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Introduction to Urinalysis. Clinical Pathology, K. Canga, RVT. Urinary System. Designed to maintain a balance between fluid, ___________________, and acid-base _____________________by selectively eliminating _______________________from the body. - PowerPoint PPT Presentation
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Introduction to Urinalysis
Clinical Pathology,
K. Canga, RVT
Urinary System
Designed to maintain a balance between fluid, ___________________, and acid-base _____________________by selectively eliminating _______________________from the body.
Urine is formed through __________________ filtration, tubular ___________________________, and ______________________secretion (remember everything you were taught in A&P).
Urogenital System
Medical Terminology
Pollakiuria _________________________________________
Polyuria _________________________________________
Oliguria _________________________________________
Anuria _________________________________________
Dysuria _________________________________________
Urinalysis
Urine collection can be accomplished through __________________/__________________, __________________, __________________, and __________________.
Advantages to Urinalysis
_____________________________ _____________________________ _____________________________ Provides useful information (urinary tract
and/or other body systems)
Voided Urine Sample
Easiest to obtain May be
____________________ from distal genital tract
Not satisfactory if examining for ____________________.
Voided Urine Sample Collection Use a clean container Wash prepuce or vulva (when possible) Try to collect ___________________ urine
Disadvantages to Voided Sample _____________________________ _____________________________ May be difficult in easily scared dogs and
short breeds. Why?
Expressing the Bladder
Use ____________, ____________ pressure Will feel like a balloon or ball under your hands. Make sure you are expressing in a squeezing
motion so that you are forcing urine _______________ down the urethra.
Wash external genitalia Contamination from lower urinary tract/genital
tract is a concern. Do not do manual expression if there is the
possibility of an __________________________________!!!
Urinary Catheterization
Act of placing a _______________ through ________________ into _____________.
Advantages: Less possibility of ________________________ from
lower genital tract. Helpful in ______________animals when
___________________ is difficult to palpate Disadvantages
Trauma to sensitive ____________ mucosa Possible ________________________
Catheterization
Cystocentesis
Act of obtaining a urine sample via a ______________ and ____________ directly from the ________________.
Advantages ________________ sample
Disadvantages Difficult to obtain in __________________animals Trauma to _________________ if not done
correctly
Urine Sample Preservation
Analyze all urine within _____ minutes if possible
May refrigerate for ______ hours if needed Bring to room temperature before
analysis Morning samples are more
_______________ If allowed to stand at room
temperature, may get false results.
Physical Characteristics of Urine _________________ _________________ _________________ _________________ _________________
Urine Color Normal color is due to pigments called
_________________________ Normal: light yellow to amber color Abnormals:
Red: _________ (____________) Reddish-brown: _____________or ____________ Dark yellow-brown: ____________
(_______________) Orange-Reddish brown: Normal in _____________
Urine Clarity
____________ vs. _____________ Cloudy could indicate increase _________,
____________, __________, ____________and _____________.
______________and some ____________ have cloudy urine due to high content of mucus and ____________ ______________________crystals.
Urine Odor Not Very __________________ Strong odor may suggest
_________________ production Male __________, ____________, and
_____________have a very strong urine odor
Urine Specific Gravity
Measure urine ___________________ which is dependent on the number, molecular size, and weight of urine ______________.
Measures the _____________ of urine as it compares to ______________
Specific gravity of water is always 1.000
Specific Gravity “normals”
Species Possible range
Usual range "Adequate” "Indequate"
Canine 1.001-1.065 1.015-1.045 >1.030 < 1.030
Feline 1.001-1.085 1.035-1.060 >1.040 < 1.040
Large Animals 1.001-1.050 1.015-1.030 >1.025 < 1.025
Source: https://ahdc.vet.cornell.edu/clinpath/modules/ua-rout/sg.htm
“Normal” Ranges per Textbook Dog: 1.001 - 1.060 Cat: 1.001 - 1.080 Horse: 1.020 - 1.050 Cow: 1.005 - 1.040
Methods of measuring urine specific gravity ____________________ _______________ _______________
Causes of Altered Specific gravity Increased specific gravity
____________________________ ____________________________ ____________________________
Decreased specific gravity ____________________________ ____________________________ ____________________________ ____________________________
Urine Volume
Influenced by several factors _______________________ _______________________ _______________________
Chemical properties Testing for various chemical constituents of
urine is performed with ________________________ impregnated with appropriate chemicals or reagent tablets.
Be aware of ________________________ Some reagent strips test for
___________________ constituents simultaneously; others exist for ______________________tests
Urine is added to reagent strip via _____________ or the strips are dipped in the urine sample and color changes are noted at specific intervals.
Reagent strips
Chemical Analysis of urine
In vet medicine, the most common chemical properties tested include: ______ _______________ _______________ _______________ _______________ _______________ _______________ _______________
pH
Urine pH is a function of the ____________ ability to regulate H+ and bicarbonate concentration within the blood. Above 7.0 = ____________; below 7.0 = ___________ Normal pH (dog and cat) = 6-7
If too acidic or too alkaline, specific _____________ or ___________ can form
pH of samples left standing open at room temp. tends to _______________ from loss of CO2 Delays in reading reaction may lead to color changes
and false readings
pH pH of urine depends largely on __________. ________________ urine is usually found in
animals on _________ diets; high-protein cereal diets or diets of animal origin cause __________ urine.
_________________ normally have alkaline urine; _______________acidic urine; _______________ either acidic or alkaline depending on what was ingested.
pHAcidic Urine
Metabolic or respiratory ________________
High ___________diet Vomiting Severe ____________ Fever _________________ Prolonged exercise Urinary acidifiers
Alkaline Urine Metabolic or respiratory
________________ Bacterial infections Renal tubular acidosis Purely
______________ diet
Protein
Usually absent or present only in ___________ amounts in normal urine obtained by ___________________ or ___________________
______________ samples or those obtained by expressing the bladder may contain small amount of protein resulting from __________________ that may contaminate urine during its passage along the urinary tract.
Protein Trauma to urinary tract from
__________________, catheterization, or bladder expression may cause sufficient _______________ to cause a trace of _____________ in the urine.
Protein levels in urine can be measured by reagent test strips, and urine protein/creatine ratio (UPC).
Protein Reagent strips (______________) measure protein
by progressive color changes on the reaction pad. Primarily detect ________________ False ________results may occur in _____________
urine depending on diet, urinary tract infection, or urine retention (urethral obstruction)
Only used as a _______________ tool for proteinuria ________ ratio can help confirm significant
amounts of protein in urine Sample is centrifuged and supernatent is used Ratio is obtained by dividing protein concentration by
creatinine concentration Use to confirm _________________ findings on dipstick Do not perform if bacteria in urine.
Protein Very __________ urine can yield false negative
because the concentration may be ________ the sensitivity of the testing method.
______________ proteinuria may result from a temporary increase in glomerular permeability, allowing excessive protein to enter filtrate May be found with ______________ exertion,
_______________________, or convulsions Occasionally a small amount of urine protein is found
after __________________, during the first few days of life, and during _____________.
Proteinuria In most cases, proteinuria
indicates disease of ____________ tract, especially the ________________
Non-renal: inflammation and/or hemorrhage of urinary or urogenital tract
Renal: _______________ disease, glomerulonephritis, amyloidosis, or _______________ syndrome
Pre-renal: Shock, _________ disease, ____________, increased physical exercise; overflow of a transient high concentration of protein in ______________ blood
Glucose Presence of glucose in urine is known as
________________ or _________________ Glucose is filtered through the
___________________ and resorbed by the proximal tubules.
Glucose is __________ normal in urine. Glucosuria usually does not occur in normal
animals unless the _________ glucose level exceeds the ___________ threshold
Renal threshold in dogs = 180 mg/dL; cats 300 mg/dL
Glucose False-__________ results for glucose may be seen
after use of various drugs, including Vitamin C (_____________ acid), morphine, aspirin, _____________ and other antibiotics.
Most reagent strips detect only ____________, not all sugars.
Glucosuria A high __________________ meal may lead to
blood glucose levels exceeding the renal threshold.
Fear, excitement, or _____________, especially in _________, often causes ____________________ and ________________ as a result of ______________________release.
Glucosuria often occurs after IV administration of fluids containing ______________ and occasionally after general __________________.
Glucosuria Diabetes mellitus is a condition in
which the body is unable to absorb and utilize blood _______________ efficiently. As a result, increased levels of glucose may be seen in the blood (hyperglycemia) and in the urine (glucosuria).
__________________ disease and _____________________ are also conditions associated with glucosuria resulting from sustained or marked transient hyperglycemia.
Ketones Ketones are chemical compounds normally
produced during _________ metabolism. They include acetone, acetoacetic acid, and beta-hydroxybutyric acid.
_________________ strips are most sensitive to ___________________ acid and mildly sensitive to _____________. However, they do not detect beta-hydroxybutyric acid which is the ketone primarily responsible for producing __________________.
Ketones are not normally found in urine; they are absorbed by the _____________ tubules. Excessive production leads to urinary excretion of ketone bodies.
Ketonuria is usually present before ____________________ can be detected.
Ketones Conditions characterized by altered _________________
may result in an excessive amount of fat ___________________ to provide energy.
Problems develop when excessive ketones are produced.
Ketones are __________, causing ________ depression and ________________.
Acidosis resulting from ketonemia is _______________________.
Ketonuria frequently occurs in animals with __________________________ (diabetic ketoacidosis).
Ketonemia with ketonuria also occurs with high-______ diets, _________________, fasting, long-term ________________, persistent fever, and impaired ______________function.
Bile Pigments
Bile pigments commonly detected in urine are ________________ and ____________________.
A small portion of __________________ bilirubin may be excreted through the kidneys.
The intestinal tract converts conjugated bilirubin to __________________________ to be excreted by kidneys and in feces.
A ________________ produced urine sample is essential for evaluation.
Bilirubin In ____________ (especially males), bilirubinuria is
common under ______________ conditions. 1+ to 2+ bilirubin with bilirubin crystalluria may be seen in
very ______________________ urine of normal dogs. Any bilirubinuria detected in ________= significant Bilirubinuria usually precedes
______________________ (urine = more ________________________ than plasma)
Bilirubin is __________________ sensitive. Any delay in processing can yield false _____________.
BilirubinuriaCommon Causes: ______________________ ______________________ _____________________ or
_____________________ hemolytic disease
______________obstruction
Urobilinogen Most is excreted in _______________; a small
amount is excreted by _________________ into the urine.
Urobilinogen in a urine sample is considered ________________.
Reliability of screening tests is _________________ because of instability of urobilinogen in urine.
Normally, no urobilinogen is detected in urine of animals.
Correlation between increases or decreases in urine urobilinogen and liver disease in animals is poor.
Urobilinogen Increased values
_____________ dysfunction hepatic ________________ excessive __________ breakdown increased urobilinogen production re-absorption (i.e. a large hematoma) _____________________
True absence or Very Low values failure of ___________ production obstruction of bile passage
Nitrites The nitrite portion of the dipstick analysis has limited
value in veterinary medicine. This is due to the high number of false ________________ test results in small animals.
Nitrites occur in urine during some _________________ infections. In order to achieve an accurate positive test result, the urine must have been retained in the bladder at least ____ hours.
A positive test indicates a bacterial infection. Gram negative __________ are more likely produce a positive test response.
Negative test results do not _____________ infection. The urinary tract infection may involve organisms that do not convert nitrites, or the urine may not have been held in the bladder greater than 4 hours.
Blood Tests for blood in urine detect ______________,
___________________, and myoglobinuria ___________________________ is usually a sign
of disease causing bleeding somewhere in the urogenital tract.
_________ cells (shells of _________ RBCs) may be seen if the source of hemoglobin is lysis of RBCs.
Moderate to large amounts of blood impart a cloudy ______, __________, or __________ color to urine
Similar colors, but with a _______________ appearance that remains after centrifugation, indicate __________________________.
Blood Hemoglobinuria is usually
caused by _____________________ hemolysis.
If urine is very _________ or very ____________, hemoblobinuria can originate from __________ of RBCs in the urine after excretion.
Blood
Urine containing _____________ is usually very dark _________ to almost black in color.
Severe ____________ damage causes myoglobin to leak from muscle cells into the blood.
Distinguishing myoglobinuria from hemoglobinuria can be difficult.
_______________ and _________________________ suggesting muscle damage help to differentiate.
Hematuria (blood in urine)
Chemical impregnated into pad on strip detects __________ groups found within hemoglobin and myoglobin.
Therefore, a positive test may indicate __________________ (confirm with microscopy) or hemoglobinuria or myoblobinuria.
Leukocytes Presumptive evidence of WBCs in urine may be
obtained with reagent strips. Designed to detect ________________________
Enzyme present in all WBCs except __________________________
Many false-negative reactions occur Especially ______________ Glucosuria, elevated ________, certain antibiotics
(tetracyclines) False-positive reactions occur with ________
Old samples, fecal contamination Microscopic evaluation necessary to confirm a positive result
Microscopic examination
Microscopic examination of urine _________________ is an important part of a complete u/a, especially for recognizing diseases of the urinary tract.
With the exception of __________ and ___________ urine, normal urine of domestic animals does not contain a large amount of sediment.
Microscopic examination Examine sediment while urine is fresh
because _________________ will multiply if allowed to stand at room temp. for a long period of time.
Urine collected via ________________ is best for microscopic exam
Sediment may be examined __________ or ______________ Stains often introduce ________________
into the sediment, particularly precipitate material and bacteria.
Possible Constituents of Urine Sediment
_____________________ _____________________ _____________________ _____________________ _____________________ _____________________, parasites, or ova Miscellaneous
Mucus threads, ____________________, fat droplets, other __________________
Erythrocytes May have several different appearances depending on
urine ____________________, ____, and time elapsed between ________________ and ______________________
In a fresh sample, RBCs are small, round, usually smooth edged, somewhat ________________, and yellow or orange May be colorless if _____has diffused during standing
In _____________________ urine, RBCs may shrink and _______________.
In ____________or _____________ urine, RBCs swell and may __________ Lysed RBCs may appear as colorless rings (shadow or ghost
cells) and vary in size.
Various RBCs in Urinalysis
Leukocytes WBCs appear _______________ and can appear
as a dull gray or greenish-yellow Identified in sediment by their characteristic
________________ or ____________________ of the nucleus
____________ are found in urine of animals without urinary or genital tract disease
WBCs ___________ in concentrated urine and ____________ in dilute urine
Finding >__-__ per HPF indicates an _________________ process somewhere in urinary or genital tracts
______________= excessive WBCs in the urine
Leukocytes in Urinalysis
Epithelial cells A few epithelial cells in urine are considered
______________ and occur from normal sloughing of old cells.
Three types of epithelial cells are found in urinary sediment: ______________, __________________, and ___________.
Epithelial Cells Squamous epithelial cells
Derived from the distal _______________, vagina, vulva, or _________________
Presence = not _______________________
Transitional Epithelial Cells
Transitional epithelial cellsDerived from the _______________, ureters, renal ____________, and proximal _________________.Increased numbers suggest ______________ or _________________________.Also may be seen with _________________________.
Renal Cells _______________ epithelial
cells observed in urine. Originate in the renal
________________ and are only slightly larger than __________.
Generally round and contain a large ____________ and nongranular or finely granular cytoplasm.
________________ numbers occur in diseases of kidney parenchyma.
Renal Epithelial cells
Casts In the renal ____________, secreted protein
precipitates in ___________ conditions and forms casts shaped like the _______________ in which they form.
Commonly classified on the basis of appearance as _____________, _______________, _______________ (RBCs and/or WBCs), _________________, ___________, _________, and ______________.
Type depends in part on how quickly the ________________ is moving through the tubules and how much tubular _______________ is present
Cast formation
Casts All are ___________________ structures with
_________________ sides; width is determined by width of the _____________ in which they are formed.
Any cells or structures in the area may also be incorporated into casts, imparting the morphologic features that allow them to be identified
Dissolve in ____________ urine (make sure sample has not become alkaline from standing too long)
May be disrupted with high-speed __________________________ and rough sample handing
Casts
Hyaline Casts
Hyaline casts are _________, colorless and sometimes _________________.
They are composed only of _____________. Hyaline casts seen can indicate the mildest
form of renal ________________, but can also be seen with ____________, poor renal _________________, strenuous _______________ or general ___________.
Hyaline casts
Granular casts
Granular casts are _______________ casts that contain _________________.
These are the most common type of casts see in animals.
The granules are from _____________ cells, __________, or _________ that become incorporated and then degenerated.
Granular casts are seen in cases of acute __________________.
Granular cast
Epithelial casts
Epithelial casts most commonly result when disease processes such as ________________, infarction, or _____________________ cause degeneration and necrosis of tubular _________________ cells.
A common scenario is the patient with severe _____________________. The resulting casts are flushed out of the tubules in urine produced following _____________________ with fluid therapy.
Epithelial casts
Leukocyte casts
Leukocyte casts contain ________, predominantly _______________________________.
The presence of white blood cells and leukocyte casts indicates _____________________ in the renal tubules.
Leukocyte cast
Erythrocyte casts
Erythrocyte casts are deep ____________ to ______________ in color.
These casts form when _______ aggregate within the lumen of the tubule.
Erythrocyte casts indicate ___________ bleeding. The bleeding may be from hemorrhage due to
______________ or bleeding disorders or as part of an ___________________________ response.
Erythrocyte cast
Waxy casts
Waxy casts resemble ________________ casts but are usually ____________ with square ends rather than ___________.
They have a ______________ appearance. These casts are ______________ or gray
and are highly _________________. These casts indicate severe or chronic
_______________________ of the tubules.
Waxy casts
More Waxy Casts
Fatty casts
Fatty casts contain droplets of _______ that appear as ____________ bodies.
These casts are commonly seen in ________ with ___________ disease.
Occasionally seen in ______________ dogs.
Fatty casts
A: Hyaline cast;B: Fatty cast; C: Hyaline to finely granular cast; D: Cellular cast; E: Cellular to coarsely granular cast; F: Coarsely granular cast; G: Finely granular cast; H: Granular to waxy cast, I: Waxy cast.
Crystals (Lab Pro book pp 173-177) Presence in urine is called _________________
Crystalluria may or may not be of _______________ significance.
Certain crystals form as a consequence of their elements being secreted into the urine by ______________ renal activity or as a consequence of metabolic diseases
Type of crystals formed depends on urine ____, ______________________ and __________________, and solubility of elements
Pg. 174 in LP book
Crystals
Crystals are generally reported as __________________, _________________, or __________.
Although crystals and uroliths are often identified based on ____________________ characteristics, the only definitive methods to identify crystals are __________ diffraction and _________________ analysis.
Struvite crystals
Typically resemble ________________ or __________; but may take other shapes
Sometimes referred to as: _______________________________________ _______________________________________ 6 to 8 sides = ______________
Found in ____________ to slightly ______________ urine.
Struvite crystals
The most ________________ type of crystals of both _______and ________.
Often seen in urine from clinically __________________ individuals.
Urinary tract infection with urease-positive ________________ can promote struvite crystalluria (and urolithiasis) by raising urine ______ and increasing free __________________.
Struvite Crystal
Struvite Crystals
Amorphous phosphate crystals Common in ________________ urine and
appear as a granular _____________________.
Similar in appearance to amorphous urate crystals; however, amorphous phosphate crystals lack ____________.
Amorphous phosphate crystals
Calcium carbonate crystals
Common in healthy ______________ and ________________
_____________ with many lines radiating from the centers or can appear as large granular masses.
Also may have a “dumbbell” shape (not common)
________________ to ______________ urine
Calcium carbonate crystals
Urate and uric acid crystals Amorphous urates (Na, K, Mg, or Ca salts) tend
to form in __________ urine, and may have a yellow or yellow-brown color.
Uric acid crystals are not common on small aminmals, but DO commonly occur in __________________ and _______________ due to their body’s inability to process purines (from certain types of meat).
Formation is most common in ___________ urine.
Urate and uric acid crystals
Figure 5-27 A, Amorphous urate crystals. A cotton fiber (contaminant) is trapped within the crystals (arrow). B, Uric acid crystals. These are not commonly found in small animals except for dalmatian dogs. C, Sodium urate crystals. May be found in association with ammonium biurate uroliths. A calcium oxalate dihyrate crystals is also present (center).
(From Raskin RE, Meyer DJ: Atlas of canine and feline cytology, St Louis, 2001, Saunders.)
Ammonium biurate crystals
Ammonium urate (or biurate) crystals generally appear as brown or yellow-brown ______________ bodies with irregular protrusions (”______________________").
Formation is favored in ______________ to _________________urine.
Both __________________ and ___________________ are predisposed to urate urolithiasis. They are rarely, if ever, seen in urine from normal cats or dogs of other breeds.
Ammonium biurate crystals
Calcium oxalate crystals
Calcium oxalate crystals are formed in acidic and neutral urine and may be seen in small numbers normally in dogs.
There are two distinct formations: Calcium oxalate monohydrate Calcium oxalate dihydrate
The urine of animals poisoned with ethylene glycol often contains large numbers of the monohydrate crystals
Calcium Oxalate Monohydrate May be small and “___________” shaped,
can also appear as a slat from a picket fence. Generally form in _________pH urine, but
are a key indicator if an animal is experiencing ______________________ toxicity!
Calcium oxalate monohydrate crystals
Calcium Oxalate Dihydrate
Generally appear as small _____________ with a visible “_____” across the top of the crystal.
Most often form in _________ and __________ urine.
Are commonly seen in small numbers in ____________ and _____________.
If seen in large numbers, can indicate ________________ formation.
Calcium Oxalate Dihydrate Crystals
Tyrosine crystals
Dark, ___________ -like projections; highly ________________; often found in small clusters
Not commonly seen in dogs/cats Associated with ____________ disease Form in _____________ urine.
Tyrosine crystals
Cystine crystals Form in _____________ urine. Often aggregate in ________________. Presence may be an indication of cystinuria, a
______________ metabolic disorder involving defective renal tubular __________________ of certain amino acids including ___________. Sex-linked inheritance is suspected since ________ dogs
are almost exclusively affected. Many breeds, as well as mixed breeds, have been reported affected .
Renal function otherwise appears to be normal and, aside from a tendency to form uroliths, the defect is without serious consequence.
Cystine crystals
Optimal pH for crystal formation
Microorganisms, parasites, ova A variety of microorganisms can be found in urine sediment, including _____________, __________, and ___________________.
Normal urine collected by __________________ or _______________________ does not normally contain bacteria and is considered ____________.
Bacteria can be identified only under ______________ magnification May be round (_______) or rod shaped (_______), usually
refract light, and appear to be quivering as a result of __________________ movement.
Are reported as few, moderate, many, or __________.
Bacteria A large number of bacteria accompanied by a
large number of ________ suggests _______________ and ________________ of the urinary tract (e.g. ___________, pyelonephritis) or ___________ tract (e.g. ______________, metritis, vaginitis).
Bacteria in the urine sample are most significant when also identified within the ___________________ of the WBCs. Submit samples for bacterial _____________&
_____________________testing.
WBCs and Bacteria in urine
Yeast, fungi
Yeast are often confused with __________ or _________ droplets but usually display characteristic _________________. Usually contaminants in urine because yeast infection
of the urinary tract are ________ in cats/dogs. Other fungi may be found (_______________
and usually ________________)
Yeast & other fungi
Ova & Parasites Parasite ova may be seen in urine sediment of
animals with urinary _____________ or because of ___________ contamination at the time of sample collection.
Parasites of the urinary tract include: ______________________ and _________________________________.
Microfilaria of ________________________ may be seen in urine sediment of dogs with circulating microfilaria if __________________ into the urine occurs from disease or ________________ during collection.
Urinary Parasite ovaCapillaria plicaDioctophyma renale
Dirofilaria immitis
Miscellaneous components of urine
Mucus threads are often confused with casts but do not have well-delineated ____________ like casts. Normal in ___________ urine (horses have mucus
glands in renal pelvis and ureter) In other animals indicates _____________ irritation
or contamination of sample with ______________ secretions.
Miscellaneous components of urine _________________ are occasionally seen
in sediment of intact male or recently bred females.
_________ droplets appear as lightly green-tinged, highly refractile, spherical bodies of ______________ sizes. Catheter lubricants, oily surfaces of collection
vials or pipettes Fat in urine = ______________ ; seen to some
degree in cats
Other artifacts
Artifacts may enter the urine sample during _________________, ____________________, or ______________________. _____________, oil droplets, starch granules (glove
powder), ________, fecal material, plant spores, ___________, cotton fiber, __________, glass particles or chips, _______________, and fungi may contaminate urine.
Ova of intestinal parasites may be observed as a result of _______________ contamination.
“Pee End”