URINALYSIS

VM608
 REASONS FOR A URINALYSIS

• Important component of baseline work up

• Along with complete blood count and biochemical analysis
• Patients with urinary clinical signs:
• Stranguria
• Polyuria
• Pollakiuria
• Pigmenturia
 REASONS FOR A URINALYSIS (CONT.)

• Patients with systemic diseases

• Renal disease
• Diabetes mellitus
• Ketones
• Hyperadrenocorticism (Cushing’s disease)
• Portosystemic shunt (PSS)/Liver disease
• Ammonium biurate crystals
• Others
 COMPONENTS OF A URINALYSIS

• Gross examination

• Assessment of specific gravity

• Semiquantitative biochemical assessment

• Microscopic examination of concentrated urine

sediment
 URINE COLLECTION

• Free catch
• Midstream voided sample is better
• Not appropriate for culture
• Urinary catheterization
• Risk of introducing bacteria, trauma
• Cystocentesis
• Invasive, may contain blood
• WBC & bacteria should not
be present
• Can culture
 GENERAL CONCEPTS OF URINE
EXAMINATION
• Examine ASAP
• pH changes
• Bacterial proliferation
• Cells/casts
• Crystals
• Urine preservation
• Refrigeration
• Mucolexx
 GROSS EXAMINATION

• Color
• Clarity
• Odor
 COLOR

• Normal color is transparent, yellow, amber

• Red urine
• Red blood cells
• Hemoglobin
• Dark yellow to brown
• Bilirubin
• Reddish brown
• Hemoglobin
• Myoglobin
 CLARITY

• Normal urine should be clear

• Horse urine is expected to be cloudy (turbid)
• Calcium carbonate crystals
• Mucus
• Cloudy urine in other species may indicate an
“active” sediment
• Further examination
 ODOR

• Limited value
• Normal, fresh urine has an aroma (urinoid)
• Ammonia (ammoniacal)
• Protein breakdown (improper storage)
• Bacteria
• Ketonuria
• Diabetic ketoacidosis
• “Fruity” odor can be detected by some
 URINE CONCENTRATION

• Specific gravity
• Rough assessment of functioning capacity of tubules and
collecting ducts
• 1.000 = specific gravity of distilled water
• Wide range
• 1.001 – 1.065
• Up to 1.080 in the cat

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REFRACTOMETER SCALES
 URINE CONCENTRATION

• Hyposthenuria
• Specific gravity: 1.001 – 1.007
• Isosthenuria:
• Specific gravity: 1.008 – 1.012
• Hypersthenuria
• Variable by species
• Cats: ≥ 1.035
• Dogs: ≥ 1.030
• Large animals: ≥ 1.025
 REMEMBER:

Must always take the animal’s hydration status, fluid

therapy, medications, concurrent diseases, etc.,
into account before deciding if a urine specific
gravity is physiologically appropriate
 URINE DIPSTICK

• Useful tests • Not useful tests

• pH • Leukocytes
• Occult blood • Urobilinogen
• Glucose • Specific gravity
• Bilirubin
• Protein
• Ketones
 USING A URINE DIPSTICK

• Timing is important
• Make sure strip is aligned properly with chart
• Record results
GLUCOSE EXAMPLE
 URINE SEDIMENT

• Concentrated urine sample

• Easier to find structures of interest
• Tubular casts
• Crystals
• Cells
• Microorganisms
 URINE SEDIMENT

• Centrifuge ~5 mL urine at 1500-2000 rpm for 3-5

minutes
• Cells and other structures settle to the bottom
• May have a visible “pellet”
• Remove all but ½ mL of supernatant to another
tube or discard
 URINE SEDIMENT

• Thoroughly re-suspend the sediment in the

remaining supernatant
• Place a drop on a slide and place a coverslip to
prepare a “wet mount”
 A NOTE ABOUT URINE STAINS

• Must use caution if staining wet mounts

• Stain precipitate may be mistaken for bacteria
• Easy for stains to become contaminated with
bacteria
• Stain may also crystallize with age
 URINE SEDIMENT

• Lower the condenser and close the iris diaphragm

on the microscope
• Decreases amount of light passing through sample
• Enhances contrast to allow non-pigmented structures to be
seen
• Same settings used to examine fecal flotations
 Condenser
knob

Iris diaphragm
lever
CONDENSER UP (BLOOD SMEAR)
CONDENSER DOWN (URINALYSIS)
CONDENSER UP (BLOOD SMEAR)
CONDENSER DOWN (URINALYSIS)
IRIS DIAPHRAGM OPEN
(BLOOD SMEAR)
IRIS DIAPHRAGM CLOSED (URINALYSIS)
 URINE SEDIMENT

• Use 10X lens and 40X dry lens

• LPF = low-powered field (10X)
• HPF = high-powered field (40X)
• Cannot use high-powered oil lenses with cover-
slipped wet mount preparations
• Use the edge of the coverslip to help correctly
focus the scope at 10X
• Make sure that you are in the correct plane
 URINE SEDIMENT

• Cells
• Casts
• Microorganisms
• Crystals
• Other structures
 URINE SEDIMENT

• Cells in urine sediment

• Red blood cells
• White blood cells
• Epithelial cells
 RED BLOOD CELLS

• RBCs can be round or crenated (“spiky”)

• Important to differentiate from fat droplets

• >5 RBCs/HPF considered significant

• Important to consider how sample was taken
• Samples collected via cystocentesis may have more RBCs
than expected
RBCS
LIPID DROPLETS
 WHITE BLOOD CELLS

• WBCs are 1.5-2X larger than RBCs and can lyse in

hypotonic or alkaline urine

• >5 WBCs/HPF are considered significant in the

absence of blood contamination

• Inflammation ≠ infection
WBCS
 EPITHELIAL CELLS

• Squamous epithelial cells

• No clinical significance if uniform
• Distal urethra and urogenital tract

• Transitional epithelial cells

• Proximal urethra, urinary bladder, ureter, renal pelvis
• No significance unless neoplastic
• Catheterized samples may have clusters of transitional cells
SQUAMOUS EPITHELIUM
TRANSITIONAL EPITHELIUM
TRANSITIONAL CELL CARCINOMA
 MICROORGANISMS

• Bacteria
• Sample collection technique and handling
• If true pathogen, not just contaminant, expect to also see
inflammation
• Brownian motion
 MICROORGANISMS

• Fungi
• Often a contaminant
• True pathogens: Blastomyces dermatitidis, Candida spp,
Cryptococcus neoformans
 MICROORGANISMS

• Parasites
• Stephanurus dentatus
• Kidney worm of swine
• Pearsonema (formerly Capillaria) plica
• Bladder worm of dogs and cats
• Dioctophyma renale
• Giant kidney worm of mustelids and dogs
• Microfilaria—Dirofilaria immitis
STEPHANURUS DENTATUS
PEARSONEMA PLICA
DIOCTOPHEMA RENALE
MICROFILARIA (DIROFILARIA IMMITIS)
 CRYSTALS

• Crystal formation affected by:

• Urine pH

• Temperature

• Medications given
 CRYSTALS

• Crystals often found in acidic urine

• Calcium oxalate
• Cystine
• Sulfonamide
• Crystals often found in alkaline urine
• Triple phosphate (aka “struvite”)
• Ammonium biurate (aka urate)
• Calcium carbonate
CHARACTERISTICS OF INDIVIDUAL
CRYSTALS
• Calcium oxalate
• Dihydrate
• “Envelopes”
• Can be seen in normal urine or associated
with urolithiasis
• Monohydrate
• “Picket fence” & “dumbbells”
• Ethylene glycol toxicity
 CALCIUM OXALATE DIHYDRATE

• “Envelopes”
CALCIUM OXALATE MONOHYDRATE

• “Picket fence”

“Dumbbell”

“Dumbbell”
CALCIUM OXALATE MONOHYDRATE
TRIPLE PHOSPHATE “STRUVITE”
 CALCIUM CARBONATE

• Normal: horses, rabbits

AMMONIUM BIURATE “THORN APPLE”

• Liver disease, PSS; not pathognomonic

• Dalmatians, English bulldogs, black Russian terriers
 AMMONIUM BIURATE “SMOOTH”

• Liver disease, PSS; not pathognomonic

• Dalmatians, English bulldogs, black Russian terriers
 URIC ACID

• Dalmatians, English bulldogs, black Russian terriers

 CYSTINE

• Defect in amino acid transport of proximal renal

tubule
 BILIRUBIN CRYSTALS

• Spill over from blood

• May indicate hyperbilirubinemia
 DRUG CRYSTALS

• Sulfonamides
• Others
 CASTS

• Mold of renal tubules

• Not seen very frequently

• Formed in the distal tubules

• Tamm-Horsfall mucoproteins
 CASTS

• May indicate renal tubular disease/destruction

• An absence of casts does not rule out renal disease

• May dissolve in alkaline and very dilute urine

• May be destroyed during centrifugation/re-

suspension
 TYPES OF CASTS

• Hyaline casts

• Cellular cast
• RBC cast
• WBC cast
• Epithelial cast

• Granular cast

• Waxy cast
• May indicate chronicity
CAST FORMATION
HYALINE CAST
CELLULAR CAST
GRANULAR AND WAXY CASTS
WAXY CAST
 OTHER STRUCTURES

• Fat droplets
• Sperm
• Plant material or pollen grains
• Others
POLLEN FIBERS

Cloth Glove Powder

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ALTERNARIA SPP.
THE END

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