Sys Path > Urinalysis > Flashcards

Urinalysis Flashcards

(71 cards)

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1
Q

what are the storage conditions for urine prior to urinalysis

A
  • ideally run UA within 30 mins of collecting sample
  • if over 30 mins then refrigerate for 12h in sterile, opaque, airtight container
  • when running UA on refrigerated sample let warm to room temp for 20 mins and gently swish to remix
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2
Q

low USG can lead to what

A

cellular lysis

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3
Q

what are the components of a complete urinalysis

A
  • gross visual assessment
  • USG
  • chemical evaluation
  • microscopic examination of sediment
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4
Q

what do we want to assess when doing our gross visual assessment of urine

A
  • color (blood, pigment, bilirubin)
  • turbidity (crystals, cells, casts, bacteria, mucus)
  • odour (ketones, ammonia, UTI)
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5
Q

T/F USG can only be run on warm urine

A

T

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6
Q

why can we only run USG on warm urine

A

cold increases the fluid density and falsely increases USG

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7
Q

what happens when trying to read USG if urine is turbid and how do we overcome this?

A

light refraction makes the line fuzzy and hard to read; analyze supernatant instead

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8
Q

you should always interpret USG with

A

hydration status

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9
Q

if we see hyposthenuria when running USG what does this mean?

A
  • active dilution or…
  • diabetes insipidus (central or nephrogenic)
  • psychogenic polydipsia
  • renal disease with decreased electrolytes (RARE)
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10
Q

what should you IGNORE on the dip stick

A
  • leukocytes
  • USG
  • nitrate
  • urobilinigen
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11
Q

what is the exception to the rule that we should NOT see glucosuria in health

A

puppies <8 weeks of age (they have immature tubules)

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12
Q

what is the renal glucose threshold in:
- dogs
- horses
- cats

A

dogs: 10 mmol/L
horses: 10 mmol/L
cats: 15 mmol/L

Note: cat glucose threshold is lower in DM

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13
Q

what are causes of glucosuria?

A
  • diabetes mellitus
  • stress/excitement in cats (transient)
  • chronic illness in cats
  • renal tubular disease (transporters not reabsorbing)
  • severe urethral obstruction in cats (pseudoglucosuria)
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14
Q

when do we consider renal tubular disease as a cause of glucosuria? what are examples of causes?

A

When normoglycemic…

Causes:
- primary renal glucosuria
- fanconi syndrome (Basenji)

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15
Q

____ (Species) have a low renal threshold for conjugated bilirubin unlike ANY other species

A

dogs

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16
Q

what percentage of dogs will have mild bilirubinuria on UA

A

> 20%

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17
Q

T/F bilirubinemia typically precedes bilirubinuria in dogs

A

F

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18
Q

what are causes of bilirubinuria

A
  • cholangiohepatopathy (ex. cholestasis)
  • hemolysis (ex. IMHA)
  • starvation/horses off feed
  • pyrexia
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19
Q

what can cause a false negative sample for bilirubinuria

A
  • aged sample
  • light exposure
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20
Q

T/F ketonuria typically precedes ketonemia

A

T

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21
Q

what are causes of ketonuria

A

Excessive/defective lipid or carbohydrate metabolism:
- NEB
- DKA
- insulinoma

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22
Q

what is weird about the dipstick test for ketones and the types mainly produced

A

dipstick tests acetoacetic acid, but BHB is the most abundantly produced

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23
Q

what can impart a red/pink/brown color to urine?

A

myoglobin, hemoglobin, RBCs

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24
Q

how can we tell whether a sample has myoglobinuria, hemoglobinuria or hematuria?

A

Hematuria:
- PCV WRI
- pre-spun urine color is red-pink but post-spun urine color is clear
- blood in sediment

Myoglobuniuria:
- PCV WRI
- pre-spun urine color is red-brown BUT plasma is clear
- no RBC in sediment
- ASK and CK increased

Hemoglobinuria:
- PCV decreased
- pre-spun urine color is red-pink AND plasma is red-pink
- no RBC in sediment
- ASK and CK WRI

All 3: positive urine blood rxn

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25
what is normal urine pH in: - dog/cat/young herbivore on milk: - herbivore:
dog/cat/young herbivore: 5.5 - 7.5 herbivore: 7 - 8.5
26
what happens to the pH in an old urine sample
falsely increased pH
27
what causes abnormally alkaline urine pH
- UTI (proteus, staphylococcus...) - low protein diet - alkalosis - alkalinizing drugs
28
what type of crystals like to form in alkaline pH
struvite
29
what causes abnormally acidic urine pH
- drugs (furosemide) - increased protein catabolism (diet, hyperthyroidism, pyrexia, steroids, neoplasia) - acidosis - hypochloremic metabolic alkalosis
30
how does hypochloremic metabolic alkalosis (ex. secondary to an LDA) result in acidic urine pH? this seems counterintuitive since it is alkalosis!!!!
sequestered HCl -> metabolic alkalosis -> hypokalemia -> excretion of H+ in urine
31
you should always interpret your dipstick in light of...
USG; ex. a mild positive in very dilute urine is significant
32
the dipstick primarily detects what type of proteinuria? importantly... it will NOT detect....
hypoalbuminemia; Bence-Jones proteinuria; globulins
33
what is the most practical and reliable way to characterize protein fractions and detect BJ proteinuria
urine protein electrophoresis
34
we tend to see false positives for proteinuria in what species
cats
35
if you don't trust your dipstick results for proteinuria, what is more quantitative and accurate (and does not rely on interpreting USG)
UPCR on (biochemical analyzer)
36
you should only use UPCR to determine proteinuria once you have ruled out...
pre and post-renal causes of proteinuria
37
how should you prepare urine sediment
- spin down - pipette supernatant leaving 10% of starting volume (~0.5 mL) and sediment - flick to re-suspend or gently pipette up and down
38
how should you stain and evaluate a wet mount for urine sediment examination
- stain part of the slide - look for casts on LPF (10x) - look for everything else on HPF (40x)
39
what is a normal amount of RBC and WBC in urine sediment
< 5 RBC and < 5 WBC per HPF in well-concentrated urine
40
what is an important consideration when evaluating RBC and WBC in urine sediment based on the urine itself
dilute and alkaline urine may lyse cells -> leads to underestimation
41
what is a normal amount of casts per LPF in well concentrated urine
< 2 granular or hyaline casts
42
T/F absence of casts rules out kidney disease
F
43
what could falsely increase RBC on urine sediment exam
cystocentesis as sample collection method (especially if bladder wall inflammation or cats)
44
how do casts change in appearance over time
epithelial -> mixed cellular and granular -> coarse granular -> fine granular -> waxy
45
what are hyaline casts
pure protein aka no cells
46
the presence of hyaline casts indicates ______ but not ___________
AKI; prognosis
47
hyaline casts indicate proteinuria of what origin
renal or extra-renal examples: - Bence Jones proteinuria - glomerular disease
48
T/F hyaline casts are more easily visible with stain
T
49
T/F only hyaline and fine granular casts are normal <2/HPF
T
50
waxy casts always indicate
chronic tubular injury
51
what part of the urethra is lined by squamous epithelial cells
distal 1/3 of urethra
52
how can we ID squamous cells on microscopic sediment exam
larger than WBC but smaller than urothelial cells
53
when might you see squamous cells in the urine sediment exam
- intact males with squamous metaplasia of prostate (dt estrogen exposure) - free catch sample
54
put the following in order from largest to smallest: - urothelial (transitional) cells - RBC - WBC
urothelial > WBC > RBC
55
if you suspect urothelial or transitional cell carcinoma based on sediment exam what should you do next
- BRAF DNA test - cytology sent out to clinical pathologist
56
what raises suspicion of a transitional cell carcinoma
hematuria + elevated urothelial cells on UA
57
how many rods and cocci are required to reliably see them on spun down urine
10,000 rods and 100,000 cocci
58
you should always interpret bacteriuria with:
- clinical signs - method of collection - other sediment/culture findings
59
what type of crystal indicates EG toxicity
calcium oxalate monohydrate
60
T/F struvites can form in urine that has been sitting
T
61
calcium carbonate crystals are most common in
herbivores: - horse - rabbit - guinea pig
62
what forms amorphous crystals (what component)
calcium or phosphorus
63
amorphous crystals can look like
aggregates of bacteria or disintegrating casts
64
calcium oxalate crystals are more common in alkaline/acidic urine
acidic
65
T/F calcium oxalate dihydrate crystals can be seen in EG toxicity
T but most reliable indicator = calcium oxalate monohydrate
66
what conditions cause ammonium biurate crystals
PSS or liver dysfunction (especially dalmatians and English bulldogs)
67
bilirubin crystals are normal in what species in low numbers
dogs (like bilirubin on dipstick) - abnormal in every other species
68
what do cysteine crystals indicate
inherited defect in renal tubular transport in cysteine; increased risk of uroliths (repeataedly)
69
cysteine uroliths are linked to what
sex-linked and androgen responsive
70
what breed most commonly gets cysteine crystals
pitbulls
71
T/F in dogs with cysteine crystals there will be concurrent signs of renal disease
F; function will look normal
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