URINALYSIS

OVERVIEW 1. Urinalysis
2. Serum/plasma urea & creatinine concentrations 3. Urine protein to creatinine ratio (UPC ratio)

1.URINALYSIS
MAIN INDICATIONS ARE: Evaluation of renal & lower urinary tract abnormalities Assessment of some metabolic/endocrine disorders Assessment of state of hydration

Gross evaluation Specific gravity (SG)

Urinalysis
Biochemical analysis

Sediment examination (microscopy)

Culture
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GROSS EVALUATION: COLOUR

Urine from healthy animals can vary in colour but is usually light, mild or dark yellow

Red discolouration

Red discolouration may indicate haemoglobinuria, myoglobinuria or haematuria.

GROSS EVALUATION: TURBIDITY

Upper sample :Clear urine Lower sample:Turbid

Turbid urine (healthy horse)

turbidity in urine from a cow with pyelonephritis 6

TURBIDITY
Healthy horses and rabbits may have turbid urine due to high concentration of mucin and crystals. In other species turbidity can indicate the presence of sediment. On refrigeration, urine samples may become turbid from crystallisation of minerals which were in solution, and they may clear when returned to room temperature

Gross evaluation Specific gravity (SG)

Urinalysis
Biochemical analysis

Sediment examination (microscopy)

Culture
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SPECIFIC GRAVITY (SG)

Ratio of weight (density) of urine to that of an equal volume of water
at the same temperature. No units. Values depend on: - hydration status and water intake - the kidneys concentrating ability It is a test of renal tubular function

Hydration status can be determined by assessing skin turgor or by measurement of serum albumin, or PCV and total proteins.

SPECIFIC GRAVITY (SG): MEASUREMENT

Reagent test strips are unreliable for animals/Always use the refractometer If the urine is turbid, centrifuge it before measuring SG of the supernatant

1.050 1.040 1.030 1.020 1.010 1.000

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SG: INTERPRETATION
HYPERSTHENURIA: concentrated urine - >1.012 -urine of healthy, normally hydrated animals

ISOSTHENURIA: urine neither concentrated nor diluted -1.007-1.012 (urine SG = plasma filtrate SG) -persistent isosthenuria warrants further investigation
HYPOSTHENURIA: urine is more diluted than plasma - <1.007 - persistent hyposthenuria warrants further investigation
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SG: INTERPRETATION
* * * * * *

The range of values for SG can vary according to water intake and hydration status. Usually SG in normal concentrated urine is >1.030 WATER DEPRIVATION TEST Contra-indication: It should never be carried out in depressed, dehydrated or azotemic animals, or if renal failure is suspected. Indication: Confirmation of the animals ability to concentrate its urine when water is withheld. Protocol: The urine SG is monitored every 2 hours until 5% of body weight is lost, or the urine SG is >1.020. Interpretation:
*

If the urine SG increases to 1.020, tubular function and ADH availability are confirmed. If the urine SG remains <1.020, diabetes insipidus is suspected.
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Gross evaluation Specific gravity (SG)

Urinalysis
Biochemical analysis

Sediment examination (microscopy)

Culture
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BIOCHEMICAL ANALYSIS URINE STRIPS

Always follow manufacturer instructions

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EXAMPLE OF A URINE STRIP CHART

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GLUCOSE
- Glucose is not normally found in urine of healthy animals
- Causes of glycosuria
Persistent hyperglycaemia

- Diabetes mellitus
Transient hyperglycaemia - Stress in cats - Drugs (xylazine, ketamine) - IV fluids containing glucose - Convulsions Renal tubular disorders

- Fanconi syndrome
- Primary glucosuria
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BILIRUBIN

Not accurate for dogs/cats

Tests utilising a tablet (ictotest) can be more accurate than striptests Light can break down bilirubin

Trace to + normal in healthy dogs.No bilirubin present in the urine of other healthy animals The bilirubin in the urine is water-soluble conjugated bilirubin Causes of bilirubinuria Same as causes of bilirubinaemia
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KETONES

Accurate test for animals

Does not detect -hydroxybutyric acid

Ketones are not present in the urine of clinically healthy animals

Trace can be normal in rabbits

Causes of ketonuria
Diabetes mellitus, pregnancy, starvation, ketosis, immediately after

calving in highproducing dairy cows

N.B. Many disorders causing anorexia in cattle (e.g. mastitis, metritis, pneumonia) will cause ketonaemia and ketonuria, but levels of ketones are generally not as high as in primary ketosis.
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BLOOD / HAEMOGLOBIN
- Accurate test for animals - Detects intact RBCs, haemoglobin or myoglobin
-

Follow-up positive result with sediment examination Interpret positive result in conjunction with the method of urine collection (cystocentesis can be a cause of presence of
blood in urine)

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pH
Acceptable test for animals - Carnivores: acidic urine is normal if fed a meat diet alkaline urine usually reflects urinary tract infection - Herbivores: alkaline urine is normal acidic urine may reflect increased protein catabolism

e.g. high protein diet, starvation, fever, nursing animals

Some drugs can influence pH Not an accurate indicator of systemic acid/base balance
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PROTEIN

Acceptable test for animals but can give false positive reaction in alkaline samples.
Test detects mainly albumin. Does not detect globulins Always interpret in conjunction with SG and sediment examination (it is not abnormal to have trace protein in concentrated urine but always abnormal finding in diluted urine). Common causes of proteinuria:

urogenital haemorrhage
urogenital inflammation renal protein loss
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NITRITE, UROBILINOGEN, LEUKOCYTES

- Nitrite
Positive results may indicate bacterial infection false negative results occur commonly

- Urobilinogen
Questionable clinical usefulness

- Leukocytes
False negative results common in dogs

False positive results common in cats

NONE ARE RELIABLE IN EXAMINING ANIMAL URINE

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2. Serum urea & creatinine concentrations

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UREA
LIVER

BLOOD
Urea Urea
75%

Urea cycle
TISSUES
NH4+

proteins

NH4+
25%

KIDNEYS Urea

Urea Dietary Proteins bacteria

NH4+
Urea in urine 24

GASTROINTESTINAL TRACT

UREA and creatinine

Glomeruli: 75% of urea is excreted (excretion or when glomerular filtration rate or ) Tubules: Urea is reabsorbed (reabsorption or when glomerular filtration rate or ) Creatinine is derived from creatine-phosphate, creatinine is excreted via the glomeruli. It is not reabsorbed in the tubules so excretion of creatinine is a measure of glomerular filtration rate.
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BUN vs. UREA

BUN = blood urea nitrogen= concentration of the nitrogen component of urea in blood

BUN value is Lower than urea value. BUN:Urea ratio is approximately 1:2

But the term BUN is used interchangeably with urea

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CREATININE
KIDNEYS creatine MUSCLE creatinine
Creatinine in urine

creatinine

creatinine

BLOOD

INTESTINES

creatinine

NH4+
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AZOTAEMIA
- Increased serum/plasma urea & creatinine concentrations

URAEMIA
Marked azotaemia and clinical signs (vomiting, anorexia, gastrointestinal ulceration)

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AZOTAEMIA
CAUSES PRE-RENAL

RENAL
POST-RENAL

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PRE-RENAL AZOTAEMIA
- DECREASED RENAL PERFUSION
- Hypovolaemia, dehydration, cardiovascular disease

Urea is and creatinine Normal /

Urine specific gravity is

- INCREASED UREA PRODUCTION

- G.I. TRACT HAEMORRHAGE

Urea is and creatinine is Normal

Urea is and creatinine is Normal
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- HIGH PROTEIN DIET

RENAL AZOTAEMIA

- RENAL DISEASE
- ONLY evident when more than 60-75% of nephrons are compromised

Urea and creatinine are

Urine is inadequately concentrated

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POST-RENAL AZOTAEMIA
- URINARY TRACT OBSTRUCTION
ureter, urethra

- URINARY TRACT RUPTURE

ureter, bladder, urethra

- Urea and creatinine are

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LOW SERUM/PLASMA UREA: CAUSES

Decreased Liver Function Portosystemic shunt Increased Excretion Extreme PU/PD Overhydration Low protein intake

Young Animals have a lower reference range

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RUMINANTS / HORSES
- Excrete most of urea via the gut (very little via kidneys). So blood urea can be normal despite severe renal disease.

- Therefore blood creatinine is a more sensitive indicator of

renal disease

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3.Urine protein to urine creatinine ratio (UPC ratio)

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UPC RATIO

Used to assess the clinical significance of proteinuria Total protein & creatinine concentrations are measured in a single urine sample and expressed in the same units UPC RATIO < 1.0 INTERPRETATION
Proteinuria if present is not significant Significant proteinuria from: urogenital haemorrhage urogenital inflammation glomerular protein loss

MILD/MODERATE INCREASES (1-2)

MODERATE/SEVERE Usually glomerular protein loss INCREASES (>2)

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Urine Sediment Examination

Produced by centrifugation of urine onto a slide Looking for:

Abnormal Cells Infectious Casts Contaminants

crystals agents

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Ammonium biurate: suggestive of liver dysfunction and/or portosystemic shunting

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Conjugated bilirubin: normal in dogs, but abnormal in other species. Suggests conjugated bilirubinemia

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Calcium oxalate: suggestive of hypercalciuria, hyperoxaluria (dietary, ethylene glycol) or calcium oxalate uroliths
Can occur normally if urine has been stored
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Magnesium ammonium phosphate (struvite) present in normal animals but excessive amounts can be an indicator of struvite uroliths or mixed uroliths
Common in bacterial-induced alkalinuria
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Calcium oxalate monohydrate suggestive of hypercalciuria or EG toxicity

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Cysteine indicative of disruption of cysteine metabolism/catabolism (drug induced or inborn error in metabolism

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Drug-associated - sulfonamides

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Tyrosine associated with severe liver disease

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Tyrosine associated with severe liver disease

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RBCs up to 5 RBC per high power field is normal. Increased RBCs in urine generally indicates hemorrhage into the bladder or urethra (artifact with catheter collection in some cases)

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WBCs up to 5 WBC per high power field is normal, higher levels suggest infection somewhere within the urinary tract

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Transitional epithelial cells from renal pelvis, ureters, urinary bladder or urethra
Morphology used for detection of neoplastic change (cytology)

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Squamous epithelial cells indicator of contamination from skin, prepuce etc

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Neoplastic cells commonly transitional cell carcinomas

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Bacteria bacili on the right, cocci on the left. Presence is always abnormal either infection or contamination (storage, collection)

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Fungi presence is always abnormal Candidiasis or Aspergillus sp. In the case of infection. Be aware: contamination, storage, growth on microscope slides or in stain preparations

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Parasites

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Casts: Hyaline casts = precipitated protein Cellular casts: These have distinct cells within the protein matrix - if the cells are of epithelial origin (i.e., not WBCs or RBCs), they are called epithelial casts.. Granular casts: As cells within the protein cast matrix break down, the cast becomes coarsely then finely granular. Waxy casts: Waxy casts are the final stage of cast degeneration (usually originating from cellular and granular casts). Compared to hyaline casts, they are readily observable because they have a smooth appearance, no internal texture, and are more refractile than the surrounding urine.
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Questions?

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