Introduction to Urinalysis

1. Introduction to Urinalysis Clinical Pathology, K. Canga, RVT

2. 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).

3. Urogenital System

4. Medical Terminology • Pollakiuria • _________________________________________ • Polyuria • _________________________________________ • Oliguria • _________________________________________ • Anuria • _________________________________________ • Dysuria • _________________________________________

5. Urinalysis • Urine collection can be accomplished through __________________/__________________, __________________, __________________, and __________________.

6. Advantages to Urinalysis • _____________________________ • _____________________________ • _____________________________ • Provides useful information (urinary tract and/or other body systems)

7. Voided Urine Sample • Easiest to obtain • May be ____________________ from distal genital tract • Not satisfactory if examining for ____________________.

8. Voided Urine Sample Collection • Use a clean container • Wash prepuce or vulva (when possible) • Try to collect ___________________ urine

9. Disadvantages to Voided Sample • _____________________________ • _____________________________ • May be difficult in easily scared dogs and short breeds. Why?

10. 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 __________________________________!!!

11. 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 ________________________

12. Catheterization

13. 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

17. 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.

18. Physical Characteristics of Urine • _________________ • _________________ • _________________ • _________________ • _________________

19. 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 _____________

21. Urine Clarity • ____________ vs. _____________ • Cloudy could indicate increase _________, ____________, __________, ____________and _____________. • ______________and some ____________ have cloudy urine due to high content of mucus and ____________ ______________________crystals.

22. Urine Odor • Not Very __________________ • Strong odor may suggest _________________ production • Male __________, ____________, and _____________have a very strong urine odor

23. 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

24. Specific Gravity “normals” Source: https://ahdc.vet.cornell.edu/clinpath/modules/ua-rout/sg.htm

25. “Normal” Ranges per Textbook • Dog: 1.001 - 1.060 • Cat: 1.001 - 1.080 • Horse: 1.020 - 1.050 • Cow: 1.005 - 1.040

26. Methods of measuring urine specific gravity • ____________________ • _______________ • _______________

27. Causes of Altered Specific gravity • Increased specific gravity • ____________________________ • ____________________________ • ____________________________ • Decreased specific gravity • ____________________________ • ____________________________ • ____________________________ • ____________________________

28. Urine Volume • Influenced by several factors • _______________________ • _______________________ • _______________________

29. 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.

30. Reagent strips

31. Chemical Analysis of urine • In vet medicine, the most common chemical properties tested include: • ______ • _______________ • _______________ • _______________ • _______________ • _______________ • _______________ • _______________

32. 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

33. 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.

34. pH Acidic 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

35. 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.

36. 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).

37. 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.

38. 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 _____________.

39. 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

40. 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

41. 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.

42. 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 __________________.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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 _____________.

48. Bilirubinuria Common Causes: • ______________________ • ______________________ • _____________________ or _____________________ hemolytic disease • ______________obstruction

49. 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.

50. 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