Clinical Chemistry 1.txt

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Clinical Chemistry 1.txt
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2012-02-18 18:34:49
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  1. Nephron
    Functional unit of the kidney - filtration and reapsorbtion
  2. 3 steps of urine formation
    • 1. Filtration
    • 2. Reapsorbtion
    • 3. Storage
  3. Degree of kidney filtration depends on
    • Pt's blood pressure
    • Amount of blood reaching glomerulus
    • Laws of diffusion
  4. Freely filtered substances in the kidney include
    • H20
    • Electrolytes
    • Glucose
    • Amino acids
    • BUN & Creatinine
  5. BUN & Creatinine
    Non-protein nitrogenous waste products
  6. Urea comes from
    Protein breakdown --> ammonia -(liver)-> urea --> urine
  7. Creatinine comes from
    Muscle contraction --> creatinine --> urine
  8. Hormones that act on renal tubules
    • ADG
    • Aldosterone
  9. ADH
    • Released from pituitary
    • Tells renal tubules to reabsorb H20
  10. Aldosterone
    • Released from adrenals
    • Controls sodium reabsorption and pottasium excretion
  11. Normal glucose for dogs
    100mg/dl
  12. renal threshold for glucose
    160-180mg/dl
  13. Glucosuria
    If blood glucose is ABOVE renal threshold, filtered glucose will not get reapsorbed and glucose will be present in the urine
  14. Early AM urine collection advantages
    • Decreased H2O intake
    • Most likely to show urine concentration
    • Normal color is yellow
    • Renal failure, can't concentrate urine
    • Increased chance of observing abnormalities like crystals
  15. Early AM urine collection disadvantages
    Poor cytology because urine is "old", "old" cells
  16. 4 methods of collecting urine sample
    • Voided
    • Manual
    • Catheterization
    • Cystocentesis
  17. Voided (free catch) urine collection
    • Easiest on animal, clients can do, no iatrogentic trauma
    • Not best method for culture because of bact. contamination.
    • Mid-stream catch decreases contamination, collect into a clean container
    • cats = empty litter pan with beads
    • female dogs = pie pans
    • horses = stimulate urination by rubbing warm wet cloth on lower abdomen
    • cattle = stimulate urination by tickling vulva
  18. Manual expression urine collection
    • Can get bladder out of the way when pt is under anesthesia for abdominal surgery
    • may require anesthesia, big dogs with tense muscles are hard
    • May cause iatrogenic trauma and cause increased RBCs.
    • Could rupture the bladder.
    • Large animal = through rectum
  19. Catherterization
    • Can usually get sample right away
    • Can clear obstruction
    • Can monitor urinary output with a foley
    • Ok for culture
    • May require anesthesia, may produce trauma
  20. Cystocentesis
    • Can usually get sample right away
    • Does not require anesthesia, animals usually handle better then catheterization
    • Causes iatrogenic trauma --> RBCs
    • 22g needle about 1"-1.5" long, 6cc or 12cc syringe, can do in dorsal but also lateral or standing
    • Draw as much bladder as possible so hole shrinks, Do NOT redirect to avoid colon contamination
  21. Urine is good for ___________ at room temp
    30 mins
  22. Urine is good for ________ refrigerated
    6 hours
  23. When urine is left at room temp, over time...
    • Increased bact
    • Increased crystals
    • Urine gets cloudy
    • Cells disintegrate
    • Casts break down
    • pH changes (tends to increase)
  24. Chemically preserving urine
    • 1 gtt 40% formaldehyde to 1 oz. urine
    • If used, do chemistries first (dip stick)
  25. 4 parts of a routine U/A
    • 1. Macroscopic eval
    • 2. USG
    • 3. Urine chemistries
    • 4. Microscopic eval
  26. Urinalysis
    Determines the function of kidneys and other organs
  27. Macroscopic eval
    • Note color and concentration.
    • Normal = straw - amber
    • Dark yellow = increased concentration because of decreased H2O
  28. Hematuria
    • RBCS in urine. Red to reddish-brown and cloudy.
    • Inflammation
    • Trauma
    • Urolithiasis
    • Neoplasia
    • Coagulopathy
    • Rough cysto/catheter/manual
  29. Hemoglobinuria
    • HgB in urine
    • Red/reddish-brown and transparent
    • Usually with hemolytic plasma
    • AIHA
    • Incompatible blood transfusion
    • toxins/poisons/snake venom
    • RBC parasites
  30. Myoglobinuria
    • Myoglobin in urine
    • Red/reddish-brown
    • clear plasma
    • Muscle cell lysis:
    • Exertional rhabdomyolysis
    • Extreme muscle exertion
    • Crushing injuries
    • Heat stroke
    • Electric shock
    • Snake bites
  31. Bilirubinuria
    • Bilirubin in urine
    • Dark yellow/yellowish-orange/yellow brown
    • Stains fingers
    • Excessive hemolysis
    • HBO
    • Lover disease
  32. Normal canine/feline urine coloration
    Clear/transparent. Increased concentration = hazy
  33. Normal equine urine coloration
    Cloudy due to crystals and mucus
  34. Normal ruminant urine coloration
    • Clear if fresh
    • Cloudy after standing
  35. Normal lab animal urine
    Cloudy, almost milky, due to crystals
  36. Strong ammonia smelling urine may indicate _______________
    Cystitis due to urease + bacteria
  37. Sweet and fruity smelling urine may indicate ______________
    Pseudomonas or ketones (due to DM)
  38. Foam in urine may indicate _____________
    Protein
  39. USG
    • Urine Specific Gravity
    • Evaluates renal-tubule function
    • (Response to ADH and reabsorption of H2O)
  40. Normal dog USG
    • Average 1.025
    • 1.018-1.045
  41. USG range to worry about
    1.008-1.012 (1.015 in the cat)
  42. Isosthinuric urine
    Same USG as glomerular filtration
  43. Fixed USG
    • range of 1.008-1.012 (1.015 in cats) that does change regardless of hydration status
    • 1/3-3/4 nephrons are non functional
    • Renal failure
  44. Reasons for decreased USG
    • Pale/Dilute Urine
    • Increased Fluid/Decreased "Stuff":
    • Pyometra
    • DI
    • Cushings
    • Diuresis
    • IV fluids
    • renal failure
  45. Reasons for increased USG
    • Increased concentration (dark yellow)
    • Dehydration
    • Acute renal failure/shut down
    • Shock
    • DM
  46. Carnivorous Urine pH
    Acidic
  47. Herbivorous Urine pH
    Alkaline
  48. Omnivorous Urine pH
    Dependent on diet
  49. Acidic urine causes
    • high protein diets
    • nursing young
    • Protein catabolic states (high fever/starvation)
  50. Alkaline urine causes
    • Vegetable based diets
    • UTI caused by Urease + organism
    • Urine retention
    • Urine allowed to stand open to air at room temperature
  51. Normal animal should have ______________ protein in their urine
    • 0-trace amounts of protein when sample is a cysto
    • Slightly higher amounts from voided sample
  52. Proteinuria
    Usually indicates urinary tract and kidney disease
  53. Normal animals should have __________ glucose in their urine
    NO
  54. Glucosuria causes
    • Blood glucose exceeds the renal threshold
    • 160-180 mg/dl dogs
    • 280-300 mg/dl cats
    • DM
    • Stress/fear/excitement
    • High carbohydrate meal
  55. Normal animals should have _________ ketones in their urine
    NO
  56. Ketonuria causes
    • DM
    • Prolonged anorexia/starvation
    • ketosis in lactating and pregant cows and ewes (pregnancy toxemia)
  57. Centrifuge urine at ___________ rpm for _________ min
    1200-1500 rpm for 3-5 minutes
  58. Sedi-stain
    Used on urine sample to show nuclear detail on microscopic eval
  59. 3 types of epithelial cells
    • 1. Squamous Epithelial Cells
    • 2. Transitional Epithelial Cells
    • 3. Renal Tubular Epithelial Cells
  60. Squamous Epithelial Cells
    • found in distal 1/3 of erethrea, vagina, vulva, and prepuse.
    • Largest epithelial cell
    • Nucleas is size of an RBC
    • Normal in MILD amounts
  61. Transitional Epithelial Cells
    • Line bladder, ureters, renal peelvis, and proximal part of the urethra
    • Vary in size and shape
    • Round, pear shaped, caudate
    • Large nucleas
    • Granular appearance
    • normal in MILD amounts
    • Seen more with cysto
  62. Increased Transitional Epithelial Cells can indicate ___________________
  63. Inflammation
    • Urolithiasis
    • Neoplasia
    • Trauma
  64. Renal Tubular Epithelial Cells
    • Originate in the Renal Tubules
    • Hard to ID
  65. Triple Phosphate Crystals
    • Struvites
    • Alkaline urine
    • Normal in mild amounts
    • Increased amounts can indicate Urolethiasis
    • Coffin lids
    • Coloreless
    • Tx = acidify urine with diet
  66. Calcium Oxalate Crystals
    • Acidic urine
    • Normal in MILD amounts in dogs, cats, and occ. horses
    • Can indicate urolethiasis or ethylene glycol toxicity
    • Tx = make urine alkaline with diet
  67. Hippuric Acid Crystal
    • Form of Calcium Oxalate Monohydrate
    • Always pathological
    • Indicate Ethylene Glycol toxicity
    • Look like picket-fence posts
  68. Calcium Carbonate Crystals
    • Common in horses
    • Reason urine is cloudy when combined with mucus
  69. Bilirubin Crystals
    • can be normal in dogs due to renal threshold for bilirubin
    • Increased indicates liver disease
  70. Ammonium Biurate Crystals
    • Due to increased excretion of uric acide in urine, this is normal in dalmations and primates
    • In all others can indicate portosystemic shunt and liver disease
  71. Cystine crystals
    • Never normal
    • Most common in dachshunds
  72. Tyrosine and Leucine Crystals
    • Never normal
    • Usually indicates severe liver disease
  73. Uric Acid Crystal
    • Normal in dalmations
    • Very little clinical significance
    • Form as urine stands or if temperature fluctuates
  74. Cholesterol Crystals
    • Can be normal
    • Can indicate severe kidney disease
    • RARE
  75. Urine Casts
    • Recorded in #/LPF
    • Form in lumen of distal renal tubules
    • Tamm-Horsfall protein forms a gelatin mold
    • Degenerate urine
    • Need more acidic urine
  76. Hyaline casts
    • 1-2/LPF normal
    • Colorless
    • parallel sides and rounded ends, cylinder shaped
    • Easily missed
    • Increased with fever, strenuous exercise, mild renal irritation
  77. Granular casts
    • 1-2/LPF normal
    • Increased numbers can indicate nephritis
  78. Cellular casts
    NEVER normal
  79. Erythrocyte casts
    • RBCs incorporated into the Tamm-Horsfall protein.
    • Deep yello to orange
    • Indicates bleeding in kidneys or pathologic
  80. Leukocyte casts
    • WBC in the tamm-horsfall protein
    • Disorganized arrangement
    • Indicates inflammation most likely due to pylonephritis
  81. Eputhelial Cell Casts
    • Contain renal tubular epithelial cells
    • hard to distinguish from WBC casts
    • More organized arrangement of granules
    • Indicates renal tubule damage
  82. Fatty Acid Casts
    • Contain fat droplets
    • DM or high fat diets
    • More common in cats
  83. Waxy cast
    • Rare
    • broader, square ends
    • more opaque then hyaline casts
    • Indicates chronic severe degeneration of renal tubules
  84. Urolithiasis
    Stones.
  85. Nidus
    • Something upon which a stone can form on
    • Bacteria, crystals, suture, etc...
  86. Acidic urine = _______ uroliths
    Oxalate
  87. Alkaline urine = ___________ uroliths
    Struvite
  88. Triple Phosphate Stones
    • Most common in dogs and cats
    • Alkaline urine
    • Secondary to bacterial infection
    • Converts urea to ammonia wich increases pH
  89. Urate/Ammonium Urate Stones
    • Uric Acid Stone
    • Common in dalmations
    • Restrict protein
  90. Calcium Oxalate Stones
    • Hard stones with sharp protrusions
    • Can damage the bladder
    • Acidic urine
  91. Azotemia
    Increase in non-protein nitrogenous wastes in blood (BUN/Creatinine)
  92. BUN
    Measures level of urea in blood and therefor measures glomerular filtration
  93. Normal BUN
    • dogs 7-27 mg/dl
    • cats 16-36 mg/dl
  94. Increased BUN
    • Azotemia
    • increased protein diet
    • increased breakdown of body protein
  95. Decreased BUN
    • liver disease
    • Young animals
    • Diuresis
    • Starvation
  96. Creatinine
    Test measures level of creatinine in blood and measures flomerular filtration
  97. Normal creatinine
    • dogs 0.5-1.8 mg/dl
    • cats 0.8-2.4 mg/dl
  98. Increased creatinine
    Azotemia
  99. Decreased Creatinine
    Diuresis
  100. Pre-renal azotemia
    • Problem is BEFORE kidney
    • Concentrated urine thus kidney is workin
    • Increased BUN
    • Increased Creatinine
    • Increased USG
  101. Primary Renal Azotemia
    • Problem is with kidney
    • Dilute urine
    • 2/3-3/4 nephrons non functional due to age, nephrotoxins, lead and arsenic, drugs, and snake venome.
    • Filtration and function do not work
    • Increased BUN and Creatinine
    • FIXED USG
  102. Post-renal azotemia
    • Probles is AFTER kidney
    • Increased BUN, Creatinine, and USG
    • Concentrated urine
    • Urinary obstruction/rupture
    • Emergency - can back up and cause primary azotemia

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