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Training Module IIIUrinalysis
The Urinalysis
What You Will Need (and where to find it)Urinalysis Stickers-upper cabinet to the left of the refrigeratorPipettes (droppers) – in the clear plexiglass shelves on counter behind fecal workstationUrine Dipsticks-cabinet above fecal workstationRefractometer-cabinet above fecal workstationV-shaped tube-first drawer left of microscopeGlass slides and cover slips-fecal workstation
UrinalysisAn important test for several organ systems.  For some things, as important as blood tests or more important than blood tests!!!Tests for Urinary Tract InfectionDiabetes screening testRenal (Kidney) DiseaseRule in or out UTI in dog’s with incontinenceEndocrine DiseaseCushing’s DiseaseDiabetes MellitusDiabetes Insipidus
Patient selectionSenior Wellness ScreeningPolyuria/PolydipsiaUrinating outside the litter box or well-trained dog urinating in houseUrine spraying in catsFrequent urination, straining to urinate, painful urinationVisibly discolored or bloody urineIncontinence
Signs of Urinary Tract Disease	Straining to urinateFrequent urination or frequent attempts to urinateRepeatedly assuming a urination postureDiscomfort on urinationVisible blood in urineUrinating in the house when well house-trainedUrinating outside the litter box (cat)Visibly abnormal urine colorUrinating large volumes and drinking excessive amounts of water (polyuria/polydipsia)Passing a visible bladder stone!
Urinary Tract InfectionCould be anywhere in urinary tractUrethritis/Vaginitis/BalanoposthitisBladder InfectionProstate InfectionKidney Infection (pyelonephritis)Of the above, the bladder is the most common.  Kidney infections in dogs and cats are rare
Indicators of UTIHigh urine pH Carnivores should be less than 7High pH may mean there is an infection or that the patient is predisposed to infection or to struvite stonesProteinuria (elevated protein level) on dipstickHematuria (blood in urine) on dipstickWhite Blood Cells on sediment examRed Blood Cells on sediment or + blood on dipstick Bacteria on sediment exam
Other things that can mimic UTIHematuria, Pyuria, Proteinuria and High pH can also occur in a bladder with stonesAnimals tend to form stones in the urinary bladder, not in the kidneysBladder stones are very common in dogs; less so in catsStruvite bladder stones are most often associated with high pH and UTIHematuria, Pyuria, Proteinuria can also occur in cases where there are tumors in the urinary tractProstate Cancer, Prostatitis or Prostate Cysts in intact male dogsIntact female dogs in heat will have hematuria and proteinuria
Sample Collection MethodsBe sure to record the method of collectionVoidedCollected in a cup or tray by the owner or veterinary staff memberClean 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 patientSpecial cat litter for urine collection (Kit4Cat)CatheterizedCystocentesisCollected usually by the veterinarian by tapping the bladder with a 22gauge 1½ inch needle on a 6 cc syringeMost accurate method, especially if doing a culture and sensitivity
Owner Psychology & Voided SpecimensA urine specimen is often every bit as important as blood tests in determining general health, especially with senior petsIf 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 urgentlySometimes 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 HandlingIf collected by owner, it should be brought in as soon as possibleRefrigerated 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 obtainedIs 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 UrinalysisColorTurbiditySpecific GravityDipstickSediment
ColorObserve the urine grosslyWrite down an easily understandable color:YellowPale YellowDark YellowGoldenrod (a very deep gold color) May contain BilirubinPinkRedPort wineMay contain myoglobin, a protein that indicates muscle breakdownGreenishMay contain deteriorated blood
TurbidityClearCan see through it like tap waterHazyA tiny bit murky but easy to see throughCloudySomewhat opaque but you could still read a newspaper through itOpaqueYou can’t read a newspaper through it
Specific GravityA measure of how concentrated urine isUrine color can be misleading here!Read with a hand-held device called a refractometerBased on distilled water having a specific gravity of 0.000Tells a lot about how well the kidneys are functioningNormal kidneys are capable of both diluting and concentrating urineHigh Specific Gravity is a good thingCats > 1.040Dogs >1.030
Refractometer
Measuring the specific gravityLift the cover flap on the refractometerPlace 2 or 3 drops of urine on the stageLower the cover flap and gently press it downAim the device up at the light and look through the viewfinderRead the scale on the right of the viewfinderIt will read in four digits, the first two being 1.0__If it is off the scale high, record it as >1.040Hyposthenuria = <1.012Isosthenuria = 1.012-1.018
The Urine DipstickCommercially made test stripsColor pads are exposed to urine and compared to a chart on the test strip bottleIn our office, kept in the cabinet above the fecal workstation
The Urine DipstickDesigned to be dipped into a specimen in a cupHere, we hold the strip horizontally and drip the urine onto each color pad with a dropperWhen 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 timeRecord the results on a Urinalysis stickerSome things are recorded as “normal” and some “negative”Some can be given a number of + signs or a numeric resultRecordpHProteinGlucoseKetonesBilirubinUrobilinogenBloodHere, We Do Not recordSpecific GravityNitriteWhite Blood cellsThe test strips are designed for humans. These tests are inaccurate in animal medicine
The Urine SedimentYou will: Place about 1 ml of urine in a v-shaped centrifuge tubeSpin in the Statspin Centrifuge on the Urine settingHave a dropper, a glass slide and coverslip readyThe vet or tech willDiscard most of the top layer of urine (called the supernantent)Tap the tube to suspend sediment in the urine that remainsPlace one drop on a slide and coverRead under the microscope
Statspin Centrifuge and tubeKept in first drawer to left of centrifugeOn counter to right of microscope
Urine Sediment ResultsRBCs = red blood cellsUnit of “measure”is /hpf, meaning per high power fieldWBCs = white blood cellsUnit of “measure” is /hpf, meaning per high power fieldCrystalsStruviteOxalateUrateCastsOtherLipid globulesEpithelial cellsBacteriaSpermatozoaAmorphous or trash – debris that cannot be categorized
Completed Urinalysis Record
Special CircumstancesBashful dogs -  urine collecting stick “Olympic Clean Catch”The urine is so badly discolored that it is hard to read the test stripsSpin 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 boxPeeing on plastic!!! Some cats will urinate on   grocery bags or saran wrap placed in or beside    the litter boxSometimes owners can actually catch it in a cup!If we need to do a culture and sensitivityOnly choice is cystocentesis
Olympic Clean CatchAn ingenious tool!!!Generally kept between the refrigerator and the lab counterCollection cups are in the exam table cabinet in Exam   Room 2
Kit4Cat Urine Collection SetContains Non-absorbent litterPipetteSample vialKept in the exam table cabinet in Exam   Room 2
What we mean by “Collection Set”A flat tray to slide under the dogVery useful for “low rider” dogsWe use recycled vaccine trays!A pipette to transfer the urine from tray to urine specimen cupA urine specimen cupBeggars can’t be choosers, we will take urine in any container  it can be caught in
Other Tests Run On Urine at AViD LabsCulture and SensitivityRun on Cystocentesis samples onlyCortisol:Creatinine RatioA screening test for Cushing’s diseaseProtein:Creatinine RatioTo assess urine protein loss
Bladder Stone AnalysisSent to Minnesota Urolith CenterWe now have a practitioner portal to submit and receive information from MN Urolith CenterCan go to the portal to submit a case and print an address labelDoesn’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:About 2 to 3 weeks after last antibiotic was given.Near the end of the antibiotic prescription but BEFORE the pet is out of antibiotic	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.QuizThe Olympic Clean Catch isa.  A game where the athletes attempt to catch the javelin b. The owner makes a diving catch with the urine cup when the doghikes his legc.  A device that holds a cup for urine collection  	d.  A device that measures the concentration of urineSpecific Gravity of urine isa.  Measured with a hand-held device called a refractometerb.  A screening test for diabetesc.  Not a valued test in animal medicined.  A measurement of urine concentratione.  A & D
Quiz, continuedWhich of the following is not a component of the urinalysis?a.  Specific Gravityb.  Colorc.   Odor/Smelld.  Turbiditye.  DipstickTurbidity meansBacteria in the urineRed blood cells in the urineThe clarity of the urineAbnormal urine pH
Quiz, continued  5	Urine from cats may be collected by all of the following except:Emptying the litter box and putting Styrofoam peanuts in itKit4Cat collecting litterUrine collected on plastic bags in or near the litter boxFollowing the cat around with a cup6.  Which of the following is/are not a useful parameter to record from the urine dipstick?a.  Bloodb.  pHc.  Nitrited.  Ketones e.  Specific Gravity f.  C & Eg.  A & D
QuizWhich of the following can be assessed with urineVestibular diseaseKidney diseaseAddison’s diseaseHeart diseaseWhich of the following is an acceptable color to record for the urinalysisFuschiaBurnt SiennaGoldenrodCrimson
Quiz, continuedDr. Burns likes to recheck urine after a UTIBefore the last antibiotic has been given.In two monthsTwo to three weeks after the last antibioticA & BA &CThe Urinalysis can be used to a.  Screen for diabetesb.  Check for bladder stones         c.  Test for urinary tract infection         d. A & C         e.  All of the Above

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Training module III - Urinalysis

  • 3. What You Will Need (and where to find it)Urinalysis Stickers-upper cabinet to the left of the refrigeratorPipettes (droppers) – in the clear plexiglass shelves on counter behind fecal workstationUrine Dipsticks-cabinet above fecal workstationRefractometer-cabinet above fecal workstationV-shaped tube-first drawer left of microscopeGlass slides and cover slips-fecal workstation
  • 4. UrinalysisAn important test for several organ systems. For some things, as important as blood tests or more important than blood tests!!!Tests for Urinary Tract InfectionDiabetes screening testRenal (Kidney) DiseaseRule in or out UTI in dog’s with incontinenceEndocrine DiseaseCushing’s DiseaseDiabetes MellitusDiabetes Insipidus
  • 5. Patient selectionSenior Wellness ScreeningPolyuria/PolydipsiaUrinating outside the litter box or well-trained dog urinating in houseUrine spraying in catsFrequent urination, straining to urinate, painful urinationVisibly discolored or bloody urineIncontinence
  • 6. Signs of Urinary Tract Disease Straining to urinateFrequent urination or frequent attempts to urinateRepeatedly assuming a urination postureDiscomfort on urinationVisible blood in urineUrinating in the house when well house-trainedUrinating outside the litter box (cat)Visibly abnormal urine colorUrinating large volumes and drinking excessive amounts of water (polyuria/polydipsia)Passing a visible bladder stone!
  • 7. Urinary Tract InfectionCould be anywhere in urinary tractUrethritis/Vaginitis/BalanoposthitisBladder InfectionProstate InfectionKidney Infection (pyelonephritis)Of the above, the bladder is the most common. Kidney infections in dogs and cats are rare
  • 8. Indicators of UTIHigh urine pH Carnivores should be less than 7High pH may mean there is an infection or that the patient is predisposed to infection or to struvite stonesProteinuria (elevated protein level) on dipstickHematuria (blood in urine) on dipstickWhite Blood Cells on sediment examRed Blood Cells on sediment or + blood on dipstick Bacteria on sediment exam
  • 9. Other things that can mimic UTIHematuria, Pyuria, Proteinuria and High pH can also occur in a bladder with stonesAnimals tend to form stones in the urinary bladder, not in the kidneysBladder stones are very common in dogs; less so in catsStruvite bladder stones are most often associated with high pH and UTIHematuria, Pyuria, Proteinuria can also occur in cases where there are tumors in the urinary tractProstate Cancer, Prostatitis or Prostate Cysts in intact male dogsIntact female dogs in heat will have hematuria and proteinuria
  • 10. Sample Collection MethodsBe sure to record the method of collectionVoidedCollected in a cup or tray by the owner or veterinary staff memberClean 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 patientSpecial cat litter for urine collection (Kit4Cat)CatheterizedCystocentesisCollected usually by the veterinarian by tapping the bladder with a 22gauge 1½ inch needle on a 6 cc syringeMost accurate method, especially if doing a culture and sensitivity
  • 11. Owner Psychology & Voided SpecimensA urine specimen is often every bit as important as blood tests in determining general health, especially with senior petsIf 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 urgentlySometimes 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
  • 12. Sample HandlingIf collected by owner, it should be brought in as soon as possibleRefrigerated 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 obtainedIs there a chance it may’ve splashed off grass or leaves”?Is there a chance it was stepped in?Could there be fecal contamination?
  • 14. ColorObserve the urine grosslyWrite down an easily understandable color:YellowPale YellowDark YellowGoldenrod (a very deep gold color) May contain BilirubinPinkRedPort wineMay contain myoglobin, a protein that indicates muscle breakdownGreenishMay contain deteriorated blood
  • 15. TurbidityClearCan see through it like tap waterHazyA tiny bit murky but easy to see throughCloudySomewhat opaque but you could still read a newspaper through itOpaqueYou can’t read a newspaper through it
  • 16. Specific GravityA measure of how concentrated urine isUrine color can be misleading here!Read with a hand-held device called a refractometerBased on distilled water having a specific gravity of 0.000Tells a lot about how well the kidneys are functioningNormal kidneys are capable of both diluting and concentrating urineHigh Specific Gravity is a good thingCats > 1.040Dogs >1.030
  • 18. Measuring the specific gravityLift the cover flap on the refractometerPlace 2 or 3 drops of urine on the stageLower the cover flap and gently press it downAim the device up at the light and look through the viewfinderRead the scale on the right of the viewfinderIt will read in four digits, the first two being 1.0__If it is off the scale high, record it as >1.040Hyposthenuria = <1.012Isosthenuria = 1.012-1.018
  • 19. The Urine DipstickCommercially made test stripsColor pads are exposed to urine and compared to a chart on the test strip bottleIn our office, kept in the cabinet above the fecal workstation
  • 20. The Urine DipstickDesigned to be dipped into a specimen in a cupHere, we hold the strip horizontally and drip the urine onto each color pad with a dropperWhen 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 timeRecord the results on a Urinalysis stickerSome things are recorded as “normal” and some “negative”Some can be given a number of + signs or a numeric resultRecordpHProteinGlucoseKetonesBilirubinUrobilinogenBloodHere, We Do Not recordSpecific GravityNitriteWhite Blood cellsThe test strips are designed for humans. These tests are inaccurate in animal medicine
  • 21. The Urine SedimentYou will: Place about 1 ml of urine in a v-shaped centrifuge tubeSpin in the Statspin Centrifuge on the Urine settingHave a dropper, a glass slide and coverslip readyThe vet or tech willDiscard most of the top layer of urine (called the supernantent)Tap the tube to suspend sediment in the urine that remainsPlace one drop on a slide and coverRead under the microscope
  • 22. Statspin Centrifuge and tubeKept in first drawer to left of centrifugeOn counter to right of microscope
  • 23. Urine Sediment ResultsRBCs = red blood cellsUnit of “measure”is /hpf, meaning per high power fieldWBCs = white blood cellsUnit of “measure” is /hpf, meaning per high power fieldCrystalsStruviteOxalateUrateCastsOtherLipid globulesEpithelial cellsBacteriaSpermatozoaAmorphous or trash – debris that cannot be categorized
  • 25. Special CircumstancesBashful dogs - urine collecting stick “Olympic Clean Catch”The urine is so badly discolored that it is hard to read the test stripsSpin 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 boxPeeing on plastic!!! Some cats will urinate on grocery bags or saran wrap placed in or beside the litter boxSometimes owners can actually catch it in a cup!If we need to do a culture and sensitivityOnly choice is cystocentesis
  • 26. Olympic Clean CatchAn ingenious tool!!!Generally kept between the refrigerator and the lab counterCollection cups are in the exam table cabinet in Exam Room 2
  • 27. Kit4Cat Urine Collection SetContains Non-absorbent litterPipetteSample vialKept in the exam table cabinet in Exam Room 2
  • 28. What we mean by “Collection Set”A flat tray to slide under the dogVery useful for “low rider” dogsWe use recycled vaccine trays!A pipette to transfer the urine from tray to urine specimen cupA urine specimen cupBeggars can’t be choosers, we will take urine in any container it can be caught in
  • 29. Other Tests Run On Urine at AViD LabsCulture and SensitivityRun on Cystocentesis samples onlyCortisol:Creatinine RatioA screening test for Cushing’s diseaseProtein:Creatinine RatioTo assess urine protein loss
  • 30. Bladder Stone AnalysisSent to Minnesota Urolith CenterWe now have a practitioner portal to submit and receive information from MN Urolith CenterCan go to the portal to submit a case and print an address labelDoesn’t take six to eight weeks like it used to!!Alternately, can send to AViD Labs
  • 31. Dr. Burns likes to recheck Urinalyses on pets with UTI’s in this manner:About 2 to 3 weeks after last antibiotic was given.Near the end of the antibiotic prescription but BEFORE the pet is out of antibiotic On pet that have had struvite bladder stones removed, Dr. Burns likes to check them:Two weeks post-op
  • 32. Then every 3 to 4 months, for life.QuizThe Olympic Clean Catch isa. A game where the athletes attempt to catch the javelin b. The owner makes a diving catch with the urine cup when the doghikes his legc. A device that holds a cup for urine collection d. A device that measures the concentration of urineSpecific Gravity of urine isa. Measured with a hand-held device called a refractometerb. A screening test for diabetesc. Not a valued test in animal medicined. A measurement of urine concentratione. A & D
  • 33. Quiz, continuedWhich of the following is not a component of the urinalysis?a. Specific Gravityb. Colorc. Odor/Smelld. Turbiditye. DipstickTurbidity meansBacteria in the urineRed blood cells in the urineThe clarity of the urineAbnormal urine pH
  • 34. Quiz, continued 5 Urine from cats may be collected by all of the following except:Emptying the litter box and putting Styrofoam peanuts in itKit4Cat collecting litterUrine collected on plastic bags in or near the litter boxFollowing the cat around with a cup6. Which of the following is/are not a useful parameter to record from the urine dipstick?a. Bloodb. pHc. Nitrited. Ketones e. Specific Gravity f. C & Eg. A & D
  • 35. QuizWhich of the following can be assessed with urineVestibular diseaseKidney diseaseAddison’s diseaseHeart diseaseWhich of the following is an acceptable color to record for the urinalysisFuschiaBurnt SiennaGoldenrodCrimson
  • 36. Quiz, continuedDr. Burns likes to recheck urine after a UTIBefore the last antibiotic has been given.In two monthsTwo to three weeks after the last antibioticA & BA &CThe Urinalysis can be used to a. Screen for diabetesb. Check for bladder stones c. Test for urinary tract infection d. A & C e. All of the Above