Urinanalysis Flashcards by Amy Carter

Define micurate

to urinate

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Define polyuria

Excessive urine production

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Define oliguria

Reduced urine output

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Define anuria

Complete suppression of urine production

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Define dysuria/stranguria

Painful or difficult urination

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Define proteinuria

Protein in the urine

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Define Urolithiasis

Uroliths/urinary crystals present

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Define haematuria

Blood in the urine

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Define glucosuria

Glucose in the urine

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Name some urine sample collection methods

Natural urination (Free catch /litter tray)

Manual expression

Catheterisation

Cystocentesis

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What equipment do you need for the free catch method?

Gloves

Commercial, sterile urine collection kit e.g. Uripet OR clean container e.g. Kidney dish

Clean, sterilised litter pan

Commercial, sterile, non absorbable cat litter e.g. Katkor

Sterile universal container

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What are the advantages of the free catch method?

Non traumatic

Quick and easy

Cheap

Non invasive

Client can obtain sample if given correct instructions

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What are the disadvantages of the free catch method?

Poor patient compliance (can be time consuming)

Mid steam sample difficult in female dogs

Sample contamination – non sterile

Only small amount of urine passed may result in insufficient sample obtained

Cat litter may become contaminated if the cat defaecates

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What equipment do you need for manual expression?

Gloves

A form of restraint – Second helper, Manual aids, or sedative

Commercial, sterile urine collection kit e.g. Uripet OR clean container e.g. Kidney dish

Sterile universal container

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What are the advantages of manual expression?

Relatively simple method of urine collection in an unconscious patient

Minimally traumatic if patient relaxed

Non invasive

Cheap if no requirement for sedation

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What are the disadvantages of manual expression?

A non sterile sample will be obtained

Can be difficult to isolate bladder if insufficient urine or large abdomen

Strong resistance may be encountered in conscious patients

Risk of bladder rupture if undue pressure is exerted, or if urethral blockage is present

Can be distressing for patient

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What equipment do you need for urinary catheterisation?

Sterile gloves

Assistant to restrain patient

Sterile 10-20ml syringe

Sterile water soluble lubricant

Adequately sized urinary catheter

A sedative may be required

Sterile container

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What are the advantages of urinary catheterisation?

Bladder does not have to be distended to sample

Quick and easy technique in male patients

Other tests may be carried out on the bladder at the same time e.g. Radiographic contrast studies

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What are the disadvantages of urinary catheterisation?

Causes discomfort to the patient so commonly carried out under sedation or GA, but can be performed conscious

Skilled technique that more difficult in female patients

Risk of urological infection

Risk of urethral or bladder wall damage

Although the external genital area and distal urethral opening are aseptically prepared, contamination of the sample will still occur

Describe cystocentesis

Gold standard method for sterile sampling

Aseptic introduction of needle through abdominal wall into bladder

MUST be performed by a vet as involves entering a body cavity

Commonly used in cats

Sedation is not commonly required

What equipment do you need for cystocentesis?

Electric clippers

Detergent scrub

e.g. Chlorhexidine

Surgical spirit

Sterile gloves

Sterile hypodermic needle

Sterile 10ml syringe

What are the advantages of cystocentesis?

Quick

Inexpensive, if sedation not required

Sterile sample

No urethral contamination

Infection uncommon

Preferred method for bacterial culture

What are the disadvantages of cystocentesis?

Can be stressful and painful for the patient

Sedation or GA may be required

Skilled technique, training required prior to performing

Risk of internal damage of the bladder or other organs

This technique can result in a false positive for haematuria

Describe urine storage and preservation

Label the sample immediately

Examine the sample within 30mins of collection

Refrigerate @ 4-8°c for no longer than 6 hrs

Urine can be frozen for delayed chemical analysis, but this process will destroy cellular content

Examine samples at room temperature

Example why preservation of urinary samples is vital

Bacteria growth will begin to occur as soon as the urine is voided, this will result in breakdown of urea and production of ammonia. This process increases the urinary pH to alkaline, which leads to precipitation of phosphates within the sample. Samples examined more than 30mins after collect may contain erroneous phosphate crystals (Struvites).

Name different types of preservatives and when you would use them

Boric acid (Red top) (0.5g/28ml urine, analyse within 8hrs) – culture Tolulene - Chemistry Formalin 10 % (1 drop to 2.5ml urine) - Cytology Thymol (1mg/ml urine) - Chemistry

How long can urine preservatives prevent bacterial growth or chemical decomposition for?

up to 2 days

How should preserved samples be stored?

room temperature

What three properties should be looked at during an urinary examination?

Physical Chemical Microscopic

Describe physical properties

Colour Odour Turbidity pH Specific Gravity A change in physical properties of the urine may indicate clinical illness

What might orange urine indicate?

Bile pigments/bilirubin

What might dark brown or black urine indicate?

Conversion of haemoglobin to methaemaglobin in acidic urine Myoglobinuria – paracetamol toxicity

What might yellow/brown/green urine indicate?

Concentrated sample, pseudomonas infection

What might green/blue urine indicate?

Methylene blue treatment

Why might rabbits have red in their urine even if it is not haematuria?

(beta-carotene)

What might the turbidity of a urine sample indicate?

Normal urine that is left to stand will become turbid due to phosphate precipitates. A turbid sample may indicate -presence of crystals, pus, mucus threads, excessive numbers of red and/or white cells, prostatic or vaginal secretions.

What might the odour of a urine sample indicate?

Normal urine should have a slightly sour, ammonia-like odour Odour intensity may vary between breed and gender of animals - Male urine is often stronger smelling. Pungent ammonia odour in fresh urine may indicated the presence of bacteria Uncontrolled diabetes mellitus patients may pass a sweet and fruity smelling urine due to presence of ketones (‘pear drops’)

What does specific gravity test?

This is the only actual test of renal function in a routine urinalysis. Sg or osmolality is a function of fluid/solute intake, glomerular filtration, renal tubular function, release and action of vasopressin and extent of extra-renal fluid losses. Animals producing a large quantity of urine would be expected to have a low USG and vice versa.

What might effect specific gravity results?

Animals being fed a dry diet may have a higher Sg to animals fed on a wet diet. Animals that are on fluid therapy or have consumed a large amount of water prior to sampling would have a low Sg. Consistently abnormal readings may indicate a clinical issue.

What are the specific gravity reference ranges?

Dog : 1.015- 1.045 Cat: 1.020 – 1.050

What may cause an inaccurate urine test strip?

Inaccurate results if passed expiry date, patient on drug therapy. Designed to measure human urine parameters – Sg is not a reliable reading and should be supported with the use of a refractometer

What are the microscopic components of urine?

Crystals Cells - Epithelial cell, transitional cells, tubular epithelial cells, leucocytes, ertythrocytes Spermatazoa Bacteria, fungi and yeasts Casts - Hyaline casts, cellular casts, granular casts, waxy casts Parasites Fat droplets

What can affect crystal production?

Genetic predisposition e.g. Dalmatian Bacterial infection Diet Concurrent illnesses Medication

Describe casts

The appearance of one to two cast per low power field is considered normal. Excessive numbers of casts may indicate a renal disease process.

Describe Lypurea

Commonly seen and can vary in size Fat cells float up under cover slip to a different plane of focus to other cells They can occur as an artefact due to catheter lubrication, catheter sample obtained. Their presence may indicate: diabetes mellitus, obesity and hypothyroidism