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Training module III - Urinalysis


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How to perform a urinalysis in small animal practice using urine dipsticks and a refractometer

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Training module III - Urinalysis

  1. 1. Training Module III<br />Urinalysis<br />
  2. 2. The Urinalysis<br />
  3. 3. What You Will Need (and where to find it)<br />Urinalysis Stickers-upper cabinet to the left of the refrigerator<br />Pipettes (droppers) – in the clear plexiglass shelves on counter behind fecal workstation<br />Urine Dipsticks-cabinet above fecal workstation<br />Refractometer-cabinet above fecal workstation<br />V-shaped tube-first drawer left of microscope<br />Glass slides and cover slips-fecal workstation<br />
  4. 4. Urinalysis<br />An important test for several organ systems. For some things, as important as blood tests or more important than blood tests!!!<br />Tests for <br />Urinary Tract Infection<br />Diabetes screening test<br />Renal (Kidney) Disease<br />Rule in or out UTI in dog’s with incontinence<br />Endocrine Disease<br />Cushing’s Disease<br />Diabetes Mellitus<br />Diabetes Insipidus<br />
  5. 5. Patient selection<br />Senior Wellness Screening<br />Polyuria/Polydipsia<br />Urinating outside the litter box or well-trained dog urinating in house<br />Urine spraying in cats<br />Frequent urination, straining to urinate, painful urination<br />Visibly discolored or bloody urine<br />Incontinence<br />
  6. 6. Signs of Urinary Tract Disease <br />Straining to urinate<br />Frequent urination or frequent attempts to urinate<br />Repeatedly assuming a urination posture<br />Discomfort on urination<br />Visible blood in urine<br />Urinating in the house when well house-trained<br />Urinating outside the litter box (cat)<br />Visibly abnormal urine color<br />Urinating large volumes and drinking excessive amounts of water (polyuria/polydipsia)<br />Passing a visible bladder stone!<br />
  7. 7. Urinary Tract Infection<br />Could be anywhere in urinary tract<br />Urethritis/Vaginitis/Balanoposthitis<br />Bladder Infection<br />Prostate Infection<br />Kidney Infection (pyelonephritis)<br />Of the above, the bladder is the most common. Kidney infections in dogs and cats are rare<br />
  8. 8. Indicators of UTI<br />High urine pH <br />Carnivores should be less than 7<br />High pH may mean there is an infection or that the patient is predisposed to infection or to struvite stones<br />Proteinuria (elevated protein level) on dipstick<br />Hematuria (blood in urine) on dipstick<br />White Blood Cells on sediment exam<br />Red Blood Cells on sediment or + blood on dipstick <br />Bacteria on sediment exam<br />
  9. 9. Other things that can mimic UTI<br />Hematuria, Pyuria, Proteinuria and High pH can also occur in a bladder with stones<br />Animals tend to form stones in the urinary bladder, not in the kidneys<br />Bladder stones are very common in dogs; less so in cats<br />Struvite bladder stones are most often associated with high pH and UTI<br />Hematuria, Pyuria, Proteinuria can also occur in cases where there are tumors in the urinary tract<br />Prostate Cancer, Prostatitis or Prostate Cysts in intact male dogs<br />Intact female dogs in heat will have hematuria and proteinuria<br />
  10. 10. Sample Collection Methods<br />Be sure to record the method of collection<br />Voided<br />Collected in a cup or tray by the owner or veterinary staff member<br />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<br />Special cat litter for urine collection (Kit4Cat)<br />Catheterized<br />Cystocentesis<br />Collected usually by the veterinarian by tapping the bladder with a 22gauge 1½ inch needle on a 6 cc syringe<br />Most accurate method, especially if doing a culture and sensitivity<br />
  11. 11. Owner Psychology & Voided Specimens<br />A urine specimen is often every bit as important as blood tests in determining general health, especially with senior pets<br />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.<br />It doesn’t have to be a “first morning” urine, but that is the time at which most pets need to urinate somewhat urgently<br />Sometimes they’ll need to confine pets overnight to keep them from urinating on their wee-wee pads or in the litter box.<br />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<br />
  12. 12. Sample Handling<br />If collected by owner, it should be brought in as soon as possible<br />Refrigerated if there is any time lapse in getting it to us.<br />Ideally less than 12 hours old (much less preferred)<br />Ask the owner how and when it was obtained<br />Is there a chance it may’ve splashed off grass or leaves”?<br />Is there a chance it was stepped in?<br />Could there be fecal contamination?<br />
  13. 13. Performing the Urinalysis<br />Color<br />Turbidity<br />Specific Gravity<br />Dipstick<br />Sediment<br />
  14. 14. Color<br />Observe the urine grossly<br />Write down an easily understandable color:<br />Yellow<br />Pale Yellow<br />Dark Yellow<br />Goldenrod (a very deep gold color) <br />May contain Bilirubin<br />Pink<br />Red<br />Port wine<br />May contain myoglobin, a protein that indicates muscle breakdown<br />Greenish<br />May contain deteriorated blood <br />
  15. 15. Turbidity<br />Clear<br />Can see through it like tap water<br />Hazy<br />A tiny bit murky but easy to see through<br />Cloudy<br />Somewhat opaque but you could still read a newspaper through it<br />Opaque<br />You can’t read a newspaper through it<br />
  16. 16. Specific Gravity<br />A measure of how concentrated urine is<br />Urine color can be misleading here!<br />Read with a hand-held device called a refractometer<br />Based on distilled water having a specific gravity of 0.000<br />Tells a lot about how well the kidneys are functioning<br />Normal kidneys are capable of both diluting and concentrating urine<br />High Specific Gravity is a good thing<br />Cats > 1.040<br />Dogs >1.030<br />
  17. 17. Refractometer<br />
  18. 18. Measuring the specific gravity<br />Lift the cover flap on the refractometer<br />Place 2 or 3 drops of urine on the stage<br />Lower the cover flap and gently press it down<br />Aim the device up at the light and look through the viewfinder<br />Read the scale on the right of the viewfinder<br />It will read in four digits, the first two being 1.0__<br />If it is off the scale high, record it as >1.040<br />Hyposthenuria = <1.012<br />Isosthenuria = 1.012-1.018<br />
  19. 19. The Urine Dipstick<br />Commercially made test strips<br />Color pads are exposed to urine and compared to a chart on the test strip bottle<br />In our office, kept in the cabinet above the fecal workstation<br />
  20. 20. The Urine Dipstick<br />Designed to be dipped into a specimen in a cup<br />Here, we hold the strip horizontally and drip the urine onto each color pad with a dropper<br />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<br />Record the results on a Urinalysis sticker<br />Some things are recorded as “normal” and some “negative”<br />Some can be given a number of + signs or a numeric result<br />Record<br />pH<br />Protein<br />Glucose<br />Ketones<br />Bilirubin<br />Urobilinogen<br />Blood<br />Here, We Do Not record<br />Specific Gravity<br />Nitrite<br />White Blood cells<br />The test strips are designed for humans. These tests are inaccurate in animal medicine<br />
  21. 21. The Urine Sediment<br />You will: <br />Place about 1 ml of urine in a v-shaped centrifuge tube<br />Spin in the Statspin Centrifuge on the Urine setting<br />Have a dropper, a glass slide and coverslip ready<br />The vet or tech will<br />Discard most of the top layer of urine (called the supernantent)<br />Tap the tube to suspend sediment in the urine that remains<br />Place one drop on a slide and cover<br />Read under the microscope<br />
  22. 22. Statspin Centrifuge and tube<br />Kept in first drawer to left of centrifuge<br />On counter to right of microscope<br />
  23. 23. Urine Sediment Results<br />RBCs = red blood cells<br />Unit of “measure”is /hpf, meaning per high power field<br />WBCs = white blood cells<br />Unit of “measure” is /hpf, meaning per high power field<br />Crystals<br />Struvite<br />Oxalate<br />Urate<br />Casts<br />Other<br />Lipid globules<br />Epithelial cells<br />Bacteria<br />Spermatozoa<br />Amorphous or trash – debris that cannot be categorized<br />
  24. 24. Completed Urinalysis Record<br />
  25. 25. Special Circumstances<br />Bashful dogs - urine collecting stick “Olympic Clean Catch”<br />The urine is so badly discolored that it is hard to read the test strips<br />Spin the urine and run the test on the clearer supernatant (the urine that rises to the top after spinning)<br />The patient is a cat!<br />Collection litter (Kit4Cat)<br />Styrofoam peanuts in a clean litter box<br />Peeing on plastic!!! Some cats will urinate on<br /> grocery bags or saran wrap placed in or beside<br /> the litter box<br />Sometimes owners can actually catch it in a cup!<br />If we need to do a culture and sensitivity<br />Only choice is cystocentesis<br />
  26. 26. Olympic Clean Catch<br />An ingenious tool!!!<br />Generally kept between the refrigerator and the lab counter<br />Collection cups are in the exam table cabinet in Exam Room 2<br />
  27. 27. Kit4Cat Urine Collection Set<br />Contains <br />Non-absorbent litter<br />Pipette<br />Sample vial<br />Kept in the exam table cabinet in Exam Room 2<br />
  28. 28. What we mean by “Collection Set”<br />A flat tray to slide under the dog<br />Very useful for “low rider” dogs<br />We use recycled vaccine trays!<br />A pipette to transfer the urine from tray to urine specimen cup<br />A urine specimen cup<br />Beggars can’t be choosers, we will take urine in any container it can be caught in<br />
  29. 29. Other Tests Run On Urine at AViD Labs<br />Culture and Sensitivity<br />Run on Cystocentesis samples only<br />Cortisol:Creatinine Ratio<br />A screening test for Cushing’s disease<br />Protein:Creatinine Ratio<br />To assess urine protein loss<br />
  30. 30. Bladder Stone Analysis<br />Sent to Minnesota Urolith Center<br />We now have a practitioner portal to submit and receive information from MN Urolith Center<br />Can go to the portal to submit a case and print an address label<br />Doesn’t take six to eight weeks like it used to!!<br />Alternately, can send to AViD Labs<br />
  31. 31. Dr. Burns likes to recheck Urinalyses on pets with UTI’s in this manner:<br />About 2 to 3 weeks after last antibiotic was given.<br />Near the end of the antibiotic prescription but BEFORE the pet is out of antibiotic <br />On pet that have had struvite bladder stones removed, Dr. Burns likes to check them:<br /><ul><li>Two weeks post-op
  32. 32. Then every 3 to 4 months, for life.</li></li></ul><li>Quiz<br />The Olympic Clean Catch is<br />a. A game where the athletes attempt to catch the javelin <br />b. The owner makes a diving catch with the urine cup when the dog<br />hikes his leg<br />c. A device that holds a cup for urine collection<br /> d. A device that measures the concentration of urine<br />Specific Gravity of urine is<br />a. Measured with a hand-held device called a refractometer<br />b. A screening test for diabetes<br />c. Not a valued test in animal medicine<br />d. A measurement of urine concentration<br />e. A & D<br />
  33. 33. Quiz, continued<br />Which of the following is not a component of the urinalysis?<br />a. Specific Gravity<br />b. Color<br />c. Odor/Smell<br />d. Turbidity<br />e. Dipstick<br />Turbidity means<br />Bacteria in the urine<br />Red blood cells in the urine<br />The clarity of the urine<br />Abnormal urine pH<br />
  34. 34. Quiz, continued<br /> 5 Urine from cats may be collected by all of the following except:<br />Emptying the litter box and putting Styrofoam peanuts in it<br />Kit4Cat collecting litter<br />Urine collected on plastic bags in or near the litter box<br />Following the cat around with a cup<br />6. Which of the following is/are not a useful parameter to record from the urine dipstick?<br />a. Blood<br />b. pH<br />c. Nitrite<br />d. Ketones<br /> e. Specific Gravity<br /> f. C & E<br />g. A & D<br />
  35. 35. Quiz<br />Which of the following can be assessed with urine<br />Vestibular disease<br />Kidney disease<br />Addison’s disease<br />Heart disease<br />Which of the following is an acceptable color to record for the urinalysis<br />Fuschia<br />Burnt Sienna<br />Goldenrod<br />Crimson <br />
  36. 36. Quiz, continued<br />Dr. Burns likes to recheck urine after a UTI<br />Before the last antibiotic has been given.<br />In two months<br />Two to three weeks after the last antibiotic<br />A & B<br />A &C<br />The Urinalysis can be used to <br />a. Screen for diabetes<br />b. Check for bladder stones<br /> c. Test for urinary tract infection<br /> d. A & C<br /> e. All of the Above<br />