TRAINING MODULE III

Urinalysis

The Urinalysis

What You Will Need (and where to find it)

Urinalysis Stickers-upper cabinet to the left of the refrigerator

Pipettes (droppers) – in the clear plexiglass shelves on counter behind fecal workstation

Urine Dipsticks-cabinet above fecal workstation

Refractometer-cabinet above fecal workstation

V-shaped tube-first drawer left of microscope

Glass slides and cover slips-fecal workstation

Urinalysis

An important test for several organ systems. For some things, as important as blood tests or more important than blood tests!!!

Tests for Urinary Tract Infection Diabetes screening test Renal (Kidney) Disease Rule in or out UTI in dog’s with incontinence Endocrine Disease

Cushing’s Disease Diabetes Mellitus Diabetes Insipidus

Patient selection

Senior Wellness Screening Polyuria/Polydipsia Urinating outside the litter box or well-

trained dog urinating in house Urine spraying in cats Frequent urination, straining to urinate,

painful urination Visibly discolored or bloody urine Incontinence

Signs of Urinary Tract Disease Straining to urinate Frequent urination or frequent attempts to urinate Repeatedly assuming a urination posture Discomfort on urination Visible blood in urine Urinating in the house when well house-trained Urinating outside the litter box (cat) Visibly abnormal urine color Urinating large volumes and drinking excessive

amounts of water (polyuria/polydipsia) Passing a visible bladder stone!

Urinary Tract Infection

Could be anywhere in urinary tract Urethritis/Vaginitis/Balanoposthitis Bladder Infection Prostate Infection Kidney Infection (pyelonephritis)

Of the above, the bladder is the most common. Kidney infections in dogs and cats are rare

Indicators of UTI

High urine pH Carnivores should be less than 7 High pH may mean there is an infection or that the

patient is predisposed to infection or to struvite stones

Proteinuria (elevated protein level) on dipstick Hematuria (blood in urine) on dipstick White Blood Cells on sediment exam Red Blood Cells on sediment or + blood on

dipstick Bacteria on sediment exam

Other things that can mimic UTI Hematuria, Pyuria, Proteinuria and High pH can also

occur in a bladder with stones Animals tend to form stones in the urinary bladder, not in

the kidneys Bladder stones are very common in dogs; less so in cats Struvite bladder stones are most often associated with

high pH and UTI Hematuria, Pyuria, Proteinuria can also occur in cases

where there are tumors in the urinary tract Prostate Cancer, Prostatitis or Prostate Cysts in intact

male dogs Intact female dogs in heat will have hematuria and

proteinuria

Sample Collection Methods

Be sure to record the method of collection Voided

Collected in a cup or tray by the owner or veterinary staff member

Clean catch, for our purposes, means it was not collected off the floor nor did it splash off leaves or grass nor was it stepped in by the patient

Special cat litter for urine collection (Kit4Cat) Catheterized Cystocentesis

Collected usually by the veterinarian by tapping the bladder with a 22gauge 1½ inch needle on a 6 cc syringe

Most accurate method, especially if doing a culture and sensitivity

Owner Psychology & Voided Specimens

A urine specimen is often every bit as important as blood tests in determining general health, especially with senior pets

If the veterinarian has recommended a urinalysis and the owner is going to attempt to collect it, it is best if the owner pre-pays for the test. They are much more likely to comply if it is something for which they have already paid.

It doesn’t have to be a “first morning” urine, but that is the time at which most pets need to urinate somewhat urgently

Sometimes they’ll need to confine pets overnight to keep them from urinating on their wee-wee pads or in the litter box.

Sometimes we need to keep pets caged here for several hours to allow their bladders to be full so that we can collect a voided sample or can do a cystocentesis

Sample Handling

If collected by owner, it should be brought in as soon as possible

Refrigerated if there is any time lapse in getting it to us.

Ideally less than 12 hours old (much less preferred)

Ask the owner how and when it was obtained Is there a chance it may’ve splashed off grass or

leaves”? Is there a chance it was stepped in? Could there be fecal contamination?

Performing the Urinalysis

Color Turbidity Specific Gravity Dipstick Sediment

Color

Observe the urine grossly Write down an easily understandable color:

Yellow Pale Yellow Dark Yellow Goldenrod (a very deep gold color)

May contain Bilirubin Pink Red Port wine

May contain myoglobin, a protein that indicates muscle breakdown

Greenish May contain deteriorated blood

Turbidity

Clear Can see through it like tap water

Hazy A tiny bit murky but easy to see through

Cloudy Somewhat opaque but you could still read a

newspaper through it Opaque

You can’t read a newspaper through it

Specific Gravity

A measure of how concentrated urine is Urine color can be misleading here!

Read with a hand-held device called a refractometer

Based on distilled water having a specific gravity of 0.000

Tells a lot about how well the kidneys are functioning Normal kidneys are capable of both diluting and

concentrating urine High Specific Gravity is a good thing

Cats > 1.040 Dogs >1.030

Refractometer

Measuring the specific gravity

Lift the cover flap on the refractometer Place 2 or 3 drops of urine on the stage Lower the cover flap and gently press it down Aim the device up at the light and look

through the viewfinder Read the scale on the right of the viewfinder

It will read in four digits, the first two being 1.0__ If it is off the scale high, record it as >1.040 Hyposthenuria = <1.012 Isosthenuria = 1.012-1.018

The Urine Dipstick

Commercially made test strips

Color pads are exposed to urine and compared to a chart on the test strip bottle

In our office, kept in the cabinet above the fecal workstation

The Urine Dipstick

Designed to be dipped into a specimen in a cup

Here, we hold the strip horizontally and drip the urine onto each color pad with a dropper

When all color pads are saturated with urine, begin timing and compare to the color pads on the side of the bottle of test strips at specified time

Record the results on a Urinalysis sticker

Some things are recorded as “normal” and some “negative”

Some can be given a number of + signs or a numeric result

Record pH Protein Glucose Ketones Bilirubin Urobilinogen Blood

Here, We Do Not record Specific Gravity Nitrite White Blood cells The test strips are designed

for humans. These tests are inaccurate in animal medicine

The Urine Sediment

You will: Place about 1 ml of

urine in a v-shaped centrifuge tube

Spin in the Statspin Centrifuge on the Urine setting

Have a dropper, a glass slide and coverslip ready

The vet or tech will Discard most of the

top layer of urine (called the supernantent)

Tap the tube to suspend sediment in the urine that remains

Place one drop on a slide and cover

Read under the microscope

Statspin Centrifuge and tube

Kept in first drawer to left of centrifuge

On counter to right of microscope

Urine Sediment Results

RBCs = red blood cells Unit of “measure”is /hpf, meaning per high power field

WBCs = white blood cells Unit of “measure” is /hpf, meaning per high power field

Crystals Struvite Oxalate Urate

Casts Other

Lipid globules Epithelial cells Bacteria Spermatozoa Amorphous or trash – debris that cannot be categorized

Completed Urinalysis Record

Special Circumstances

Bashful dogs - urine collecting stick “Olympic Clean Catch” The urine is so badly discolored that it is hard to read the test

strips Spin the urine and run the test on the clearer supernatant (the

urine that rises to the top after spinning) The patient is a cat!

Collection litter (Kit4Cat) Styrofoam peanuts in a clean litter box Peeing on plastic!!! Some cats will urinate on grocery bags or saran wrap placed in or beside the litter box Sometimes owners can actually catch it in a cup!

If we need to do a culture and sensitivity Only choice is cystocentesis

Olympic Clean Catch

An ingenious tool!!!

Generally kept between the refrigerator and the lab counter

Collection cups are in the exam table cabinet in Exam Room 2

Kit4Cat Urine Collection Set

Contains Non-absorbent

litter Pipette Sample vial

Kept in the exam table cabinet in Exam Room 2

What we mean by “Collection Set” A flat tray to slide

under the dog Very useful for “low

rider” dogs We use recycled

vaccine trays! A pipette to transfer

the urine from tray to urine specimen cup

A urine specimen cup

Beggars can’t be choosers, we will take urine in any container it

can be caught in

Other Tests Run On Urine at AViD Labs

Culture and Sensitivity Run on Cystocentesis samples only

Cortisol:Creatinine Ratio A screening test for Cushing’s disease

Protein:Creatinine Ratio To assess urine protein loss

Bladder Stone Analysis

Sent to Minnesota Urolith Center We now have a practitioner portal to submit

and receive information from MN Urolith Center

Can go to the portal to submit a case and print an address label

Doesn’t take six to eight weeks like it used to!!

Alternately, can send to AViD Labs

Dr. Burns likes to recheck Urinalyses on pets with UTI’s in this manner:

Near the end of the antibiotic prescription but BEFORE the pet is out of antibiotic

About 2 to 3 weeks after last antibiotic was given.

On pet that have had struvite bladder stones removed, Dr. Burns likes to check them:• Two weeks post-op• Then every 3 to 4

months, for life.

Quiz

1. The Olympic Clean Catch is

a. A game where the athletes attempt to catch the javelin

b. The owner makes a diving catch with the urine cup when the dog

hikes his leg

c. A device that holds a cup for urine collection

d. A device that measures the concentration of urine

2. Specific Gravity of urine is

a. Measured with a hand-held device called a refractometer

b. A screening test for diabetes

c. Not a valued test in animal medicine

d. A measurement of urine concentration

e. A & D

Quiz, continued

3. Which of the following is not a component of the urinalysis?

a. Specific Gravity

b. Color

c. Odor/Smell

d. Turbidity

e. Dipstick

4. Turbidity means

a. Bacteria in the urine

b. Red blood cells in the urine

c. The clarity of the urine

d. Abnormal urine pH

Quiz, continued

5 Urine from cats may be collected by all of the following except:

a. Emptying the litter box and putting Styrofoam peanuts in it

b. Kit4Cat collecting litter

c. Urine collected on plastic bags in or near the litter box

d. Following the cat around with a cup

6. Which of the following is/are not a useful parameter to record from the urine dipstick?

a. Blood

b. pH

c. Nitrite

d. Ketones

e. Specific Gravity

f. C & E

g. A & D

Quiz

7. Which of the following can be assessed with urine

a. Vestibular disease

b. Kidney disease

c. Addison’s disease

d. Heart disease

8. Which of the following is an acceptable color to record for the urinalysis

a. Fuschia

b. Burnt Sienna

c. Goldenrod

d. Crimson

Quiz, continued

9. Dr. Burns likes to recheck urine after a UTI

a. Before the last antibiotic has been given.

b. In two months

c. Two to three weeks after the last antibiotic

d. A & B

e. A &C

10. The Urinalysis can be used to

a. Screen for diabetes

b. Check for bladder stones

c. Test for urinary tract infection

d. A & C

e. All of the Above