Urinalysis

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kris10leejmu
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134111
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Urinalysis
Updated:
2012-02-18 13:00:24
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Lab Tech
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Lab Tech
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  1. What is the path of urine from where it is produced to where it exits the body?
    • Passive diffusion in glomerulus (filtrate)
    • Reabsorption of solutes from filtrate in proximal tubule via active transport
    • Counter current multiplier at Loop of H
    • Concentrated filtrate flows out of collecting ducts to renal pelvis then to ureters and then to the bladder
  2. List 4 ways to collect urine.
    • Free Catch
    • Express Bladder
    • Catheterization
    • Cystocentesis
  3. What are the disadvantages of catching urine using the free catch method?
    not a sterile sample
  4. What are the disadvantages of collecting urine using the manual expression of the bladder method?
    • not a sterile sample
    • can't use if animal is obstructed
  5. What are some disadvantages of collecting urine using the catheterization method?
    some require sedation
  6. What are the disadvantages of collecting urine using the cystocentesis method?
    bladder must be palpable
  7. Describe how to obtain a free catch sample.
    • use a clean, dry container
    • clean area first
    • catch the urine in midstream for fewer contaiminants
  8. Describe how to collect urine by expressing the bladder.
    • make sure animal is relaxed
    • clean external genitalia
    • gently compress posterior abdomen with fingers (for large animals its done rectally)
  9. Describe how to collect urine using a catheter.
    • may require some sedation
    • need sterile catheter and lube
    • thread catheter thru urethra into bladder
    • discard the first few cc's withdrawn
    • collect into sterile container using a syringe or gravity
  10. What are some catheters that are used for urine collection?
    • rubber
    • polypropylene
    • metal catheter
  11. List the three parts of a urinalysis
    • gross exam
    • chemical exam
    • sediment exam
  12. What are the 4 components of the gross examination of urine?
    • color
    • odor
    • clarity
    • specific gravity
  13. What size needle is appropriate for cystocentesis in dogs and cats?
    • 22x1 for cats
    • 22x1.5 for dogs
  14. When, during the day, is the ideal time to get a free-catch sample?
    1st thing in the morning
  15. Which will provide the most diagnostic sample: early, mid, or late-stream free-catch? Why?
    mid stream because it has fewer contaminants
  16. Describe the gross appearance of normal urine from a dog and a horse.
    • dog: clear & yellow
    • horse: dark
  17. What does the urine specific gravity actually evaluate?
    • measures the concentration of the urine (how thick it is compared to water)
    • evaulates tubular function
  18. List two ways to measure urine specific gravity.
    • refractometer
    • urinometer
  19. List at least nine different things measured by the various urine dip-stix.
    • pH
    • protein
    • glucose
    • ketones
    • bilirubin
    • urobilinogen
    • blood
    • nitrate (for humans)
    • USG (for humans)
  20. Which of these things are found in normal urine - pH, protein, glucose, ketones, bilirubin, urobilinogen, blood, nitrate, USG?
    urobilinogen
  21. Which part of the dip stix tests are not used in veterinary medicine?
    • nitrate
    • USG
  22. Describe the differences in appearance amongst the three different epithelial cells seen in urine sediment.
    • Squamous: large, plate-like
    • Transitional: smaller than squamous cells - oval/roundish
    • Renal Tubular Cells: smallest, least common, slightly larger than WBCs, same size as RBC (hard to tell the difference)
  23. Name five other cells seen in urine sediment.
    • erythrocytes
    • leukocytes
    • bacteria and yeast
    • sperm
    • parasite eggs
  24. Name three stains commonly used to perform a sediment exam.
    • supravital stains
    • romanowsky stains
    • gram stain
  25. Why look at urine sediment unstained first?
    because stains can have artifacts that we may mistake for parasites or bacteria
  26. What happens to urine as it sits around on a counter?
    • chemical changes occur (decrease in bilirubin, ketons, and glucose...increase in pH)
    • casts dissolve
    • cells break down
    • bacteria increases
  27. What changes occur in urine that is exposed to light for a period of time?
    bilirubin converts to biliverdin within 1 hour when exposed to light and gives us false negatives
  28. What changes occur in uring that is refrigerated?
    crystals form
  29. Define polyuria.
    excess urine volume
  30. Define polydipsia.
    excess drinking
  31. Define pollakiuria.
    excessively frequent urination
  32. Define hematuria.
    blood in urine
  33. Define dysuria.
    difficulty urinating
  34. Define stranguria.
    straining to urinate
  35. Define oliguria.
    not much urine produced
  36. Define anuria.
    no urine produced
  37. Define pyuria.
    pus in the urine
  38. Define hyposthenuria/hypotonic
    • very dilute urine (less solutes than the blood)
    • erythrocytes will swell/lyse
  39. Define isosthenuria/isotonic.
    • specific gravity of 1.008 - 1.012
    • not concentrated
    • same specific gravity as blood, no concentration went on
  40. Define hypersthenuria/hypertonic
    • very concentrated urine
    • erythrocytes will crenate
  41. Define turbid
    floating above or on the surface
  42. Define flocculent
    floaties, chunks in urine
  43. Why is it important to evaluate components of the urine in light of specific gravity?
    because it measures how much the light is bent
  44. What causes a sweet, fruity odor to urine and how does it that condition develop?
    • ketosis
    • due to fatty acid catabolism (breakdown), byproducts of fat metabolism
  45. What causes urine to have an ammonia odor?
    • urease-producing bacteria (urea - breaks down molecule bonds and then it smells different)
    • may indicate infection if fresh
  46. What species' urine is normally cloudy and why?
    • horses, rabbits, rodents
    • due to the presence of CaCO3 crystals
  47. What should you do to refrigerated urine prior to analyzing it?
    restore to room temperature
  48. What is the significance of Tmax?
    • transportation maximum is the maximum speed at which a transport molecule can work
    • the renal threshold
  49. What are the common causes of hyperglycemia?
    • diabetes mellitus
    • excitement (cats)
    • post-prandial sample
    • IV fluids containing glucose
    • glucocorticoids (released from stress)
  50. What are causes of proteinuria?
    • hemorrhage
    • inflammation
    • +/- infection
  51. What would be the significance if an animal never had urobilinogen in the urine?
    bile duct blocked
  52. Protein content of urine should be evaluated based on what other urine parameter?
    creatinine
  53. Dipsticks are limited in that they only measure one kind of protein. What type?
    albumin
  54. What is creatinine and why is it in urine?
    a crystalline end product of creatine
  55. What is the significance of a urine:creatinine ratio greater than 1?
    indicates protein loss in urine - glomerular disease
  56. What influences the pH of a urine sample?
    diet
  57. What animals have an acidic pH?
    carnivores and nursing herbivores
  58. What animals have an alkaline pH?
    herbivores
  59. What does a specific gravity between 1.008 - 1.012 mean about the animals ability to concentrate its urine?
    unable to concentrate urine
  60. What species normally have a trace of bilirubin in the urine? Why?
    • dogs
    • they have a low renal threshold
  61. Describe the differences between hematuria, hemoglobinuria, and myoglobinuria.
    • hematuria: bleeding in the tract
    • hemoglobinuria: IV hemolysis, hemolysis in urine
    • myoglobinuria: brown urine
  62. How long should urine be centrifuged and at what rpm?
    3 - 5 minutes at ~2000 rpm (slow)
  63. What is a problem with using supravital stains in terms of interpretation of urine sediment?
    contains lot of contaminants
  64. List two supravital stains used in U/A's.
    • NMB
    • sedistain
  65. Unstained urine will require less light. What are three ways to decrease the light coming through your sample on the microscope?
    • close the iris diaphragm
    • turn rheostat down
    • drope condenser down
  66. At what power(s) is urine sediment examined? How many fields should you look at?
    • low and high power fields
    • at least 10 fields
  67. Give 2 examples of Romanowsky stains. How do you use these stains?
    • Diff Quik and Wright's stain
    • set it in fixative for a long time, gently dip in eosino stain, gently dip in baso stain, rinse - let water hit the etched edge and run down the slide
  68. How can you tell the difference between WBCs and RBCs in urine?
    • RBCs: small, round, uniform in size, no internal structures
    • WBCs: round, slightly larger than RBCs, usually appear granular (nucleus)
  69. How is formation of crystals related to U.S.G?
    U.S.G is determined by size, weight, and number of dissolved particles so if there are crystals it will change the USG
  70. Why must you always consider the method of collection when viewing urine results?
    because free catch samples and expressed bladder samples are not a sterile sample and may have some contaminants
  71. How many WBC are normal in urine sediment collected by each method?
    • up to 7/hpf for free catch and expressed bladder
    • 0 - 3/hpf for cystocentesis
  72. How many RBC are normal in urine sediment collect by cysto/cath?
    up to 2 - 3/hpf
  73. Where do squamous epithelial cells come from and what is their significance?
    • distal urethra, vagina, prepuce
    • common in free catch or catheterized samples
  74. Where do transitional cells come from and what is their significance?
    • renal pelvis, ureters, bladder, proximal urethra
    • increase in inflammation and catheterized samples
  75. Where do renal tubular cells come from and what is their significance?
    • renal tubules
    • normal in small numbers (0-1/hpf)
  76. What is the significance of bacteria found in urine collected by different methods?
    • normal in voided samples
    • abnormal in cystocentesis
  77. What is the significance of fungal elements found in urine collected by different methods?
    only significant if sampled collected through cystocentesis
  78. What is Capillaria plica and why might you find its eggs in urine?
    • bladder worm in dog
    • asymptomatic
    • causes: cystitis, hematuria, dysuria
  79. How would heartworm microfilaria get into urine?
    if there is bleeding in the bladder and the heartworms that are in the blood get into the bladder
  80. What is a cast and how is it made?
    • concretions formed in distal renal tubule
    • in an area of low pH, protein precipitates get trapped in that spot
  81. What pH do struvite crystals precipitate out at and what is their significance?
    • alkaline pH
    • related to diet, may indicate urolith but they are often insignificant
  82. What are the most commone crystals seen in urine sediment?
    • struvite
    • calicum oxalate
    • calcium carbonate
    • uric acid
  83. What species or breeds are predisposed to urate uroliths?
    dogs and cats
  84. What type of cast is most commonly seen? How is it formed? What is it composed of?
    • granular casts
    • granules are degraded tubular cells and WBC that are trapped in hyaline casts
    • hyaline casts (plain gelatinous mucoprotein with no cells) that contain granules
  85. Why are casts hard to find in anything but fresh urine?
    not stable and readily dissolve
  86. What are the four criteria needed for cast formation?
    • acidic urine
    • concentrated urine
    • reduced tubular flow rate
    • presence of mucoprotein matrix
  87. What is the significance of leukocyte casts?
    indicates inflammation within tubules (pyelonephritis)
  88. Which type of cast has square ends? What is the significance of finding this type of cast?
    • waxy casts
    • indicate chronic severe tubular degeneration
  89. In which species are fat droplets commonly found in the urine? Of what significance are they?
    • dogs and cats
    • insignificant
  90. How should urine dipsticks be stored prior to use?
    keep dry and out of light
  91. What does a urinalysis provide information on?
    • urinary tract disease
    • reproductive tract disease
    • systemic disease
  92. What are the 3 steps of urine production? And where do these steps occur?
    • filtration (glomerulus of renal nephron)
    • reabsorption (renal tubule)
    • active secretion (renal tubule)
  93. What is urine?
    waste product
  94. Does urine change throughout the day? Due to what?
    • yes
    • eating and drinking
  95. What are urine samples affected by?
    • collection method
    • time since collection
    • storage technique
  96. When should a urine sample by analyzed?
    within 30 minutes?
  97. What do you do if you can't examine urine within 30 minutes?
    refrigerate
  98. Which type of urine collection is most commonly used?
    free catch
  99. How do you obtain a free catch sample in dogs? Cats? Cows? Horses?
    • Dogs: cup with or without a stick
    • Cats: litter box (nosorb, styrofoam peanuts, empty box)
    • Cows: rub ventral to vulva
    • Horses: whistle (race horses), place in clean stall, rub warm moist cloth on belly
  100. Which type of urine collection method is preferred? Why?
    • cystocentesis
    • sterile sample
  101. What might you see in the urine due to a cystocentesis?
    microscopic hemorrhage (small amounts of blood)
  102. How should you enter the bladder with the needle during a cystocentesis?
    at an angle
  103. What happens to the color of urine when it is really concentrated?
    darker yellow
  104. What happens to the color of urine when it is really diluted?
    colorless
  105. What happens to the color of urine when there is hematuria?
    red - reddish brown
  106. What is myoglobin?
    what is in skeletal muscle that carries oxygen
  107. What is specific gravity?
    density of a liquid compared with equal amounts of distilled water
  108. What is the normal range of specific gravity for most animals?
    1.001 - 1.065
  109. Are urine sticks accurate when deterimining specific gravity?
    no
  110. What are the steps to using a dipstick?
    • immerse in room temperature urine for 2 - 3 seconds
    • remove excess (tap on side of cup)
    • compare color to label at specific time
  111. Beside dipping a dipstick in urine, what is another way to preform this test?
    add a drop to each test pad using a pipette
  112. What can cause a pH to decrease?
    • fever
    • acidosis
    • exercise
    • drugs
  113. What can cause a pH to increase?
    • urinary infections
    • drugs
  114. What are the units for measuring protein?
    mg/dl
  115. What may cause protein to increase?
    • collection method
    • presence of blood
    • false positive if alkaline pH
  116. What does proteinuria indicate in a patient?
    glomerular disease
  117. Where is glucose filtered?
    at glomerulus
  118. Where is glucose reabsorbed?
    at PCT (proximal tubule) via active transport
  119. How are glucose molecules actively transported?
    • carrier molecules within the membrane move glucose across the membrane, and require energy in order to reset the carrier after transport.
    • can move molecules agains the concentration gradient, resulting in high concentration on one side of the barrier membrane
  120. What is the renal threshold for dogs? Cats?
    • dogs: ~180 mg/dl
    • cats: ~280 mg/dl
  121. What happens if blood glucose is over 180 mg/dl in dogs and 280mg/dl in cats?
    the nephrons will be incapable of reabsorbing all the glucose forom the filtrate and there will be glucose in the urine
  122. When are ketones seen in urine?
    • sick ruminants
    • diabetic ketoacidosis in dogs and cats
    • pregnancy toxemia (rabbits, guinea pigs, humans)
  123. Is any bilirubin considered normal for cats?
    no
  124. What are the causes of bilirubinuria?
    • liver disease
    • biliary obstructioin
    • hemolytic anemia (extravascular hemolysis, intravascular hemolysis)
  125. What should be present if bile duct is open?
    urobilinogen
  126. What could cause a false negative urobilinogen?
    dilute urine
  127. How much urine do we need to preform a sediment exam? Do we need the same amount each time?
    • 5 ml
    • yes
  128. What are the steps to preparing for a sediment exam?
    • centrifuge for 3 - 5 minutes
    • decant (take off) supernatant - dump it down the drain
    • flick bottom of the tube several times or use pipette to re-suspend sediment
    • place 1 drop on slide
    • place coverslip
    • allow to settle for 30 - 60 seconds
  129. What do we find first to help us focus our microscopes when doing a sediment exam?
    the corner of the coverslip
  130. What are noncellular components of sediment?
    • crystals
    • casts
  131. Which cell is the second largest cell in urine?
    transitional cells
  132. Describe the nucleus of a squamous epithelial cell?
    • small
    • small nuclear:cytoplasmic ratio
  133. Describe the nucleus of a transitional cell.
    centered nucleus (larger than squamous cell nucleus)
  134. Describe a renal tubular cell.
    • eccentric nucleus
    • resemble mononuclear cells
  135. Which epithelial cells are the smallest and least common?
    renal tubular cells
  136. What is brownian movement?
    molecules move due to the movement of the earth
  137. What do bacteria look like?
    • rods
    • cocci
    • in clumps
    • chains
  138. What is tritrichomonas?
    sexually transmitted disease
  139. What species are tritrichomonas usually seen in?
    • cows
    • humans
  140. What does tritrichomonas cause?
    • infertility
    • abortions
  141. What happens to crystals when refrigerated?
    increases the number of them
  142. What is amorphous phosphate?
    • aggregates of finely granular material
    • common in alkaline urine
  143. What species is calcium oxalate common in?
    dogs and cats
  144. What is calicum oxalate related to?
    diet
  145. What could calicum oxalate indicate?
    urolith
  146. What are crystals related to?
    • pH
    • U.S.G
    • diet
  147. What species are calcium carbonate crystals common in?
    • horse
    • rabbit
    • goat
    • guinea pig
  148. Are calcium carbonate crystals seen in acidic or alkaline urine?
    alkaline
  149. Which breed of dog is uric acid crystals seen in?
    dalmations
  150. Are bilirubin crystals normal?
    no
  151. Are cystine crystals normal?
    no
  152. What could cystine crystals indicate?
    • tubular dysfunction
    • cystine urolithiasis
  153. Are tyrosine crystals normal?
    no
  154. What do tyrosine crystals indicate?
    liver disease
  155. How many casts are typically seen in a field in concentrated urine?
    1 - 2/lpf
  156. What do hyaline casts composed of and what could they indicate?
    • plain gelatinous mucoprotein with no cells
    • mild irritation of renal tubule
  157. What are the two categories of granular casts?
    • fine
    • coarse
  158. What could granular casts indicate?
    more severe tubular damage than hyaline casts
  159. What do epithelial casts indicate?
    tubular degeneration
  160. What are erythrocyte casts?
    hyaline casts that contain RBCs
  161. What do erythrocyte casts indicate?
    renal bleeding due to trauma, bleeding disorders, inflammation
  162. What are fatty casts?
    lipid trapped in hyaline or granular casts
  163. Which species are fatty casts most common?
    cats
  164. What do fat droplets look like?
    • smaller, but vary in size
    • often out of focus since they float
    • round
    • refractile


  165. What is this?
    amorphous phosphate (aggregates of finely granular material)


  166. What is this? Stained or unstained?
    • bacteria
    • stained


  167. What kind of crystals are these?
    calcium carbonate crystals


  168. What kind of crystals are these?
    calcium oxalate (3D pyramid, "x" on top, colorless)


  169. What is this?
    capillaria plica (bladder worm of dog)


  170. What kind of cast is this?
    coarse granular cast (rounded ends, large WBCs)


  171. What type of crystal is this?
    cystine crystal (hexagonal)


  172. What type of cast is this?
    epithelial cast


  173. What type of cast is this?
    erythrocyte cast (hyaline cast that contains RBCs)


  174. What are these?
    fat dropplets (round, refractile, small than RBC)


  175. What type of cast is this?
    fatty cast


  176. What type of cast is this?
    fine granular cast


  177. What type of cast is this?
    hyaline cast (clear, colorless, highly refractile)


  178. What type of cast is this?
    Leukocyte cast


  179. What is this?
    heartworm microfilaria


  180. What type of cells are these?
    renal tubular cells (slightly larger than WBCs, eccentric nucleus, hard to tell difference from WBCs)


  181. Which cell is on the top, which cell is on the bottom?
    • squamous cell
    • transitional cell


  182. What type of crystals are these?
    struvite (coffin lid appearance)


  183. What type of cells are these?
    transitional cells (round to oval with round centrered nucleus)


  184. What is this?
    tritrichomonas


  185. What type of crystals are these?
    tyrosine crystals


  186. What is this? Stained or unstained?
    • RBCs
    • unstained


  187. What is this? Stained or unstained?
    • WBCs
    • unstained


  188. What type of crystals are these?
    uric acid crystals


  189. What type of cast is this?
    waxy cast (square ends, empty - can see through them)


  190. What are these? Stained or unstained?
    • WBCs (segs)
    • stained

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