and mucus found in their urine

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5
Q

What is the Specific Gravity of a urine sample?

A

Ratio of weight (density) of urine to that of an equal volume of water at the same temperature
- It is a test of renal tubular function

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6
Q

What values should you always evaluate SG with?

A

Hydration status: PCV and TP

Serum Urea/ Creatinine

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7
Q

Define Isosthenuria

A

A urine SG between 1.008 - 1.012

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8
Q

Define Hypersthenuria

A

A urine SG above > 1.012

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9
Q

Define Hyposthenuria

A

A urine SG below < 1.008

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10
Q

What are the causes of a low SG?

A 
Polydipsia
Iatrogenic
Endocrine
Diuretic therapy
Renal disease
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11
Q

What test can be done if you want to examine the animals ability to concentrate its urine?

A

Water Deprivation Test

Interpretation of results:

  • If urine SG increases to 1.020, tubular function and ADH availability are confirmed
  • If urine SG remains <1.020, diabetes insipidus is suspected
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12
Q

The Protein parameter on a Dipstick measures what protein?

A

Albumin

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13
Q

Trace of 1+ protein in the urine can be normal if _______

A

if urine SG is high

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14
Q

What other parameters should be taken into account when measuring Protein on a Dipstick?

A

Urine SG

Serum Albumin

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15
Q

What causes increased protein in the urine ?

A

Inflammation
Infection
Haemorrhage
Protein losing Nephropathy (glomerular damage)

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16
Q

When proteinuria is found on a dipstick, what should be evaluated next?

A

Urine Protein to Creatinine Ratio

UPC <1.0 = not significant
UPC 1-2 = urogenital haemorrhage, inflammation or glomerular protein loss
UPC >2 = usually glomerular protein loss

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17
Q

Why might Glucose be found in the urine?

A
  • Diabetes mellitus
  • Stress
  • Cystitis in cats
  • Severe exertion or tremors
  • Drugs (Rompun and Ketamine)
  • Fanconi Syndrome
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18
Q

In what species are ketones normally found in the urine?

A

Rabbits only

all other species shouldn’t have ketones in the urine

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19
Q

Why might be the reason for Ketones in the urine?

A
  • Diabetes mellitus
  • Pregnancy toxemia in Sheep
  • Ketosis and fatty liver in cattle
  • Secondary to anorexia, starvation and other illnesses
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20
Q

Why might blood be found in the urine?

A
  • Catheterization or cystocentesis contamination
  • Estrus
  • Trauma
  • Coagulopathy
  • Urogenital Inflammation or neoplasia
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21
Q

Why might Hemoglobin be found in the urine?

A
  • Acute Hemolysis
  • Bacillary Hburia
  • Cu toxicity
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22
Q

Why might Bilirubin be found in the urine?

A
  • Healthy dogs can have 1+

- Icterus: pre-hepatic, hepatic and post-hepatic

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23
Q

Which measurements on a Dipstick are considered variable/ Inaccurate in animals?

A
  • Nitrite
  • WBC’s
  • SG
  • Urobilinogen sometimes: presence of Urobilinogen confirms patency of bile duct and that bile is entering the intestine
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24
Q

Why might Urea be increased in a serum/ plasma sample?

A
  • Prerenal, renal or postrenal problems

Uremia is a clinical syndrome due to reduced renal excretion of toxic substances

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25
Q

Why might Urea be decreased in a serum/ plasma sample?

A
  • Protein deficient diets/ malabsoprtion
  • Decreased Liver Function: PSS or Heptaic Insufficiency
  • Overhydration
  • Young animals
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26
Q

Blood Urea should also be evaluated with ______?

A

Creatinine and Urine SG

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27
Q

What is the source of creatinine in a blood sample?

A

Spontaneous degredation of creatine in the muscle

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28
Q

Why might increased levels of creatinine occur in a blood sample?

A
  • Renal disease

note: 80-90% of nephrons must be lost for creatinine to rise significantly

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29
Q

What are the causes of pre-renal azotemia (increased urea and creatinine in blood)?

A
  • Decreased renal perfusion: urea high
  • Hemoconcentration, endotoxemia, reduced cardiac output or shock: urea high, creatinine normal, SG increased
  • high protein diet or GI haemorrhage: urea high, creatinine normal
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30
Q

A dog has increased serum urea/creatinine and a SG > 1.030, what should be considered?

A

Pre-renal disease

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31
Q

A dog has increased serum urea/creatinine and a SG between 1.008-1.012, what should be considered?

A

Primary renal disease

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32
Q

A cat has increased serum urea/creatinine and a SG > 1.035, what should be considered?

A

Pre-renal disease

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33
Q

A cat has increased serum urea/creatinine and a SG between 1.008-1.012, what should be considered?

A

Primary renal disease

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34
Q

A horse has increased serum creatinine and a SG > 1.025, what should be considered?

A

Pre-renal disease

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35
Q

A horse has increased serum creatinine and a SG between 1.008-1.012, what should be considered?

A

Primary renal disease

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36
Q

Ketonuria is not a sign of renal pathology but is an indication that _____

A

the renal threshold for ketone bodies has been exceeded, and therefore are leaking into the urine from the blood

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37
Q

Urine bilirubin should always be evaluated with?

A

Serum bilirubin, urine SG and other physical findings/ history

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38
Q

What is the urine sediment examined for?

A
  • White cells
  • Red cells
  • epithelial cells
  • crystals
  • casts
  • bacteria
  • fat
  • Miscellaneous: sperm, fungi
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39
Q

> 5 WBC’s per high power field (40x objective) are seen on urine sediment, what does this suggest?

A

inflammation of the urinary or urogenital tract

This is considered to be an active sediment

40
Q

The presence of bacteria along with white cells in urine sediment suggests?

A

Bacteral UTI

41
Q

A urine sample collected by cystocentesis shows the presence of bacteria, but no white cells. What does this suggest?

A
  • Possible contamination
  • Conditions such as hyperadrenocorticism and diabetes mellitus: these can result in a poor inflammatory response to infection and thus White cells may not be found
42
Q

A cat presents with blood in the urine, urinalysis shows the presence of blood cells, no white cells and 3+ struvite crystals, what does this suggest?

A

Feline Lower Urinary Tract Syndrome (FLUTD)
this is a syndrome with several potential causes: urolithiasis, urethral obstruction, urinary infection with a poor immune response, feline idiopathic cystitis, and even diabetes and hyperthyroidism

43
Q

The presence of squamous cells means?

A

Not much, they can come from the vulva, prepuce or skin

44
Q

The presence of a few transitional cells means?

A

Not much, they can be found in normal healthy animals as the distal urinary tract sheds

45
Q

The presence of lots, varied size, and clumped transitional cells suggests?

A

Transitional Cell Carcinoma

46
Q

What are urinary casts?

A

Tiny tube-shaped particles, that can be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat

note: they are tube-shaped because they maintain the shape of the tubules
Whatever particle is contained in a cast comes from the KIDNEYS

47
Q

Where are urinary casts formed?

A

Distal tubules and collecting ducts

48
Q

What are Hyaline casts, and what do their presence suggest?

A

These are smooth, round-ended and acellular, which contain mucoproteins
They suggest protein loss

49
Q

What are Waxy casts, and what do their presence suggest?

A

fine, granular, degenerating epithelial cells

They suggest tubular injury: ischemia, infarction or nephrotoxicity usually

50
Q

What are Red Blood Cell casts, and what do their presence suggest?

A

red cells clumped together

Suggestive of glomerular injury

51
Q

What are White Blood Cell casts, and what do their presence suggest?

A

white cells clumped together

Suggestive of pyelonephritis or glomerulonephritis

52
Q

Is it normal to find crystals in the urine of all species?

A

Yes

53
Q

What crystals are common to find in acidic urine?

A

Calcium oxalate dihydrate

54
Q

What crystals are normal to find in birds and reptiles?

A

Urates

55
Q

What crystals are common to find in alkaline urine?

A

Phosphate/ Struvite

56
Q

Healthy horses and rabbits with a significant portion of hay in their diet are expected to find ______ crystals in their urine

A

Calcium Carbonate

57
Q

Bilirubin crystals can be normally found in what species?

Bilirubin crystals are not normal in what species?

A

Normal to find in dog urine in small quantities

Abnormal to find in all other species, and thus hyperbilirubinemia must be explored in these species e.g. IMHA, intravascular hemolysis, bile duct obstruction

Must always be examined with serum bilirubin

58
Q

Ammonium urate crystals may be seen in which species, and why?

A

Dalmations, English bulldogs: due to hereditary defect in purine metabolism

Other breeds of dogs raises concerns as it suggests liver disease or PSS, and a need for ammonium to be excreted

59
Q

The presence of Calcium Oxalate dihydrate crystals (maltese cross) suggests?

A

Cows, horses and cats: normal

Dogs: hyperparathyroidism or a genetic defect found in Schnauzers

60
Q

The presence of Calcium Oxalate monohydrate crystals suggests? (long, 6-sided and sharp edges)

A

Ethylene glycol poisoning

61
Q

The presence of Calcium Oxalate monohydride crystals suggests? (oval, dumbell form)

A

Chocolate poisoning in dogs

62
Q

Which crystal types will you find in liver disease or PSS?

A
  • Leucine (square)
  • Cystine (hexagonal)
  • Tyrosine (needle-shapes)
  • Ammonium biurate
63
Q

A brown discoloration to the urine might be caused by?

A

Endogenous: myoglobinura, porphyria

Exogenous: metronidazole, nitrofurantoin

64
Q

A red discolouration to the urine might be caused by?

A

Endogenous: hemoglobinuria, hematuria

Exogenous: warfarin, rifampin

65
Q

A yellow discolouration to the urine might be caused by?

A

Endogenous: bilirubinuria

Exogenous: riboflavin

66
Q

A black discolouration to the urine might be caused by?

A

Endogenous: melanuria

67
Q

A blue-green discolouration to the urine might be caused by?

A

Exogenous: methylene blue, doxorubicin, triamterene

68
Q

What gives urine its normal yellow-ish colour?

A
  • Urochrome: which gets darker as it ages
  • Urobilin: breakdown product of Hb
  • Uroerythrin: metabolism of melanin
  • Uroporphyrins: breakdown of Hb
  • Trace levels of Riboflavin
69
Q

What are the possible causes/ differentials that might cause an abnormal colour?

A
  • diet
  • errors in metabolism
  • rhabdomyolysis
  • medications
  • hemolysis
  • metabolic defect
  • environment
  • hematuria
70
Q

What might you see on urine cytology if renal hematuria is suspected?

A
  • Distorted RBC’s: target cells (doughnut shape) and blebs

- +/- RBC casts

71
Q

What are the differentials when renal hematuria is present?

A
  • renal trauma
  • renal calculi
  • acute renal failure
  • coagulopathy
  • thrombocytopenia
  • acute pyelonephritis, glomerulonephritis
  • renal neoplasia
  • parasitism
  • renal cysts
  • renal infarcts/ embolism
72
Q

A urine sample is spun down and the urine appears orange-red to brown (mahogany brown), what might this be indicative of?

A

Myoglobinuria: damage to the myocytes (muscles)

73
Q

A urine sample is spun down and the urine appears red to red-brown (port wine red), what might this be indicative of?

A

Hemoglobinuria:

  • IMHA
  • Red maple toxicity in horses
  • Onion/ chive/ leek/ garlic ingestion in all species
  • Cu toxicity in sheep
  • Zinc toxicity in dogs: eating US pennies
  • Acetominophen in dogs and cats
  • Babesia or Lepto
74
Q

How can you tell between hemoglobinuria, hematuria and myoglobinuria?

A
  • Dipstick:
  • Speckled colour change = intact red cells
  • Uniform colour change = Mburia or Hburia
  • If Hburia is due to Hbemia, you will see a clear red discolouration in the serum or plasma
  • Dark red urine, with NO Hbemia or intact red cells on urine sediment = myoglobinuria
  • Dark red urine + elevated CK and AST = myoglobinuria
  • Ammonium Sulphate Precipitation Test = positive result means myoglobinuria
75
Q

If you do a dipstick test on a dark pigmented urine sample, but the dipstick test strip is negative, what is this indicative of?

A

Pigmenturia due to: porphyria or exogenous pigments (e.g. drugs)

76
Q

If Melanuria is seen (dark black pigmented urine), what is this indicative of?

A

A rare metastatic malignant melanoma

77
Q

What is NOT filtered through the glomerulus of the nephron?

A

RBC’s and proteins (e.g. albumin)

78
Q

What is reabsorbed in the Proximal Convoluted Tubule of the Nephron?

A
  • WATER
  • Glucose
  • Ions (Na+, Cl-, K+, Ca+, Pi)
  • Amino acids, + small peptides
  • Bicarbonate (~90% reabsorbed)
79
Q

What is the effect of PTH on the proximal convoluted tubules?

A

Calcium reabsorption

Pi secretion

80
Q

What are the 2 hormones that affect the Proximal convoluted tubules?

A
  • Angiotensin II

- Parathyroid Hormone

81
Q

What is secreted at the level of the proximal convoluted tubules?

A
  • Waste metabolites: urate, bile salts, acids
  • Hormones: Epinephrine, prostaglandins
  • Drugs and Toxic metabolites:
    Oxalate: from ethylene glycol poisoning
    Diuretics: to enable their effect on renal transports on the lumenal side of the tubule cells
    Antibiotics
82
Q

What is reabsorbed at the level of the Descending loop of Henle?

A

Water

83
Q

What is reabsorbed at the level of the Ascending loop of Henle?

A

Na+

Cl-

84
Q

What hormone affects the Ascending loop of Henle?

A

Angiotensin II

85
Q

Furosemide exerts its effect on the ___________ of the Nephron by?

A
  • Affects the Ascending Loop of Henle (loop diuretic)

- Inhibits luminal Na-K-Cl cotransporter causing Na, Cl and K loss into the urine

86
Q

What is reabsorbed at the level of the Distal Convoluted Tubule?

A
  • Water
  • Ca+
  • Na+
  • Cl-
87
Q

Thiazide diuretics exert their effect on the ___________ of the Nephron by?

A
  • Distal Convoluted Tubules

- Blocking Na-Cl cotransport, causing lack of Na+/Cl- reabsorption

88
Q

Where in the Nephron does Angiotensin II exert its effect?

A
  • Efferent renal capillary
  • Proximal Convoluted tubule
  • Ascending loop of Henle
  • Distal Convoluted tubule
89
Q

Where in the Nephron does Aldosterone exert its effect?

A

Distal Convoluted tubule

90
Q

Where in the Nephron does ADH exert its effect?

A
  • Distal convoluted tubule

- Collecting Ducts

91
Q

Where in the Nephron does Atrial Natriuretic Peptide exert its effect?

A
  • Afferent renal capillary

- Distal convoluted tubule

92
Q

What is the effect of Angiotensin II on the Nephron?

A

Synthesized in response to BP drop

  • Increase efferent arteriole constriction
  • Increase GFR
  • Increase Na+ reabsorption
  • Increase circulating volume
93
Q

What is the effect of Atrial natriuretic peptide on the Nephron?

A

Secreted in response to increased atrial pressure

  • Increases GFR
  • Increases Na+ loss and subsequent volume loss
94
Q

What is the effect of Aldosterone on the Nephron?

A

Secreted in response to decreased blood volume and increased plasma [K+]

  • Increases Na+ reabsorption
  • Increases K+ secretion
  • Increases H+ secretion
95
Q

What is the effect of ADH on the Nephron?

A

Secreted in response to increased plasma osmolarity and decreased blood volume
- Increases the number of aquaporins and subsequent water reabsorption

Clinical Urology (8 decks)

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