Urinalysis

Niki Skeldon; Jelena Ristić

doi:10.22233/9781910443255.10

Urinalysis

British Small Animal Veterinary Association , 183 (2016); https://doi.org/10.22233/9781910443255.10

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Urinalysis

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Authors: Niki Skeldon and Jelena Ristić
From: BSAVA Manual of Canine and Feline Clinical Pathology
Item: Chapter 10, pp 183 - 218
DOI: 10.22233/9781910443255.10
Copyright: © 2016 British Small Animal Veterinary Association
Publication Date: March 2016

Abstract

Urinalysis is one of the most useful diagnostic tools available to the practitioner. The specimen is readily available, provides extensive information about the animal’s health, and routine urinalysis tests are cheap to perform. The majority of these tests can be performed in-house; not only is this more economical, but it avoids any artefactual changes which can occur with delayed urine processing and hinder interpretation of the results. This chapter looks at sampling: collection and storage, normal urine, macroscopic examination, specific gravity, chemical analysis, wet sediment examination, urine cytology, urolith analysis, water deprivation testing, tests for glomerular pathology, tests for tubular pathology, urinary tests for adrenal disease, detection of systemic infectious diseases, detection of toxic substances, miscellaneous tests and urinalysis in animals less than 6 months old. Also included are case examples and a quiz question.

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Figures

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10.1

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10.1 Use of non-absorbent cat litter to harvest urine.

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10.4

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10.4 Wet sediment examination: sample preparation and examination.

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10.6

Macroscopic appearance of normal urine, demonstrating the variation in colour intensity depending on urine concentration (left to right: least to most concentrated samples). © 2016 British Small Animal Veterinary Association

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10.6 Macroscopic appearance of normal urine, demonstrating the variation in colour intensity depending on urine concentration (left to right: least to most concentrated samples).

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10.8

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10.8 Maintenance of the refractometer.

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10.12

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10.12 Chemical analysis of urine: dipsticks.

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10.19

Urine protein electrophoresis. (a) Trace from an apparently healthy dog with normal UPCR (UPCR: 0.19; reference interval (RI): 0–0.5). Only albumin is present in appreciable amounts. Many apparently healthy dogs excrete a small amount of albumin in their urine. (b) Trace from a dog with suspected glomerulonephritis. The UPCR is significantly elevated (UPCR: 3.48; RI: 0–0.5), and all protein fractions are present in increased amounts in the urine, suggesting disruption of the glomerular filtration barrier. (c) Serum and urine traces from a dog with suspected myeloma. There is a monoclonal peak in the γ-globulin region in the serum and a similar monoclonal peak is present in the urine, consistent with urinary paraproteins. © 2016 British Small Animal Veterinary Association

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10.19 Urine protein electrophoresis. (a) Trace from an apparently healthy dog with normal UPCR (UPCR: 0.19; reference interval (RI): 0–0.5). Only albumin is present in appreciable amounts. Many apparently healthy dogs excrete a small amount of albumin in their urine. (b) Trace from a dog with suspected glomerulonephritis. The UPCR is significantly elevated (UPCR: 3.48; RI: 0–0.5), and all protein fractions are present in increased amounts in the urine, suggesting disruption of the glomerular filtration barrier. (c) Serum and urine traces from a dog with suspected myeloma. There is a monoclonal peak in the γ-globulin region in the serum and a similar monoclonal peak is present in the urine, consistent with urinary paraproteins.

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10.21

Wet sediment examination: cells. (a) Individual epithelial cells. The two smaller cells on the right could be small epithelial cells or white blood cells (WBCs). The angular object out of the plane of focus on the left is an artefact. (Original magnification X400). (b) Cluster of three epithelial cells. (Sedi-Stain; original magnification X400). (c)Sheet of squamous epithelial cells (note angular shape). (Sedi-Stain; original magnification X400). (d) Pyuria and bacteriuria. Note relative sizes of epithelial cell (asterisk) and WBCs (arrowed). (Original magnification X400). (e) Pyuria, haematuria and bacteriuria. Note relative sizes of epithelial cell (asterisk), WBC (arrowed) and erythrocytes. Some erythrocytes are crenated. Cocci and bacilli are visible in the background. (Original magnification X400). (f) Pyuria, haematuria and bacteriuria. There is a central cluster of WBCs, with individual red blood cells (RBCs) and bacteria in the background. Note the more refractile, granular quality of WBCs compared with RBCs. (Original magnificationX400). (g) Use of Sedi-Stain to highlight WBCs against the background RBCs. (Sedi-Stain; original magnification X400) © 2016 British Small Animal Veterinary Association

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10.21 Wet sediment examination: cells. (a) Individual epithelial cells. The two smaller cells on the right could be small epithelial cells or white blood cells (WBCs). The angular object out of the plane of focus on the left is an artefact. (Original magnification X400). (b) Cluster of three epithelial cells. (Sedi-Stain; original magnification X400). (c)Sheet of squamous epithelial cells (note angular shape). (Sedi-Stain; original magnification X400). (d) Pyuria and bacteriuria. Note relative sizes of epithelial cell (asterisk) and WBCs (arrowed). (Original magnification X400). (e) Pyuria, haematuria and bacteriuria. Note relative sizes of epithelial cell (asterisk), WBC (arrowed) and erythrocytes. Some erythrocytes are crenated. Cocci and bacilli are visible in the background. (Original magnification X400). (f) Pyuria, haematuria and bacteriuria. There is a central cluster of WBCs, with individual red blood cells (RBCs) and bacteria in the background. Note the more refractile, granular quality of WBCs compared with RBCs. (Original magnificationX400). (g) Use of Sedi-Stain to highlight WBCs against the background RBCs. (Sedi-Stain; original magnification X400)

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10.24

Wet sediment examination: struvite crystals. (a) Classic struvites with spermatozoa and amorphous debris in the background. (Original magnification X400). (b) Non-classic struvites with RBCs in the background. (Original magnification X100). (c) Non-classic struvites with the spermatozoa and bacteria in the background. Do not confuse the small cuboidal struvites with calcium oxalate dihydrate crystals. (Original magnification X200). (d) Non-classic struvites. (Original magnification X400). (e) Cluster of non-classic struvites with RBCs in the background. (Original magnification X400) © 2016 British Small Animal Veterinary Association

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10.24 Wet sediment examination: struvite crystals. (a) Classic struvites with spermatozoa and amorphous debris in the background. (Original magnification X400). (b) Non-classic struvites with RBCs in the background. (Original magnification X100). (c) Non-classic struvites with the spermatozoa and bacteria in the background. Do not confuse the small cuboidal struvites with calcium oxalate dihydrate crystals. (Original magnification X200). (d) Non-classic struvites. (Original magnification X400). (e) Cluster of non-classic struvites with RBCs in the background. (Original magnification X400)

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10.25

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10.25 Wet sediment examination: calcium oxalate dihydrate crystals. (Original magnification X400)

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10.26

Wet sediment examination: calcium oxalate monohydrate crystals. (a) Classic ‘picket fence’ calcium oxalate monohydrate crystals, with spermatozoa in the background. (Original magnification X500). (b) A cluster of calcium oxalate monohydrate crystals, with erythrocytes and squamous epithelial cells also present. (Sedi-Stain; original magnification X500). (c) Non-classic calcium oxalate monohydrates from an apparently healthy cat. (Original magnification X400). (a, First published in Ristić and Skeldon (2011) , © Niki Skeldon; b, © Kathleen Tennant) © 2016 British Small Animal Veterinary Association

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10.26 Wet sediment examination: calcium oxalate monohydrate crystals. (a) Classic ‘picket fence’ calcium oxalate monohydrate crystals, with spermatozoa in the background. (Original magnification X500). (b) A cluster of calcium oxalate monohydrate crystals, with erythrocytes and squamous epithelial cells also present. (Sedi-Stain; original magnification X500). (c) Non-classic calcium oxalate monohydrates from an apparently healthy cat. (Original magnification X400). (a, First published in Ristić and Skeldon (2011) , © Niki Skeldon; b, © Kathleen Tennant)

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10.27

Wet sediment examination: other calcium crystals. (a) Amorphous phosphates and bacteria. (Original magnification X400). (b) Calcium phosphate crystals, with small calcium oxalate dihydrates also present. (Original magnification X400). (Courtesy of Microbiology Dept., Axiom Veterinary Laboratories Ltd) © 2016 British Small Animal Veterinary Association

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10.27 Wet sediment examination: other calcium crystals. (a) Amorphous phosphates and bacteria. (Original magnification X400). (b) Calcium phosphate crystals, with small calcium oxalate dihydrates also present. (Original magnification X400). (Courtesy of Microbiology Dept., Axiom Veterinary Laboratories Ltd)

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10.28

Wet sediment examination: urate crystals. (a) Classic ammonium urate crystals, with struvites and bacteria also present. (Original magnification X400). (b) Ammonium urate crystals, smooth type. (Original magnification X500) © 2016 British Small Animal Veterinary Association

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10.28 Wet sediment examination: urate crystals. (a) Classic ammonium urate crystals, with struvites and bacteria also present. (Original magnification X400). (b) Ammonium urate crystals, smooth type. (Original magnification X500)

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10.29

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10.29 Wet sediment examination: bilirubin crystal with red blood cells. (Original magnification X400)

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10.30

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10.30 Wet sediment examination: cystine crystals with erythrocytes also present. (Original magnification X400)

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10.31

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10.31 Wet sediment examination: cholesterol crystal. (Sedi-stain; original magnification X400)

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10.32

Wet sediment examination: drug crystals. (a) Sulphonamide crystal. (Original magnification X400). (b) Sulphonamide crystals. (Original magnification X1000). (c) Xanthine crystals. (Original magnification X500) © 2016 British Small Animal Veterinary Association

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10.32 Wet sediment examination: drug crystals. (a) Sulphonamide crystal. (Original magnification X400). (b) Sulphonamide crystals. (Original magnification X1000). (c) Xanthine crystals. (Original magnification X500)

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10.33

Wet sediment examination: casts. (a) Hyaline cast. (Original magnification X400). (b) Granular cast. (Original magnification X400). (c) Artefact, not to be confused with a cast, with WBCs and an epithelial cell also present. (Original magnification X400) © 2016 British Small Animal Veterinary Association

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10.33 Wet sediment examination: casts. (a) Hyaline cast. (Original magnification X400). (b) Granular cast. (Original magnification X400). (c) Artefact, not to be confused with a cast, with WBCs and an epithelial cell also present. (Original magnification X400)

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10.34

Wet sediment examination: yeasts and fungi. (a) Fungal hyphae. (Original magnification X100). (b) Yeasts (probably Candida spp.), demonstrating budding (arrowed). (Original magnification X400) © 2016 British Small Animal Veterinary Association

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10.34 Wet sediment examination: yeasts and fungi. (a) Fungal hyphae. (Original magnification X100). (b) Yeasts (probably Candida spp.), demonstrating budding (arrowed). (Original magnification X400)

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10.35

Wet sediment examination: parasites. Adult Pearsonema (formerly Capillaria) plica nematode containing ova. (Original magnification X100). (Courtesy of Microbiology Dept., Axiom Veterinary Laboratories Ltd) © 2016 British Small Animal Veterinary Association

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10.35 Wet sediment examination: parasites. Adult Pearsonema (formerly Capillaria) plica nematode containing ova. (Original magnification X100). (Courtesy of Microbiology Dept., Axiom Veterinary Laboratories Ltd)

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10.37

Wet sediment examination: contaminants and findings of little/no diagnostic significance. (a) Spermatozoa with WBC and amorphous debris. (Original magnification X400). (b) Presumed plant fibre. (Original magnification X400). (c) Glass shards. (Original magnification X400). (d) Air bubbles with struvite crystals. (Original magnification X100). (e) Stain precipitate. (Sedi-Stain; original magnification X400) © 2016 British Small Animal Veterinary Association

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10.37 Wet sediment examination: contaminants and findings of little/no diagnostic significance. (a) Spermatozoa with WBC and amorphous debris. (Original magnification X400). (b) Presumed plant fibre. (Original magnification X400). (c) Glass shards. (Original magnification X400). (d) Air bubbles with struvite crystals. (Original magnification X100). (e) Stain precipitate. (Sedi-Stain; original magnification X400)

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10.38

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10.38 (a) A mini culture tray designed for use in general practice. It can be used to culture samples from skin, ears and urine. (b) A table-top incubator.

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10.40

Comparative features of normal transitional and squamous epithelial cells in cytological samples. (a) Two normal transitional epithelial cells with small artefact between them. (b) Three squamous epithelial cells against a background of granular debris. (Original magnification of both photographs X500). N:C = nuclear to cytoplasmic. © 2016 British Small Animal Veterinary Association

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10.40 Comparative features of normal transitional and squamous epithelial cells in cytological samples. (a) Two normal transitional epithelial cells with small artefact between them. (b) Three squamous epithelial cells against a background of granular debris. (Original magnification of both photographs X500). N:C = nuclear to cytoplasmic.

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10.41

Cytology: urinary tract infection. (a) Note very poorly preserved neutrophils (arrowed), moderate numbers of erythrocytes, abundant extracellular bacteria (monomorphic population) and frequent lysed cells (arrowhead). (Modified Wright’s stain; original magnification X500). (b) Same case as in (a); intracellular bacteria are just visible (arrowed). (Modified Wright’s stain; original magnification X1000). Inset: higher magnification showing intracellular bacteria. © 2016 British Small Animal Veterinary Association

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10.41 Cytology: urinary tract infection. (a) Note very poorly preserved neutrophils (arrowed), moderate numbers of erythrocytes, abundant extracellular bacteria (monomorphic population) and frequent lysed cells (arrowhead). (Modified Wright’s stain; original magnification X500). (b) Same case as in (a); intracellular bacteria are just visible (arrowed). (Modified Wright’s stain; original magnification X1000). Inset: higher magnification showing intracellular bacteria.

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10.42

Cytology: transitional cell carcinoma (TCC). (a) TCC with neutrophilic inflammation and haematuria. There is a cluster of pleomorphic epithelial cells with deeply basophilic and variably vacuolated cytoplasm, variably shaped nuclei with coarse chromatin and multinucleation. Also present are more normal-appearing poorly preserved epithelial cells (red arrow), many poorly preserved neutrophils (arrowhead), erythrocytes (green arrows) and lysed cells (asterisk). (Modified Wright’s stain; original magnification X500). (b) Same case as in (a); there is a central cluster of neoplastic epithelial cells demonstrating anisocytosis, anisokaryosis and bizarre nuclear morphology (nuclear fragmentation). Neutrophils, erythrocytes and lysed cells are also present. (Modified Wright’s stain; original magnification X500). (c) Same case as in (a) showing pleomorphic epithelial cells, including small cells with a high nuclear to cytoplasmic (N:C) ratio (red arrow). One cell contains a single large pink cytoplasmic globule characteristic of TCC. Frequent poorly preserved neutrophils (arrowheads) and erythrocytes (green arrow) are also present. (Modified Wright’s stain; original magnification X1000). (d) TCC, catheter biopsy sample. The sample is highly cellular with good preservation. There is a markedly pleomorphic population of epithelial cells which demonstrate multiple features of malignancy, including multinucleation with incomplete nuclear separation and prominent nucleoli of variable size (arrowed). Many cells contain the pink cytoplasmic globules characteristic of TCC. (Modified Wright’s stain; original magnification X500) © 2016 British Small Animal Veterinary Association

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10.42 Cytology: transitional cell carcinoma (TCC). (a) TCC with neutrophilic inflammation and haematuria. There is a cluster of pleomorphic epithelial cells with deeply basophilic and variably vacuolated cytoplasm, variably shaped nuclei with coarse chromatin and multinucleation. Also present are more normal-appearing poorly preserved epithelial cells (red arrow), many poorly preserved neutrophils (arrowhead), erythrocytes (green arrows) and lysed cells (asterisk). (Modified Wright’s stain; original magnification X500). (b) Same case as in (a); there is a central cluster of neoplastic epithelial cells demonstrating anisocytosis, anisokaryosis and bizarre nuclear morphology (nuclear fragmentation). Neutrophils, erythrocytes and lysed cells are also present. (Modified Wright’s stain; original magnification X500). (c) Same case as in (a) showing pleomorphic epithelial cells, including small cells with a high nuclear to cytoplasmic (N:C) ratio (red arrow). One cell contains a single large pink cytoplasmic globule characteristic of TCC. Frequent poorly preserved neutrophils (arrowheads) and erythrocytes (green arrow) are also present. (Modified Wright’s stain; original magnification X1000). (d) TCC, catheter biopsy sample. The sample is highly cellular with good preservation. There is a markedly pleomorphic population of epithelial cells which demonstrate multiple features of malignancy, including multinucleation with incomplete nuclear separation and prominent nucleoli of variable size (arrowed). Many cells contain the pink cytoplasmic globules characteristic of TCC. (Modified Wright’s stain; original magnification X500)

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10.43

Radiographs of uroliths. (a) Lateral abdominal radiograph of a 7-year-old female entire Cavalier King Charles Spaniel. There is a single large radiopaque urolith in the bladder. This was analysed and found to be a struvite urolith. (b) Lateral abdominal radiograph of an 11-year-old male neutered Bichon Frise. There are several irregular radiopaque masses in the dependant portion of the bladder. These were removed surgically and found to be calcium oxalate uroliths. (Courtesy of Heath and Reach Veterinary Surgery) © 2016 British Small Animal Veterinary Association

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10.43 Radiographs of uroliths. (a) Lateral abdominal radiograph of a 7-year-old female entire Cavalier King Charles Spaniel. There is a single large radiopaque urolith in the bladder. This was analysed and found to be a struvite urolith. (b) Lateral abdominal radiograph of an 11-year-old male neutered Bichon Frise. There are several irregular radiopaque masses in the dependant portion of the bladder. These were removed surgically and found to be calcium oxalate uroliths. (Courtesy of Heath and Reach Veterinary Surgery)

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10.49

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10.49 (a–d) Four photographs of urine sediment are presented. Can you identify the structures present?