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Urinalysis
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112
Veterinary Medicine
02/15/2010

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Term
what does a urinalysis provide info about
Definition
urinary tract disease, reproductive tract disease, systemic disease
Term
why should we run a urinalysis in house
Definition
simple, fast (less than 10min), inexpensive
Term
Urine is the first indication of what...
Definition
systemic disease
Term
Does losing nephrons or a kidney harm the animal
Definition
No, animals can lose about 75% nephrons before obvious to people, have way more than need and can survive without a kidney too
Term
Describe the parts involved in making urine
Definition
glomerulus (involved in filtration), renal tubule (involved in reabsorption and secretion)
Term
What is a glomerulus
Definition
tuft of capillaries where h20 soluble materials come out and collected by the Bowman's capsule
Term
what is the unit within the kidney where urine production takes place
Definition
the nephron
Term
What happens to useful materials within the nephron
Definition
they are reabsorbed into the blood from tubule so body can use, ex glucose...if normal, 100% be reabsorbed
Term
Secretion is important in what?
Definition
Homeostatic processes (such as salt balance); secretion implies H+, Na+, Cl- etc are secreted
Term
Do any type of metabolic changes occur outside of the nephron or the glomerulus?
Definition
No, only in glomerulus; from renal pelvis of the kidney to elsewhere is only transport and no changes
Term
Urine is what type of product?
Definition
Waste product & unstable medium (thus why we shouldn't send out to labs...get different results)
Term
Urine is made where?
Definition
in renal nephrons
Term
Urine content changes or stays the same?
Definition
Changes thru the day due to eating and drinking, changes in metabolism
Term
Nephrons are located where in the kidney?
Definition
cortex
Term
What are the parts of a urinalysis?
Definition
Gross exam (color, odor, clarity, specific gravity), chemical exam (dip stix which does 8-11 tests), sediment exam (microscopic exam)
Term
A urine sample can be affected by
Definition
Collection method, time since collected, storage technique...thus urine is not stable! must eval results based on above info
Term
What is the only reason might see changes in the urine outside the nephron?
Definition
pathology
Term
When is the best urine sample collected?
Definition
In the am when animals haven't been drinking or peeing O/N
Term
When refer to clarity on a gross urine exam, what is it?
Definition
clear vs cloudy; clear is not a color
Term
What are some things that will cause the kidneys to shut down?
Definition
antifreeze (ethylene glycol), certain rodenticides, blood b/c blood supply decreased to kidney
Term
You can't evaluate urine results without knowing...
Definition
collection method, time since collected (dilute or conc...when sitting, changing), storage technique (did client refridge)
Term
Do animals have different looking nephrons?
Definition
All basically same for function and anatomy
Term
What kind of changes over time would you see in urine if left to sit
Definition
Chemical changes (bilirubin, ketones, and glucose decrease, pH increases), casts dissolve (not stable at all, labs won't see later if send out), cells break down *basically may not find what was there when collected so look at as soon as get
Term
What are some measures you can take to minimize changes?
Definition
Examine within 1 hr (in am best, try to get sterile sample (best, but may not need, depends on what looking for, trying confirm dx usually & get surprised), refrigerate (if can't get to until later)& check within 6 hrs (but restore to room temp first!), never freeze!
Term
Why do we need to restore urine to room temp before using?
Definition
Things like dipsticks are temp sensitive and chemical rxns are temp dependent so lower temps slow down rxn & could miss something on test
Term
To preserve cells for later, what can you use or do?
Definition
Do chemical tests first like dipstick, still refrigerate it, and then can use 1) 1-2 drops plasma/albumin, 1 drop 40% formalin, 1 part 5% phenol to 9 parts urine, toluene layer on top (ALL RARE b/c practices don't keep materials around)
Term
Name some common ways to collect urine from the patient
Definition
free catch (client can do), manual expression of bladder (by gently squeezing), catheterization (w/ sedation, sterile), cystocentesis (sterile)
Term
Your collection method affects....
Definition
Interpretation of results!
Term
If trying to collect sterile urine, what would you use and what test would you be performing it for?
Definition
Collect in syringe; do a culture and sensitivity on it afterward...would want if had looked at urine & saw bacteria so to confirm, get sterile sample...if send out, don't want contaminate, need 1/2 cc to do and 24h to do it in; Recurring urinary infections would show bacteria in urine and need a C/S to confirm..tx will fail with these animals and they will present with lot of urinary infections; can put sample in culturette or on swab and in container then to fridge until picked up by lab
Term
Does PU/PD automatically indicate a urinary problem?
Definition
No, a number of diseases cause PU/PD not just urinary; client could call saying PU/PD with red in blood...does NOT mean dx without looking at urine..could see glucose in there and go looking for diabetes now (a systemic prob)
Term
What is the most common method of urine collection?
Definition
Free catch
*if clients are getting this, need ask when got, if put in fridge, has animal been experiencing changes in urinary habits, look for color in urine
*prefer 1st sample in AM, midstream (so let flow little b4 get & helps wash away contaminate), clean dry container, and can wash area 1st if in clinic so sample doesn't contact discharge/contaminate on prepuce or hair etc
Term
Most ppl will notice a urinary problem in what animals?
Definition
Domestic dog and cat, not really LA or rabbit etc, or with multi-cat household can't pinpoint right cat and need some to show signs or lock up separately
Term
What are some ways to perform free catch on different spp?
Definition
Dogs- cup with or without stick
cat- plastic liner or beads
(dairy)cow- rub ventral to vulva
horse- whistle (been trained on racing track to do on command for urine test), place in clean stall (want to mark territory), rub warm moist cloth on belly
Term
When getting a sample from a cat box, what materials can you use and how would you get it out of the box?
Definition
nosorb, aquarium gravel, styrofoam peanuts, empty clean box, popcorn kernels; collect with syringe; don't use chemicals in box to clean etc b4 getting sample, refridge til can drop off later (make sure tell receptionist that it was sitting)
Term
How would you express the bladder of a patient and under what circumstances?
Definition
in clinic with relaxed animal (if try when tense, could burst bladder esp. if obstruction present), clean external genitalia, gently compress posterior abdomen with fingers, don't use if obstructed!, go in rectally with LA (can feel bladder, don't stand directly behind!)
Term
Is catheterization same with all spp?
Definition
No, technique varies with spp AND sex (M different from F); some need sedation; will need sterile catheter and tube for this procedure though and thread catheter thru urethra into bladder but be careful
*females are more difficult
Term
Name some types of catheters
Definition
rubber, polypropylene, metal
Term
Why do we do catheterization?
Definition
Usually to relieve obstruction, can produce inflammation when doing and contamination (so flush w/ antib after); is emergency situ that causes renal shutdown, kidney fills up and stops making urine
*try minimize trauma passing it in and collect in sterile container
Term
Males or females tolerate catheters better? Who is more difficult to catheterize?
Definition
Male tolerate better; females more difficult
Term
How would you catheterize a male dog?
Definition
draw prepuce back, measure tip urethra to ischium to figure out length of catheter you need, lube catheter and watch out for os penis when inserting, can use 11+ Fr for dogs (14-15in), a polypropylene cath works well b/c stiff; if bladder full then should flow out, so have syringe or cup ready to collect urine; try palpate first b/c if no urine in bladder then no sample and waste catheter/time
Term
How would you catheterize a male cat?
Definition
tomcats need a 3Fr (fr = diameter of catheter) and usually same length; use gloves to keep procedure sterile; sedate b/c not letting you do this while awake!; have narrow urethra & if blocked then put in short metal catheter to unblock & flush back into bladder (most times doing this b/c they are blocked); stitch to either side and leave in 24h or more to allow grit to dissolve if possible; change diet of cat or back to square 1...
Term
Dogs get blocked b/c of...? And cats?
Definition
Stone in urethra; cat-grit in urethra
Term
How would you catheterize a female dog?
Definition
Need speculum to see small slit about 1'' inside vagina (opening to urethra), use metal or red rubber catheter, HARD; feel with 1 finger while threading so do not catheterize the blind pouch inside (diverticulum) and never just stick catheter in; softer red rubber is better, can tie in; rare to see blocked female (cats do more)
Term
What procedure has replaced catheterization mostly?
Definition
cystocentesis
Term
What procedure would you want to do to gather a sterile sample without being too invasive? How would you do it?
Definition
cystocentesis; bladder must be half full and palpable...use 1-1 &1/2 inch needle, aspectically prepare abdomen with clip and scrub, enter bladder at angle to skin so when pull out hole closes basically and urine doesn't squirt out; DO NOT do awake in cats is possible but dogs can; if need relieve pressure then do fast as possible but make sure not obstructed too or it fills again
Term
When getting a history from owner, what are you looking for?
Definition
Polyuria (excess urine volume), polydipsia (excess drinking), pollakiuria (more freq urinating,usually see this), hematuria (blood in urine, common, cat ppl notice this first), strangiuria (straining, see in blocked cats and crying, oliguria (not much urine, dx by collecting and measuring in clinic), anuria (no urine, BAD, renal shutdown due to shock etc) and dysuria (diff. urinating, can look like stranguria, vets use dysuria more, sign would be dog licking self b/c painful)
*keep in mind, clients don't always see them pee or drink esp if outside until do in house so a problem couldve been going on for while!
Term
On a gross exam, what color urine is normal? what is abnormal?
Definition
urine is norm clear and yellow; more concentrated (like in AM) = darker, dilute urine colorless (low specific gravity), red or red brown is hematuria, brown is myoglobinuria (horse urine will norm turn dark if stands for while; see in urine of horses that did not work on sun back in the day and turned brown on mon...sign of massive muscle breakdown! "tying up" or azoturia!
Term
What does transparency mean in terms of urine?
Definition
Does light pass thru it...clarity!
*norm is clear (except horses, rabbits, rodents b/c of CaCO3 crystals), little sediment when clear (can still do microscope exam)
*abnorm= cloudy = increased sediment (cells, crystals) OR flocculent= suspended stuff, BAD b/c implies pus
*freq see cloudy urine!
Term
What kinds of odor is normal for urine and abnorm?
Definition
Intact males have very sharp and pungent urine (odiferous) esp cats, ferrets, goats
*abnorm - ammonia odor (fresh ammonia odor implies urease producing bacteria and infection...if sits and smells like ammonia then contaminate and not as sig); if ammonia to breath then renal failure
*abnorm- sweet and fruity...ketosis! not good in sm. animal "juicy fruit smell"; ketosis seen in dairy cow more
Term
When is ketosis seen?
Definition
Serious in dogs and cats b/c seen with severe diabetes (cause = increase in glucose not getting in cells, give insulin, final step b4 die or go into ketoacidiosis); see in preg toxemia with rabbits, guineas, humans (causes sudden death, be depressed and not eat); ketosis common in ruminants (still serious but fleeting usually...have higher ketone levels in blood so handle better, cause for ruminants is decrease in glucose, so give glucose)
Term
What odor does dilute urine have?
Definition
None
Term
Myoglobinuria is primarily seen in...?
Definition
Horses; performance animals
Term
In pregnancy toxemia, what is a big sign will see from animal?
Definition
Cloudy urine turns clear, BAD
Term
Do you really need to do a foam test for urine?
Definition
Not really; protein is on dipstick (and it's a risk b/c cow urine can have lepto!)
Term
What is specific gravity?
Definition
Density of liquid compared with equal amount of distilled water (=1.000 SG); determined by # and MW or dissolved solutes; VERY IMP
Term
If an animal is experiencing polyuria, what would you see for specific gravity? What about oliguria?
Definition
Low SG; high SG
Term
What is specific gravity used for on a urinalysis?
Definition
Gives indication of animal's ability to concentrate urine, way to tell if renal tubules are working well (proximal and collecting tubules specifically); if animal dehydrated then pulls H20 back in to blood (by re-absorption)
Term
Cats or dogs concentrate urine more effectively?
Definition
Cats!
Term
If you have disease in the glomerulus, what occurs?
Definition
No urine at all is made because that is where filtrate is made
Term
Name the parts of the nephron involved with urine concentration (and ie re-absorption)
Definition
Proximal tubule, glomerulus, hoop of henle, distal tubule, collecting tubule
Term
Where is h20 absorbed
Definition
hoop of henle and collecting tubule (desert animals have long loop of henle)
Term
If an animal cannot concentrate its urine, what clinical sign would you see?
Definition
drinking more water
Term
How much water and ions are absorbed in an animal?
Definition
varies depending on what animals needs; Na and H20 reabsorped everywhere; hormones can affect like aldosterone and ADH causes H20 absorption (works against making urine)
Term
What is the name of the instrument that we use to measure SG and TP?
Definition
refractometer
Term
What is the definition of light refraction
Definition
light waves slow down as pass through a thicker substance and appears to bend object
Term
what does a refractometer measure
Definition
refractive index or how much light is bent which gives estimate of SG; shows 1.000 for distilled water and SG for most animals should be 1.000-1.055 (there is no normal number though; and remember that is person says 1055 means there is a decimal in there)
Term
What all does specific gravity measure?
Definition
tells concentration of urine and evaluates tubular function
Term
A higher specific gravity indicates what..?
Definition
more concentrated urine, see bright yellow urine as well; drinking a lot will give low SG on the other hand and means dilute urine
Term
What is the specific gravity for isothenuria? what does the term mean?
Definition
1.010; urine has same SG as find in glomerular filtrate
Term
What values is Dr. P looking for to see if renal tubules are working properly?
Definition
Above 1010-1015; keep in mind that if drink a lot H20 then this be lower; wants know basically can he concentrate or not concentrate urine?
Term
Is not concentrating urine when renal tubule failing the same as renal glomerular disease?
Definition
No
Term
With diabetes insipidus, what causes animal not to concentrate urine?
Definition
Low (or lack of) ADH
Term
With specific gravity, what tools can you use to do it?
Definition
Urinometer (cylinder and float-on top of float = scale & where scale meets top urine is where read, need about 10 cc urine- hard to get this amt all the time); stix which not very accurate (about 0.005 lower than actual value); refractometer
Term
What specific gravity value tells that the tubules are working?
Definition
Above 1.020 (H20 being re-absorbed, all it tells, not tell if have kidney disease or anything about bladder which only stores urine)
Term
With chemical tests, what are some general guidelines?
Definition
Many diff ones (usu stix), Want urine at room temp, most use reagent strips, some aren't useful for animals (made for humans usu), follow manufacturer recommendations, read color changes in time (ie its result of chemical rxn, expose chemical to urine, is timed so don't use cold urine)
Term
Name general features about reagent strips
Definition
Most are dipsticks; many brands avail; some tablets (rare); keep dry and out of light (that is why in dark container and put top back on quick to keep out moisture); some eval UTD & others systemic disease; more expensive if add more tests to it- can do multiple or few tests
Term
With reagent stix, what are we interested in?
Definition
Glucose usually
Term
How do you use the stix?
Definition
Immerse in room temp urine for 2-3 sec (not too hot or cold) OR may add drop to each test pad; rim stix over edge; compare color to chart (note time test req)
Term
What is the first test on the reagent stix?
Definition
pH- 60 sec test
Term
WNL on a pH test pad is dependent on what?
Definition
Diet- carnivores and nursing have more acidic pH (under 7, usu 6 to 6.5) while herbivores have alkaline (above 7 or usu 8/8.5, never above 9)
*decreases with fever, acidosis, exercise; increases with infection in bladder/kidney, retention and drugs may increase or decrease
*our cells function best in ph of 7.35-7.45 in blood and too hi or low=mass system shutdown
Term
How do you see acidosis on a pH test pad of a reagent stick?
Definition
anything that increases CO will cause like diarrhea, anesthesia with depressed respir...and kidney dumps H+ into urine and pee becomes more acidic
*tx with bicarbonate
Term
Is alkalosis or acidosis in the urine more of a problem?
Definition
acidosis
Term
Protein is normally present or not on a test pad? What would elevate? Is a positive significant?
Definition
Normally absent or trace (bc proteins are lg molecules = not pass thru capillaries); many factors elevate like collection method, blood (protein is in blood normally), stix measure albumin (most numerous in body), and false positive if alkaline pH (get elevated levels protein when alkaline pH to pee); positive sig if low SG (ie more sig if urine dilute)
Term
The bumintest is a "what" test? What does it measure? How would you get a false neg or a true pos?
Definition
Tablet test usually done in humans; uses 5 drop urine and 10 h20, wait for set time
*more sensitive esp to globulins
*looking for turbidity
*if very dilute see false neg; pos if hemoglobinuria (hemoglob in urine)
Term
Why does pregnancy toxemia cause urine to go clear?
Definition
urine is more acidic
Term
How would you clear up cystitis?
Definition
acidify urine and bacteria not like it so clears infection
Term
Why do animals get proteunuria?
Definition
Many causes and may be significant pathology; protein loss may also be significant...tell with a urine protein:creatinine ratio which sig if over 1 (have send to lab)
Term
What is ERD?
Definition
early renal disease; measures microalbumuria (sm amt albumin in pee); picks up renal disease before signs show
Term
How do you perform a urine protein:creatinine ratio?
Definition
submit one urine sample for protein and for creatinine determinations; if the ratio b/w the two is less than 0.5 normal..0.5-1 is questionable and abnorm is greater than 1.0 (could explain clinical signs)
Term
Why is there a glucose test pad on the urine strip?
Definition
Not much to do with urinary tract; more of total body
Term
Is glucose re-absorbed or comes out in urine? How do you know if proper amt being absorbed?
Definition
Re-absorbed actively, H20 soluble so makes to proximal tubule and re-absorbed
*see pos glucose test if blood glucose above Tmax and glycosuria = hyperglycemia (which has many causes like stress.. but its NOT diabetes mellitus!)
*on color comparison chart, use a "+" system sometimes
Term
What is the Tmax?
Definition
max amt proximal tubule re-absorbs and above this comes out in pee
*dog= above 180mg/dl, 280 cat
Term
Why would you see false positive on glucose test pad?
Definition
ascorbic acid (vit c) in diet
Term
Why would an animal have hyperglycemia?
Definition
high carb meal; IV fluids containing glucose; excitement; diabetes mellitus; stress (wrestling, try minimize and use smaller needle and keep calm esp if try assess insulin effectiveness, dont mistake bc you stressed animal!), steriods
Term
What do clinitest tablets measure? How would you perform this test?
Definition
Detect any sugar in urine (glucose most common), were used to monitor insulin tx b/c clients gave insulin at home (so had educate them to use) but not used much in vet med today
*performed by mixing with water and add tablet (HOT RXN), compare color with chart and note "pass through"; tablets should be white not black (bad tab)
Term
What does a "pass through" on a clinitest tell?
Definition
sometimes too much glucose in urine so passes through; report as +4 which greatest level possible and then any result above ++ meant needed increase insulin to patient by couple units
Term
Why are ketones produced?
Definition
due to fatty acid catabolism; normally body would break down carbs but without then body breaks down fat and fat breakdown produces ketones...some would be normal but lots of fat breakdown raises level ketones and get excreted in urine
-IOW, see in starvation, high fat diets, diabetes mellitus (no insulin or not enough being produced to break down glucose and body breaks down fat)
Term
Is ketosis normal?
Definition
Commonly seen in ruminants; dogs and cats get ketoacidosis
Term
First sign that dairy cow has ketosis?
Definition
Milk production decreases then depression; ppl can monitor how much feed dairy take in and change is bad
-dairy or lactating animals produce milk and have higher fat levels so see ketones in milk
Term
Ketones are discovered in urine by what tests?
Definition
ross test; acetest tablets; powder (in LA) where put powder on sponge and allow cow to pee on it and look for color change then test milk..severe if see +, tx for ketosis
Term
What is bilirubin and when is it normally seen? Abnormally seen?
Definition
a product from broken down blood cells; usually present in dog urine; abnorm in cat; any increase means have hyperbilirubinemia and means have icterus or will have (usu due to RBC breakdown or liver disease)
*in light converted to biliverdin
Term
What test is used to test for bilirubin? What can mess it up?
Definition
Ictotest detects minute amount (a tablet test!); ascorbic acid can interfere with, not useful test
*if see +++, expect hyperglycemia and do glucose test
Term
What is urobilinogen?
Definition
a breakdown produce of bilirubin, occured in SI, present in urine if bile ducts open; basically this is what bacteria converted in SI after coming thru bile duct and it gets picked up in blood & goes to kidney & out in pee (bc any bilirubin in urine is h20 sol) or some stays in feces to give brown color
Term
What are the results for a urobilinogen test?
Definition
Not valid test in animals; if consistently neg, duct blocked! false neg in dilute urine (SO if see dilute pee, look at 1st pee in am and see def a increase in urobilinogen);
*essentially, increased bilirubin will up urobilinogen
Term
When will you see blood in urine?
Definition
pos in hematuria (see bleeding in tract); hemoglobinuria (in things like IV hemolysis, hemolysis in urine, basically see this more due to breakdown of blood in tract), myoglobinuria or azoturia
*if blood present at all, pee be red; blood in pee = bleeding in bladder (most common) & kidney (at lv of glomerulus) & urethra
*longer sits in urine, blood will breakdown
Term
What are some signs of myoglobinuria?
Definition
don't want move and stiff
Term
What will the test on the dipstick indicate for blood?
Definition
neg, non hemolyzed (meaning RBC present); if blood hemolyzed test be pos showing RBC were present in pee even if not find in sediment exam later (bc hemolyzed)
Term
If you find red urine, what should you do?
Definition
Centrifuge the urine
*once centrifuged, see if clears --> hematuria (rbc will settle to bottom) & not clear --> look at plasma/serum, if clear --> myoglobin and red = hemoglobin
Term
What test is done for blood in urine?
Definition
can do a dipstick which sensitive at 5-20 rbc/ul; more sensitive to free HbG; chemstrips are more sensitive to intact rbcs; hematest senstitive to 50 rbc/ul;
*urinary acidifiers may interfere with! these are used to tx blocked tom, acidifierds usually ascorbic acid which interferes with lot of these tests
*hematest is a tablet! most not using; used call occult test to test for blood in feces/urine that didnt seem present; common used with melena (black tarry stool see with anemia or blood high in GI)
Term
What is nitrite? Is the test used a lot?
Definition
produced by bacteria so if + certain ones present that convert nitrate to nitrite; not used much in vet med (look for bacteria or culture instead);
*ascorbic acid will cause be false
Term
How are leukocytes found in urine?
Definition
test pad on dipstick; LONG test = 2min; NEWEST test; accurate to greater than 5/hpf
*remember that most blood and thus WBC coming from bladder; lot bleeding means most def have WBC
Term
What produces false neg on leukocyte test?
Definition
ascorbic acid; tetracycline; cephalosporins; increased glucose will increase SG and decrease results on this
*SO just look at sediment exam instead
*lot blood interfere with dipstick colors, odd colors = mark invalid