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Urinary System &
    Urinalysis
VTT 250 Anatomy & Pathology Lab
Structures
Kidneys
Ureters
Bladder
Urethra
Kidneys
Function
Production of urine which is the fluid that
facilitates the elimination of metabolic waste
materials from the body.
Helps maintain homeostasis by manipulating
the composition of blood plasma.
Regulation of the acid-base balance and fluid
electrolyte balance.
Blood filtration, reabsorption, and secretion.
Function…
Fluid Balance Regulation-
  The amount of urine produced helps ensure that
  the body contains the right amount of water.
  If the body has excess water and needs to get rid
  of it, more urine is formed (diuresis).
  If the body needs to conserve water, less urine will
  be produced.
  Much of this function is under the control of
  antidiuretic hormone (ADH) and aldosterone.
Function…
Acid-Base Balance Regulation-
  Enabled by the ability to remove hydrogen and
  bicarbonate ions from the blood and excrete them in the
  urine.
Hormone Production-
  The kidneys have a close association with the endocrine
  system.
  They can influence the rate of release of ADH and
  aldosterone.
  They also produce erythropoietin and some
  prostaglandins.
Gross Anatomy
Bean shaped and
covered by a fibrous
capsule.
The indented area is
called a hilus.
Renal pelvis- a urine
collection chamber that
forms the beginning of
the ureter
Gross Anatomy
Renal cortex- outer
portion.
Renal medulla-
surrounds the renal
pelvis and has a smooth
appearance.
Microscopic Anatomy
The Nephron-
  The basic functional unit of
  the kidney.
  Each nephron is composed
  of a:
     Renal corpuscle
     Proximal Convoluted
     Tubule (PCT)
     Loop of Henle
     Distal Convoluted Tubule
     (DCT)
Terms to
        Remember…
Osmosis- the passage of water across a semi-
permeable membrane from a weaker to a stronger
solution.
Diffusion- the passage of a substance from an area
of high concentration to an area of low concentration.
Reabsorption- the passage of chemical substances
from the lumen of the renal tubules into the renal
capillaries, back into the body.
Secretion- the passage of chemical substances from
the renal capillaries into the lumen of the renal
tubules, out of the body, into the urine.
Microscopic
            Anatomy…
Renal corpuscle- located in the cortex of
the kidney.
  Made up of the glomerulus (a tuft of capillaries)
  and Bowman’s capsule.
  The function is to filter blood in the first stage of
  urine production.
  The blood pressure within each glomerulus is high
  because the blood comes directly from the renal
  artery and the aorta.
  The walls of the efferent arteriole of the
  glomerulus are able to constrict under the
  influence of renin.
Microscopic
         Anatomy…
High pressure forces fluid and small
molecules out through the pores and into the
lumen of the glomerular capsule.
This process of ultrafiltration results in the
formation of glomerular filtrate.
It is very dilute and consists of 99% water and
1% chemical solutes and is isotonic with
plasma.
Microscopic
         Anatomy…
PCT- a continuation of Bowman’s capsule.
  The longest part of the nephron.
  Functions-
    Reabsorption of glucose, water, and sodium from the
    filtrate.
    Secretion of toxins and certain drugs (penicillin).
    Concentration of nitrogenous waste- mainly urea
    produced as a result of protein metabolism.
Microscopic
         Anatomy…
Loop of Henle-
  Function: to concentrate or dilute the filtrate
  according to the status of the blood plasma and
  the rest of the extracellular fluid.
  Occurs in 2 stages:
    Descending loop- water is drawn out of the filtrate by
    sodium ions and is reabsorbed by the capillaries.
    Ascending loop- sodium is pumped out of the filtrate
    into the medullary tissue.
Microscopic
         Anatomy…
Loop of Henle…
 Na+ and Cl- are pumped out of the ascending loop into
 the tissue of the surrounding medulla.
 Normally, water would follow Na+ by osmosis but the
 walls of the ascending loop are impermeable to water
 so this does not occur.
 The walls of the descending loop are permeable to
 water, so water is drawn out by osmosis.
Microscopic
         Anatomy…
The resulting filtrate, now referred to as urine,
is more concentrated and is reduced in
volume.
Microscopic
DCT-
          Anatomy…
 Function: to make final adjustments to the chemical make-
 up of urine in response to the status of blood plasma.
 Under the control of aldosterone.
    Reabsorption of sodium ions.
    Excretion of potassium ions.
    Regulation of the acid-base balance (pH) of the blood by the
    excretion of hydrogen ions.
 In this part of the tubule, water is not reabsorbed in any
 great quantity.
Microscopic
         Anatomy…
Collecting Ducts-
  Carry tubular filtrate through the medulla and
  eventually empty into the renal pelvis.
  Function: make final adjustments to the water
  content of urine.
  This change occurs by altering the permeability of
  the duct walls.
    Under the control of antidiuretic hormone (ADH).
Physiology…
Reabsorption-                   Sodium
  The glomerular filtrate       Potassium
  contains the waste
  products that need to be      Calcium
  removed from the body.        Chloride
  That filtrate also contains   Magnesium
  substances found in
  plasma that need to be        Glucose
  reabsorbed to maintain        Amino acids
  homeostasis.
                                Bicarbonate
                                Water
Physiology…
Reabsorption-
  Some substances make this movement passively through
  osmosis or diffusion.
  Others have to be actively transported across cell
  membranes.
  About 65% of all tubular reabsorption takes place in the
  PCT.
  About 80% of the water, sodium, chloride, & bicarbonate are
  reabsorbed.
  100% of the glucose and amino acids are reabsorbed.
Glucose Threshold
               (p . 3 1 2 )
The limit of the amount of glucose that can be
reabsorbed
Dogs: 180 mg/dl
Cats: 240 mg/ml
Physiology…
Secretion-
  Many waste products are not filtered from the
  blood in sufficient amounts from the glomerular
  capillaries.
  The “left over” substances are removed by tubular
  secretion.
  Most tubular secretion occurs in the DCT.
  Hydrogen, potassium, & ammonia are some of
  the substances eliminated by secretion.
Urine Volume
       Regulation
ADH & aldosterone are responsible for the
majority of urine volume regulation.
Urine Volume
      Regulation
ADH acts on the DCT & collecting ducts to
promote water reabsorption.
Aldosterone increases the reabsorption of sodium
into the bloodstream.
This causes an osmotic imbalance that
encourages water to follow sodium.
Water cannot move out of the DCT unless
sufficient ADH control is present.
Ureters
The tubes that exit the kidney at the hilus and
connect to the bladder.
They continuously move urine from the
kidneys to the bladder.
The smooth muscle layer propels the urine
through the ureter by peristaltic contractions.
Bladder
Stores urine as it is produced and releases it
from the body.
Lined with transitional epithelium that
stretches as the bladder fills.
The wall contains smooth muscle.
  When it contracts, urine is expelled.
Urethra
A continuation of the neck of the bladder that
runs through the pelvic canal.
Carries urine from the bladder to the external
environment.
Pathology
Acute Renal Failure
An abrupt decrease in glomerular filtration.
Usually the result of hypoperfusion or
nephrotoxic injury to the kidney, which
causes damage to the nephron.
  Nephrotoxins- ethylene glycol, gentamicin,
  sulfonamides…
Azotemia- a build-up of toxins within the
body.
Chronic Renal Failure
“CRF”
A common disease of older pets.
An irreversible and progressive decline in renal
function caused by destruction of the nephron units.
Main coon, Abyssinian, Russian Blue, and Burmese
breeds seem to be predisposed.
Irreversible destruction of the nephron results in
uremia.
BUN,  Creatinine, & isothenuria specific
gravity=water
Ethylene Glycol
          Toxicity
Most dangerous form of antifreeze.
Most commercial antifreeze products contain
between 95-97% ethylene glycol.
Minimum lethal dose of undiluted ethylene glycol
antifreeze is 4.4-6.6ml/kg in dogs and 1.4ml/kg in
cats.
Causes metabolic acidosis and acute renal tubular
necrosis.
Peak levels of ethylene glycol are reached within 1-4
hours post ingestion.
Ethylene Glycol
       Toxicity…
Clinical Signs:
Vomiting is seen within the first few hours
progressing to depression, ataxia, weakness,
tachypnea, polyuria, and polydipsia (1-6
hours)
18-36 hours acute renal failure occurs.
Diabetes Insipidus
               (p . 3 1 2 )
Insipid means tasteless***
A decrease in the pituitary release of ADH
(antidiuretic hormone)
ADH is responsible for regulating urine
volume
The collecting ducts do not reabsorb
adequate amounts of water which causes
PU/PD
FLUTD/FUS & Urolithiasis
                      Colville p. 317
“Feline Lower Urinary Tract Disease” or “Feline Urologic
Syndrome”
Presence of mineral precipitates
Urolith’s are the most common cause
Calcium oxylate is the most common mineral found (urine is too
acidic)
Signs- hematuria, dysuria
Detected by urinalysis, radiographs or ultrasound.
Urolith’s that remain in the bladder can damage the bladder
lining, resulting in secondary bacterial infections and hematuria.
Different Types of
 Bladder Stones
     (Urolith’s)
URINALYSIS
Physical Properties
Include all observations that can be made
without the aid of a microscope or chemical
reagents.
Color
Normal is light yellow to amber and is a result
of pigments called urochromes.
The magnitude of color depends on the
degree of urine concentration or dilution.
Color…
Colorless-
  Low specific gravity.
  Associated with polyuria.
Dark yellow-
  High specific gravity.
  Associated with oliguria.(less urine than norm)
Yellow-brown or green- is likely to contain
bile pigments.
Color…
Red or reddish-brown- indicates the
presence of red cells (hematuria) or
hemoglobin (hemoglobinuria).
Brown- may contain myoglobin, which is
excreted during conditions that cause muscle
cell lysis, such as rhabdomyolysis.
Clarity (Transparency)
Normal is clear/transparent.
Urine may become cloudy while standing
because of bacterial multiplication or crystal
formation.
Odor
Samples standing at room temperature may
develop an ammonia odor as a result of
bacterial growth.
Sweet or fruity odor indicates the presence of
ketones.
Urine Specific Gravity
       (USG)
Defined as the weight (density) of a liquid compared
to that of distilled water.
May be determined before or after centrifugation.
USG yields information on the hydration status and
the ability of the kidney to concentrate or dilute urine.
Only the refractometer should be used to determine
USG.
Urine Specific Gravity
      (USG)…
Causes of  USG-
   water intake
   fluid loss
  Acute renal failure
  Dehydration
  Shock
Urine Specific Gravity
      (USG)…
Causes of  USG-
  Water re-absorption problems
   fluid intake
  Excessive fluid administration
  Pyometra
  Diabetes insipidus
  Diuretic therapy
Urine Specific Gravity
      (USG)…
Isothenuria “Fixed USG”-
  1.008-1.012
  Occurs when the USG approaches that of
  glomerular filtrate.
  Urine in this range has not been concentrated or
  diluted by the kidneys.
  The closer the USG is to isothenuric, the greater
  the amount of kidney function has been lost
  (~75%).
CHEMICAL ANALYSIS
pH
Expresses the hydrogen ion (H+) concentration.
A measure of the degree of acidity or alkalinity of
urine.
A pH >7.0 is alkaline, <7.0 is acidic.
Urine left standing open at room temperature
tends to increase in pH resulting from a loss
of carbon dioxide.
The pH of urine is largely dependant on diet.
pH…
Decreased pH-
  Fever, starvation, high protein diet, acidosis, excessive
  muscular activity.
Increased pH-
  Alkalosis, high fiber diets, urethral obstruction, bladder
  paralysis (urine retention).
An abnormal pH can result in crystal or urolith
formation.
The pH can be corrected by manipulating the diet to
help dissolve the solids or prevent uroliths from
forming.
Protein
Usually absent or present in trace amounts of
normal urine.
Urine dip sticks allow semi-quantitative
measurements by progressive color changes
on the reagent pad.
  Reagent strips commonly detect albumin and
  are not very sensitive to globulins (proteins
  insoluble in water).
Protein…
Urine Protein : Creatinine Ratio-
  This test is used to confirm significant amounts of
  protein in the urine.
  Used to determine the degree of protein loss in
  chronic renal disease.
  See page 161
Protein…
Protein interpretation-
  Very dilute urine may yield a false negative because
  the protein concentration may be below the sensitivity
  of the testing method.
  Transient Proteinuria- may result from a
  temporary increase in glomerular permiability.
     This condition is caused by increased pressure in the
     glomerular capillaries and may be found in muscle exertion,
     emotional stress, or convulsions.
Protein…
Protein interpretation-
  Proteinuria indicates disease of the urinary
  tract, especially the kidneys.
  Both acute and chronic renal disease lead to
  proteinuria.
  Acute nephritis is characterized by marked
  proteinuria with WBC’s and casts in the urine.
Glucose
The presence of glucose in the urine is known as
glucosuria.
Glucose is filtered through the glomerulus and
reabsorbed by the tubules.
Glucosuria usually does not occur unless the blood
glucose level exceeds the renal threshold.
At this concentration, tubular reabsorption cannot
keep up with the glomerular filtration of glucose, and
glucose passes into the urine.
Glucose…
Glucosuria occurs in diabetes mellitus as a
result of a deficiency of insulin or an inability
of insulin to function.
Transient glucosuria- a release of
epinepherine causes glucose levels to rise for
energy.
  Causes: fear, excitement, restraint.
Ketones
Includes: acetone, acetoacetic acid, and β-
hydroxybutyric acid.
Ketone bodies are formed during incomplete
catabolism of fatty acids.
When fatty acid metabolism is not
accompanied by sufficient carbohydrate
metabolism, excess ketones are present in
the urine.
  A condition known as ketonuria.
Ketones…
Ketonuria frequently occurs in animals with diabetes
mellitus.
Because the animal lacks the insulin necessary for
carbohydrate metabolism, fat is broken down to meet
the animal’s energy needs and excess ketones are
excreted in the urine.
Ketones are toxic, causing CNS depression and
acidosis.
  Hence- ketoacidosis or acidosis resulting from ketonuria.
Ketones…
Transient ketonuria- can occur with starvation
or prolonged anorexia.
 ketones can suggest diabetes mellitus.
Bile Pigments
Bilirubin and urobilinogen.
Only conjugated (water soluble) bilirubin is
found in urine.
Bilirubinuria can be seen with bile duct
obstructions, liver disease, and hemolytic
anemia.
Bile Pigments…
 Bilirubin (bilirubinuria) suggests:
  Excessive hemolysis of RBC’s.
  Hepatobiliary obstruction
  Liver disease
Blood
Tests for blood in the urine detect:
  Hematuria- usually a sign of disease causing
  bleeding somewhere in the urogenital tract.
  Hemoglobinuria- usually the result of
  intravascular hemolysis.
  Myoglobinuria-
     Myoglobin is a protein found in muscle.
     Severe muscle damage causes myoglobin to leak from
     muscle cells into the blood.
Blood…
Causes of hematuria-
  Inflammation (cystitis)
  Urolithiasis
  Bladder tumors- transitional cell carcinoma
  Iatrogenic trauma- catheter placement,
  cystocentesis.
Causes of hemoglobinuria-
  Excessive lysis of RBC’s (hemoglobinemia)
  IMHA
  Mismatched blood transfusion
  RBC parasites
Blood…
Causes of myoglobinuria-
  Muscle cell lysis
  Excessive exercise
  Electrical shock
  Heat stroke
  Snake venoms
Leukocytes
You can believe a positive reaction but never
believe a negative reaction.
Always examine the sediment for
confirmation.
Presence usually indicates a bacterial
infection in the urogenital tract.
A positive nitrate reaction occurs with a
large quantity of bacteria in the urine.
Microscopic Examination
        of Urine
                The 5 “C’s”
  Cells, Casts, Crystals, Critters, & Crap
Page 165
Cells
Erythrocytes- may have
several different
appearances depending on
the urine concentration, pH,
and time elapsed between
collection and examination.
May be confused with fat
globules or yeast.
Indicates bleeding
somewhere in the urogenital
tract.
Cells…
Leukocytes-
  Larger than RBC’s.
  Finding more than 2-3/hpf
  indicates an inflammatory
  process in the urogenital
  tract.
  Pyuria is indicative of
  nephritis, cystitis, or
  urethritis.
  Urine with pyuria should
  always be cultured for
  bacteria.
Cells…
Squamous Epithelial
Cells-
  Their presence usually is
  not considered
  significant.
  They often have straight
  edges and distinct
  corners which sometimes
  curl or fold.
  They contain a small,
  round nucleus.
Cells…
Transitional Cells-
   Come from the bladder,
   ureters, renal pelvis, and
   proximal urethra.
   Usually round, may be
   pear-shaped or caudate.
   Small nucleus.
   Increased numbers
   suggest cystitis or
   pyelonepheritis.
Cells…
Renal Epithelial Cells-
   The smallest epithelial cells
   observed in urine.
   Originate in the renal
   tubules.
   Often confused with WBC’s.
   Generally round with a large
   nucleus.
   Increased numbers occur in
   diseases of the renal
   parenchyma.
Casts
Formed in the lumen of the distal and collecting
tubules of the kidney.
   Where the concentration and acidity of urine is the greatest.
In the renal tubules, secreted protein precipitates in
acidic conditions and forms casts shaped like the
tubules.
All casts are cylindrical structures, with parallel sides.
Their ends may be tapered or round.
Casts dissolve in alkaline urine.
Larger numbers may indicate a lesion in the renal
tubules.
Cast Formation
Casts…
Hyaline Casts-
   Clear, colorless, and
   somewhat transparent
   structures.
   Composed only of protein.
   Usually only identified in dim
   light.
   Numbers are increased with
   renal irritation, fever, poor
   renal profusion, or general
   anesthesia.
Casts…
Granular Casts-
  Hyaline casts containing
  granules.
  Most common type of
  cast.
  May be coarse or fine.
  Seen with acute
  nepheritis.
Casts…
Leukocyte Casts-
  The presence of
  leukocyte casts indicates
  inflammation in the renal
  tubules.
Casts…
Erythrocyte Casts-
  Indicate renal bleeding.
Casts…
Waxy Casts-
  Usually wider, with
  square ends.
  Highly refractile.
  Indicates chronic, severe
  degeneration of the renal
  tubules.
Casts…
Fatty Casts-
   Contain many small droplets
   of fat that appears as
   refractile bodies.
   Frequently seen in cats with
   renal disease because they
   have lipid in their renal
   parenchyma.
   Suggestive of degeneration
   of the renal tubules.
Crystals
“Crystalluria”
Some crystals form as a consequence of
metabolic diseases.
Conditions that lead to crystal formation (diet)
may also cause formation of urinary calculi.
The type of crystal depends on the urine pH,
concentration, and temperature.
Crystals…
Triple Phosphate-
  Alkaline urine.
  “Coffin lids”
Crystals…
Amorphous
phosphates-
  Found in alkaline urine.
Amorphous urates-
  Found in acidic urine.
Crystals…
Ammonium biurate-
  Yellow
  Dumbbell or sheaves of
  needles.
  Spheres with spicules-
     “Thorn apples”
Crystals…
Calcium Oxylate-
  Acidic urine.
  Monohydrate-
     “Picket fence”
     Common in ethylene
     glycol toxicity.
  Dihydrate-
     “Envelopes”
Crystals…
Uric Acid-
  Acidic urine.
  Yellow or brown.
  Normal in which
  species?
     Dalmations
Crystals…
Leucine-
  Acidic urine.
  Yellow or brown
  Highly refractive
Crystals…
Tyrosine-
   Acidic urine
   Fine needles grouped in
   clusters.
Bilirubin-
   Acidic urine.
   Yellow needles.
Crystals…
Cystine-
  Acidic urine
  Colorless and highly
  refractive.
  Hexagonal plates.
Crystals…
Calcium Carbonate
“Critters”
Capillaria plica- bladder
worm of dogs
Dirofilaria
Dioctophyma renale-
kidney worm of dogs
“Critters”
Spermatozoa-
  Presence of sperm
  indicates that the urine
  has been mixed with
  semen.
  Sperm may be found in
  intact males when urine
  is collected by
  cystocentesis.
“Critters”…
Bacteria-
  Small and consistent in
  shape.
  Rods or cocci.
  Usually accompanied by
  leukocytes.
  Beware of contamination!
“Critters”…
Fungal Hyphae-
  Colorless.
  Usually contaminants of
  a urine sample.
“Crap”
Mucus Threads-
  Long, narrow, wavy
  strands.
  Originate from mucous
  surfaces.
  Normal in small numbers.
  Greatly increased with
  irritation of any kind.
“Crap”
Serum Chemistries
     (Review)
BUN- evaluates the kidneys ability to remove
urea from the blood.
Creatinine- formed from creatine, found in
skeletal muscle, also evaluates the kidneys
filtering ability.
Glucose- useful to evaluate the renal
threshold and diabetes.
Electrolyte Assays
       (Review)
Sodium- evaluates filtration and
reabsorption.
Chloride- evaluates water distribution and
osmotic pressure.
CO2/Bicarbonate- evaluates excretion and
reabsorption.
Send Out Tests
       (Usually)
Urine Culture and Sensitivity (C&S)
Creatinine : Cortisol Ratio
Protein : Creatinine Ratio
The End!!
Lp 16 urinary system & urinalysis 2008

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Lp 16 urinary system & urinalysis 2008

  • 1. Urinary System & Urinalysis VTT 250 Anatomy & Pathology Lab
  • 4. Function Production of urine which is the fluid that facilitates the elimination of metabolic waste materials from the body. Helps maintain homeostasis by manipulating the composition of blood plasma. Regulation of the acid-base balance and fluid electrolyte balance. Blood filtration, reabsorption, and secretion.
  • 5. Function… Fluid Balance Regulation- The amount of urine produced helps ensure that the body contains the right amount of water. If the body has excess water and needs to get rid of it, more urine is formed (diuresis). If the body needs to conserve water, less urine will be produced. Much of this function is under the control of antidiuretic hormone (ADH) and aldosterone.
  • 6. Function… Acid-Base Balance Regulation- Enabled by the ability to remove hydrogen and bicarbonate ions from the blood and excrete them in the urine. Hormone Production- The kidneys have a close association with the endocrine system. They can influence the rate of release of ADH and aldosterone. They also produce erythropoietin and some prostaglandins.
  • 7. Gross Anatomy Bean shaped and covered by a fibrous capsule. The indented area is called a hilus. Renal pelvis- a urine collection chamber that forms the beginning of the ureter
  • 8. Gross Anatomy Renal cortex- outer portion. Renal medulla- surrounds the renal pelvis and has a smooth appearance.
  • 9. Microscopic Anatomy The Nephron- The basic functional unit of the kidney. Each nephron is composed of a: Renal corpuscle Proximal Convoluted Tubule (PCT) Loop of Henle Distal Convoluted Tubule (DCT)
  • 10. Terms to Remember… Osmosis- the passage of water across a semi- permeable membrane from a weaker to a stronger solution. Diffusion- the passage of a substance from an area of high concentration to an area of low concentration. Reabsorption- the passage of chemical substances from the lumen of the renal tubules into the renal capillaries, back into the body. Secretion- the passage of chemical substances from the renal capillaries into the lumen of the renal tubules, out of the body, into the urine.
  • 11. Microscopic Anatomy… Renal corpuscle- located in the cortex of the kidney. Made up of the glomerulus (a tuft of capillaries) and Bowman’s capsule. The function is to filter blood in the first stage of urine production. The blood pressure within each glomerulus is high because the blood comes directly from the renal artery and the aorta. The walls of the efferent arteriole of the glomerulus are able to constrict under the influence of renin.
  • 12. Microscopic Anatomy… High pressure forces fluid and small molecules out through the pores and into the lumen of the glomerular capsule. This process of ultrafiltration results in the formation of glomerular filtrate. It is very dilute and consists of 99% water and 1% chemical solutes and is isotonic with plasma.
  • 13. Microscopic Anatomy… PCT- a continuation of Bowman’s capsule. The longest part of the nephron. Functions- Reabsorption of glucose, water, and sodium from the filtrate. Secretion of toxins and certain drugs (penicillin). Concentration of nitrogenous waste- mainly urea produced as a result of protein metabolism.
  • 14. Microscopic Anatomy… Loop of Henle- Function: to concentrate or dilute the filtrate according to the status of the blood plasma and the rest of the extracellular fluid. Occurs in 2 stages: Descending loop- water is drawn out of the filtrate by sodium ions and is reabsorbed by the capillaries. Ascending loop- sodium is pumped out of the filtrate into the medullary tissue.
  • 15. Microscopic Anatomy… Loop of Henle… Na+ and Cl- are pumped out of the ascending loop into the tissue of the surrounding medulla. Normally, water would follow Na+ by osmosis but the walls of the ascending loop are impermeable to water so this does not occur. The walls of the descending loop are permeable to water, so water is drawn out by osmosis.
  • 16. Microscopic Anatomy… The resulting filtrate, now referred to as urine, is more concentrated and is reduced in volume.
  • 17. Microscopic DCT- Anatomy… Function: to make final adjustments to the chemical make- up of urine in response to the status of blood plasma. Under the control of aldosterone. Reabsorption of sodium ions. Excretion of potassium ions. Regulation of the acid-base balance (pH) of the blood by the excretion of hydrogen ions. In this part of the tubule, water is not reabsorbed in any great quantity.
  • 18. Microscopic Anatomy… Collecting Ducts- Carry tubular filtrate through the medulla and eventually empty into the renal pelvis. Function: make final adjustments to the water content of urine. This change occurs by altering the permeability of the duct walls. Under the control of antidiuretic hormone (ADH).
  • 19.
  • 20. Physiology… Reabsorption- Sodium The glomerular filtrate Potassium contains the waste products that need to be Calcium removed from the body. Chloride That filtrate also contains Magnesium substances found in plasma that need to be Glucose reabsorbed to maintain Amino acids homeostasis. Bicarbonate Water
  • 21. Physiology… Reabsorption- Some substances make this movement passively through osmosis or diffusion. Others have to be actively transported across cell membranes. About 65% of all tubular reabsorption takes place in the PCT. About 80% of the water, sodium, chloride, & bicarbonate are reabsorbed. 100% of the glucose and amino acids are reabsorbed.
  • 22. Glucose Threshold (p . 3 1 2 ) The limit of the amount of glucose that can be reabsorbed Dogs: 180 mg/dl Cats: 240 mg/ml
  • 23. Physiology… Secretion- Many waste products are not filtered from the blood in sufficient amounts from the glomerular capillaries. The “left over” substances are removed by tubular secretion. Most tubular secretion occurs in the DCT. Hydrogen, potassium, & ammonia are some of the substances eliminated by secretion.
  • 24. Urine Volume Regulation ADH & aldosterone are responsible for the majority of urine volume regulation.
  • 25. Urine Volume Regulation ADH acts on the DCT & collecting ducts to promote water reabsorption. Aldosterone increases the reabsorption of sodium into the bloodstream. This causes an osmotic imbalance that encourages water to follow sodium. Water cannot move out of the DCT unless sufficient ADH control is present.
  • 26. Ureters The tubes that exit the kidney at the hilus and connect to the bladder. They continuously move urine from the kidneys to the bladder. The smooth muscle layer propels the urine through the ureter by peristaltic contractions.
  • 27. Bladder Stores urine as it is produced and releases it from the body. Lined with transitional epithelium that stretches as the bladder fills. The wall contains smooth muscle. When it contracts, urine is expelled.
  • 28. Urethra A continuation of the neck of the bladder that runs through the pelvic canal. Carries urine from the bladder to the external environment.
  • 30. Acute Renal Failure An abrupt decrease in glomerular filtration. Usually the result of hypoperfusion or nephrotoxic injury to the kidney, which causes damage to the nephron. Nephrotoxins- ethylene glycol, gentamicin, sulfonamides… Azotemia- a build-up of toxins within the body.
  • 31. Chronic Renal Failure “CRF” A common disease of older pets. An irreversible and progressive decline in renal function caused by destruction of the nephron units. Main coon, Abyssinian, Russian Blue, and Burmese breeds seem to be predisposed. Irreversible destruction of the nephron results in uremia. BUN,  Creatinine, & isothenuria specific gravity=water
  • 32. Ethylene Glycol Toxicity Most dangerous form of antifreeze. Most commercial antifreeze products contain between 95-97% ethylene glycol. Minimum lethal dose of undiluted ethylene glycol antifreeze is 4.4-6.6ml/kg in dogs and 1.4ml/kg in cats. Causes metabolic acidosis and acute renal tubular necrosis. Peak levels of ethylene glycol are reached within 1-4 hours post ingestion.
  • 33. Ethylene Glycol Toxicity… Clinical Signs: Vomiting is seen within the first few hours progressing to depression, ataxia, weakness, tachypnea, polyuria, and polydipsia (1-6 hours) 18-36 hours acute renal failure occurs.
  • 34. Diabetes Insipidus (p . 3 1 2 ) Insipid means tasteless*** A decrease in the pituitary release of ADH (antidiuretic hormone) ADH is responsible for regulating urine volume The collecting ducts do not reabsorb adequate amounts of water which causes PU/PD
  • 35. FLUTD/FUS & Urolithiasis Colville p. 317 “Feline Lower Urinary Tract Disease” or “Feline Urologic Syndrome” Presence of mineral precipitates Urolith’s are the most common cause Calcium oxylate is the most common mineral found (urine is too acidic) Signs- hematuria, dysuria Detected by urinalysis, radiographs or ultrasound. Urolith’s that remain in the bladder can damage the bladder lining, resulting in secondary bacterial infections and hematuria.
  • 36. Different Types of Bladder Stones (Urolith’s)
  • 38. Physical Properties Include all observations that can be made without the aid of a microscope or chemical reagents.
  • 39. Color Normal is light yellow to amber and is a result of pigments called urochromes. The magnitude of color depends on the degree of urine concentration or dilution.
  • 40. Color… Colorless- Low specific gravity. Associated with polyuria. Dark yellow- High specific gravity. Associated with oliguria.(less urine than norm) Yellow-brown or green- is likely to contain bile pigments.
  • 41. Color… Red or reddish-brown- indicates the presence of red cells (hematuria) or hemoglobin (hemoglobinuria). Brown- may contain myoglobin, which is excreted during conditions that cause muscle cell lysis, such as rhabdomyolysis.
  • 42. Clarity (Transparency) Normal is clear/transparent. Urine may become cloudy while standing because of bacterial multiplication or crystal formation.
  • 43. Odor Samples standing at room temperature may develop an ammonia odor as a result of bacterial growth. Sweet or fruity odor indicates the presence of ketones.
  • 44. Urine Specific Gravity (USG) Defined as the weight (density) of a liquid compared to that of distilled water. May be determined before or after centrifugation. USG yields information on the hydration status and the ability of the kidney to concentrate or dilute urine. Only the refractometer should be used to determine USG.
  • 45. Urine Specific Gravity (USG)… Causes of  USG-  water intake  fluid loss Acute renal failure Dehydration Shock
  • 46. Urine Specific Gravity (USG)… Causes of  USG- Water re-absorption problems  fluid intake Excessive fluid administration Pyometra Diabetes insipidus Diuretic therapy
  • 47. Urine Specific Gravity (USG)… Isothenuria “Fixed USG”- 1.008-1.012 Occurs when the USG approaches that of glomerular filtrate. Urine in this range has not been concentrated or diluted by the kidneys. The closer the USG is to isothenuric, the greater the amount of kidney function has been lost (~75%).
  • 49.
  • 50.
  • 51. pH Expresses the hydrogen ion (H+) concentration. A measure of the degree of acidity or alkalinity of urine. A pH >7.0 is alkaline, <7.0 is acidic. Urine left standing open at room temperature tends to increase in pH resulting from a loss of carbon dioxide. The pH of urine is largely dependant on diet.
  • 52. pH… Decreased pH- Fever, starvation, high protein diet, acidosis, excessive muscular activity. Increased pH- Alkalosis, high fiber diets, urethral obstruction, bladder paralysis (urine retention). An abnormal pH can result in crystal or urolith formation. The pH can be corrected by manipulating the diet to help dissolve the solids or prevent uroliths from forming.
  • 53. Protein Usually absent or present in trace amounts of normal urine. Urine dip sticks allow semi-quantitative measurements by progressive color changes on the reagent pad. Reagent strips commonly detect albumin and are not very sensitive to globulins (proteins insoluble in water).
  • 54. Protein… Urine Protein : Creatinine Ratio- This test is used to confirm significant amounts of protein in the urine. Used to determine the degree of protein loss in chronic renal disease. See page 161
  • 55. Protein… Protein interpretation- Very dilute urine may yield a false negative because the protein concentration may be below the sensitivity of the testing method. Transient Proteinuria- may result from a temporary increase in glomerular permiability. This condition is caused by increased pressure in the glomerular capillaries and may be found in muscle exertion, emotional stress, or convulsions.
  • 56. Protein… Protein interpretation- Proteinuria indicates disease of the urinary tract, especially the kidneys. Both acute and chronic renal disease lead to proteinuria. Acute nephritis is characterized by marked proteinuria with WBC’s and casts in the urine.
  • 57. Glucose The presence of glucose in the urine is known as glucosuria. Glucose is filtered through the glomerulus and reabsorbed by the tubules. Glucosuria usually does not occur unless the blood glucose level exceeds the renal threshold. At this concentration, tubular reabsorption cannot keep up with the glomerular filtration of glucose, and glucose passes into the urine.
  • 58. Glucose… Glucosuria occurs in diabetes mellitus as a result of a deficiency of insulin or an inability of insulin to function. Transient glucosuria- a release of epinepherine causes glucose levels to rise for energy. Causes: fear, excitement, restraint.
  • 59. Ketones Includes: acetone, acetoacetic acid, and β- hydroxybutyric acid. Ketone bodies are formed during incomplete catabolism of fatty acids. When fatty acid metabolism is not accompanied by sufficient carbohydrate metabolism, excess ketones are present in the urine. A condition known as ketonuria.
  • 60. Ketones… Ketonuria frequently occurs in animals with diabetes mellitus. Because the animal lacks the insulin necessary for carbohydrate metabolism, fat is broken down to meet the animal’s energy needs and excess ketones are excreted in the urine. Ketones are toxic, causing CNS depression and acidosis. Hence- ketoacidosis or acidosis resulting from ketonuria.
  • 61. Ketones… Transient ketonuria- can occur with starvation or prolonged anorexia.  ketones can suggest diabetes mellitus.
  • 62. Bile Pigments Bilirubin and urobilinogen. Only conjugated (water soluble) bilirubin is found in urine. Bilirubinuria can be seen with bile duct obstructions, liver disease, and hemolytic anemia.
  • 63. Bile Pigments…  Bilirubin (bilirubinuria) suggests: Excessive hemolysis of RBC’s. Hepatobiliary obstruction Liver disease
  • 64. Blood Tests for blood in the urine detect: Hematuria- usually a sign of disease causing bleeding somewhere in the urogenital tract. Hemoglobinuria- usually the result of intravascular hemolysis. Myoglobinuria- Myoglobin is a protein found in muscle. Severe muscle damage causes myoglobin to leak from muscle cells into the blood.
  • 65. Blood… Causes of hematuria- Inflammation (cystitis) Urolithiasis Bladder tumors- transitional cell carcinoma Iatrogenic trauma- catheter placement, cystocentesis. Causes of hemoglobinuria- Excessive lysis of RBC’s (hemoglobinemia) IMHA Mismatched blood transfusion RBC parasites
  • 66. Blood… Causes of myoglobinuria- Muscle cell lysis Excessive exercise Electrical shock Heat stroke Snake venoms
  • 67. Leukocytes You can believe a positive reaction but never believe a negative reaction. Always examine the sediment for confirmation. Presence usually indicates a bacterial infection in the urogenital tract. A positive nitrate reaction occurs with a large quantity of bacteria in the urine.
  • 68. Microscopic Examination of Urine The 5 “C’s” Cells, Casts, Crystals, Critters, & Crap
  • 70. Cells Erythrocytes- may have several different appearances depending on the urine concentration, pH, and time elapsed between collection and examination. May be confused with fat globules or yeast. Indicates bleeding somewhere in the urogenital tract.
  • 71. Cells… Leukocytes- Larger than RBC’s. Finding more than 2-3/hpf indicates an inflammatory process in the urogenital tract. Pyuria is indicative of nephritis, cystitis, or urethritis. Urine with pyuria should always be cultured for bacteria.
  • 72. Cells… Squamous Epithelial Cells- Their presence usually is not considered significant. They often have straight edges and distinct corners which sometimes curl or fold. They contain a small, round nucleus.
  • 73. Cells… Transitional Cells- Come from the bladder, ureters, renal pelvis, and proximal urethra. Usually round, may be pear-shaped or caudate. Small nucleus. Increased numbers suggest cystitis or pyelonepheritis.
  • 74. Cells… Renal Epithelial Cells- The smallest epithelial cells observed in urine. Originate in the renal tubules. Often confused with WBC’s. Generally round with a large nucleus. Increased numbers occur in diseases of the renal parenchyma.
  • 75. Casts Formed in the lumen of the distal and collecting tubules of the kidney. Where the concentration and acidity of urine is the greatest. In the renal tubules, secreted protein precipitates in acidic conditions and forms casts shaped like the tubules. All casts are cylindrical structures, with parallel sides. Their ends may be tapered or round. Casts dissolve in alkaline urine. Larger numbers may indicate a lesion in the renal tubules.
  • 77. Casts… Hyaline Casts- Clear, colorless, and somewhat transparent structures. Composed only of protein. Usually only identified in dim light. Numbers are increased with renal irritation, fever, poor renal profusion, or general anesthesia.
  • 78. Casts… Granular Casts- Hyaline casts containing granules. Most common type of cast. May be coarse or fine. Seen with acute nepheritis.
  • 79. Casts… Leukocyte Casts- The presence of leukocyte casts indicates inflammation in the renal tubules.
  • 80. Casts… Erythrocyte Casts- Indicate renal bleeding.
  • 81. Casts… Waxy Casts- Usually wider, with square ends. Highly refractile. Indicates chronic, severe degeneration of the renal tubules.
  • 82. Casts… Fatty Casts- Contain many small droplets of fat that appears as refractile bodies. Frequently seen in cats with renal disease because they have lipid in their renal parenchyma. Suggestive of degeneration of the renal tubules.
  • 83. Crystals “Crystalluria” Some crystals form as a consequence of metabolic diseases. Conditions that lead to crystal formation (diet) may also cause formation of urinary calculi. The type of crystal depends on the urine pH, concentration, and temperature.
  • 84. Crystals… Triple Phosphate- Alkaline urine. “Coffin lids”
  • 85. Crystals… Amorphous phosphates- Found in alkaline urine. Amorphous urates- Found in acidic urine.
  • 86. Crystals… Ammonium biurate- Yellow Dumbbell or sheaves of needles. Spheres with spicules- “Thorn apples”
  • 87. Crystals… Calcium Oxylate- Acidic urine. Monohydrate- “Picket fence” Common in ethylene glycol toxicity. Dihydrate- “Envelopes”
  • 88. Crystals… Uric Acid- Acidic urine. Yellow or brown. Normal in which species? Dalmations
  • 89. Crystals… Leucine- Acidic urine. Yellow or brown Highly refractive
  • 90. Crystals… Tyrosine- Acidic urine Fine needles grouped in clusters. Bilirubin- Acidic urine. Yellow needles.
  • 91. Crystals… Cystine- Acidic urine Colorless and highly refractive. Hexagonal plates.
  • 93. “Critters” Capillaria plica- bladder worm of dogs Dirofilaria Dioctophyma renale- kidney worm of dogs
  • 94. “Critters” Spermatozoa- Presence of sperm indicates that the urine has been mixed with semen. Sperm may be found in intact males when urine is collected by cystocentesis.
  • 95. “Critters”… Bacteria- Small and consistent in shape. Rods or cocci. Usually accompanied by leukocytes. Beware of contamination!
  • 96. “Critters”… Fungal Hyphae- Colorless. Usually contaminants of a urine sample.
  • 97. “Crap” Mucus Threads- Long, narrow, wavy strands. Originate from mucous surfaces. Normal in small numbers. Greatly increased with irritation of any kind.
  • 99. Serum Chemistries (Review) BUN- evaluates the kidneys ability to remove urea from the blood. Creatinine- formed from creatine, found in skeletal muscle, also evaluates the kidneys filtering ability. Glucose- useful to evaluate the renal threshold and diabetes.
  • 100. Electrolyte Assays (Review) Sodium- evaluates filtration and reabsorption. Chloride- evaluates water distribution and osmotic pressure. CO2/Bicarbonate- evaluates excretion and reabsorption.
  • 101. Send Out Tests (Usually) Urine Culture and Sensitivity (C&S) Creatinine : Cortisol Ratio Protein : Creatinine Ratio