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Clinical Pathology
2nd edition
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10
Urine analysis
Joy Archer
Introduction
Constituent
Gross appearance
Before beginning any analysis the urine sample should
be observed in a transparent container for clarity (turbidity) and colour, and these recorded using a consistent system of semiquantitative reporting. Normal urine
should be clear and yellow to straw-coloured, depending on concentration of coloured pigment molecules.
The interpretation of gross findings is summarized in
Figure 10.2.
Change
Cause
pH
Increase
Bilirubin
Decrease
Casts
Disintegration
Sediment
Epithelial cells
Crenation, lysis
Bacteria
Growth
10.1
149
Appearance
Cause
Bright red
Red
Redbrown
Dark redbrown
Myoglobin
Transfusion of haemoglobin-based
oxygen-carrying solution (Oxyglobin)
Redpink
Dark yellow/greenish
Bilirubin
Orangeyellow
Cloudy
10.2
Refractometers
Refractometers are calibrated to read RI, SG and
plasma protein. Many refractometers compensate for
changes in temperature between 15 and 37C. Most
are calibrated for use with human samples, although
instruments for veterinary use are available. The latter
have one calibration scale for dogs and large animal
urine (which is similar to a scale for human urine) and
a separate scale for cat urine. Human-based instruments will slightly overestimate the SG of cat urine.
Care of the refractometer is summarized in Figure
10.3. Urine SG can be determined by some dipsticks
by a chemical method but this is unreliable in veterinary
patients and is not recommended.
Rinse and dry the clear optical surface after each use
Regularly check the zero setting with double distilled water
(ddH2O): SG 1.000
Check accuracy of calibration with 5% NaCl solution in ddH20:
SG 1.022
Use it within the temperature range of calibration (1537C)
Avoid scratching/damaging the optical surface
10.3
Interpretation of results
Specific gravity
The specific gravity (SG) of urine is a useful indicator of
renal concentrating ability. This can be readily obtained by measuring the refractive index (RI) in a
specially calibrated refractometer. The instrument
measures the degree through which light is bent (refracted) when it passes through a liquid: the amount of
refraction (refractive index) is a function of the amount
and type of solute (particles) in that liquid. RI and SG
are correlated, as the SG is defined as the ratio of the
weight of the liquid to an equal volume of distilled water.
The SG of a solution thus depends on the number and
molecular weight (size) of particles in the solution.
Urine always has an SG greater than that of distilled
water, which has an SG of 1.000. The SG of urine is
increased by large amounts of glucose, protein, lipid
and contrast material.
There is also a reasonably close relationship between SG and osmolality. However, urine SG varies
with the type of solute present, while osmolality does not.
Osmolality depends on the number of osmotically active
particles in solution regardless of their size (SG depends
upon both number and size) and is considered to be a
more accurate assessment of renal tubular concentrating (and diluting) ability than SG. However, SG is easily
measured (refractometer), while osmolality determinations require a special freeze point depression osmometer. In dogs, it is possible to calculate approximate
osmolality from urine SG: multiplication of the last 2
150
SG
Osmolality
(mOsm)
1.0151.045
1.0351.060
Possible range
1.0011.080
Hyposthenuria
<1.008
<300
Isosthenuria
1.0081.012
Approximately
300
Hypersthenuria
>1.012
>300
10.4
Osmotic diuresis
Loss of medullary tonicity (renal medullary
washout)
Deficiency in anti-diuretic hormone (ADH)
Resistance to ADH.
Causes
>1.030 dog
>1.035 cat
Dehydration
<1.030 dog
<1.035 cat
Dehydration
1.0121.030 dog
1.0121.035 cat
Polyuria
1.0201.030
Polyuria/ polydipsia
1.0081.012
(see also below)
Polyuria/ polydipsia
1.0081.012
or <1.008
Polyuria/ polydipsia
No azotaemia with:
Blood glucose
Diabetes mellitus
Hyperadrenocorticism
Clinical findings
Hypercalcaemia
Na+ and K+
Hypoadrenocorticism
Urea
Hepatic insufficiency
T4
Hyperthyroidism (cats)
None
10.5
Polyuria/ polydipsia
Pyometra, pyelonephritis
Inflammatory leucogram
<1.008
Calcium
SG
151
Practical guidelines for dipstick use are summarized in Figures 10.6 and 10.7.
Reported range
Method
pH
59
Glucose
Negative
1+ (2.8 mmol/l)
2+ (5.5 mmol/l)
3+ (17 mmol/l)
4+ (55 mmol/l)
Glucose oxidase/peroxidase
reaction. Calibrated to avoid
interference by vitamin C
(>5 mmol/l)
Ketones
Negative
1+ (0.54 mmol/l)
2+ (410 mmol/l)
3+ (>10 mmol/l)
Nitroprusside reaction
Protein
Negative
1+ (0.3 g/l)
2+ (1.0 g/l)
3+ (5.0 g/l)
Bilirubin
Negative
1+
2+
3+
Blood
Negative
1+ (510 RBC/l)
2+ (25 RBC/l)
3+ (50 RBC/l)
4+ 250 RBC/l)
Erythrocytes result in
speckles on pad but high
numbers give diffuse colour
Haemoglobin
Negative
1+, 2+, 3+, 4+
same equivalents
as blood
As for blood
Urobilinogen
Negative
1+ (17 mol/l)
2+ (70 mol/l)
3+ (140 mol/l)
4+ (200 mol/l)
10.6
152
Comments
Interference
False pH: contamination with acid from
albumin strip, detergents. False colour due
to presence of blood substitute (Oxyglobin)
Test
Reported range
Method
Comments
Interference
Nitrites
Negative or
positive
Leucocyte
esterase
Negative or
positive
10.6
Test
pH
Normal value
Altered value
Possible causes
6.07.5
Increase
Decrease
Metabolic acidosis
Hypochloraemic metabolic alkalosis (uncommon)
Renal tubular acidosis
Hypokalaemia
Glucose
Negative or trace
1+ or greater
Ketones
Negative or trace
1+ or greater
Diabetic ketoacidosis
Starvation
Very young animals
Protein
Negative or trace
2+ or more
>1+ in dilute urine
Pyuria (infection)
Glomerulonephritis or amyloidosis leading to protein-losing nephropathy
Haemorrhage (see text)
Genital tract secretions
Bilirubin
Haemolytic anaemia
Hepatobiliary disease (especially cats)
Blood
Negative
Positive
Haemoglobin
Negative
Positive
Urobilinogen
Negative
Positive
Nitrites
Negative
Leucocyte
esterase
Negative
10.7
Urine pH
Urine pH does not necessarily reflect the bodys pH
and is also influenced by diet, recent feeding, bacterial infection and storage time. Urine is usually acidic
in dogs and cats. Studies have shown that dipstick
measurements of pH are inherently inaccurate when
153
Proteinuria
A small amount of protein may be normal but the
dipstick result should be interpreted with knowledge of
the urine SG, as the significance of the result is related
to the concentration of the urine. For example, a 3+
protein dipstick result in urine of SG 1.008 indicates a
much greater protein loss than the same 3+ protein in
urine of SG 1.045. Proteinuria may result from
glomerulonephropathy, tubular transport defects, or
inflammation or infection within the urinary tract. Haemorrhage must be marked (macroscopic rather than
microscopic) before it causes significant proteinuria
(Vaden et al., 2004). Thus sediment examination is
important in the evaluation of proteinuria.
Urine protein:creatinine ratio
If there is no evidence of inflammation in the sediment
or no gross haematuria, the urine protein:creatinine
ratio (UPC) can be used to quantify proteinuria (Figure
10.8). The quantity of protein lost is related to the
amount of creatinine in the urine to correct for variation
in urine SG. This is possible because the excretion of
creatinine is relatively stable for an individual and there
is essentially no tubular reabsorption in dogs and cats.
Urine total protein and creatinine are measured on the
same sample by automated chemical methods, reported in the same units and a ratio obtained:
Urine protein:creatinine ratio (UPC) = Urine protein (mg/dl)
Urine creatinine (mg/dl)
Units may need to be converted from SI units to
perform the calculation:
Protein (g/l) x 100 = Protein (mg/dl)
Creatinine (mmol/l) x 1000/88.4 = Creatinine (mg/dl)
Glucosuria
Glucose is freely filtered then reabsorbed in the proximal tubule, but resorptive capacity is limited. Glucosuria occurs when blood glucose exceeds this renal
threshold, for example in diabetes mellitus or as a
result of stress in cats (fructosamine is useful to distinguish stress and diabetes, see Chapter 16). The renal
threshold in dogs is 10 mmol/l and is slightly higher in
cats (1417 mmol/l).
Glucosuria in the absence of hyperglycaemia reflects a tubular resorption defect in which the renal
tubules fail to reabsorb glucose from the glomerular
filtrate. Fanconi syndrome and primary renal glucosuria are examples of tubular transport defects that
occur in dogs (see Chapter 11).
Ketonuria
In small animals ketonuria is usually associated
with diabetic ketoacidosis (DKA), although it may
also be seen in starvation. It is important to note that
dipsticks detect acetoacetate and, to a lesser extent,
acetone, but do not detect betahydroxybutyrate
(BHB). During the initial stages of insulin therapy for
DKA there is increased conversion of BHB to acetoacetate and so the degree of ketonuria may initially
appear to increase.
154
UPC
Significance
<0.5
Normal
0.51.0
>2.0
Significant proteinuria
>5.0
>8.012.0
Bilirubinuria
There is a low renal threshold for bilirubin and even small
increases in plasma bilirubin can lead to bilirubinuria.
Thus bilirubinuria is detected prior to hyperbilirubinaemia or jaundice. Bilirubin in urine is in the form of
conjugated bilirubin, since unconjugated bilirubin is bound
to albumin, which does not usually pass through the
glomerular barrier in significant amounts unless glomerular disease is present. Bilirubinuria is not seen in healthy
cats but a small amount of bilirubin may be found in the
urine of normal dogs (see Figure 10.7). This is in part
because they have a very low renal threshold, and in part
because canine renal tubular cells are able to catabolize
haemoglobin to unconjugated bilirubin, conjugate it and
then secrete it into the urine. Increased bilirubinuria may
be caused by cholestasis or haemolytic anaemia.
155
Element
Look-alike
Red blood
cells (RBCs)
White blood
cells (WBCs)
Bacteria
Crystals
Casts
10.9
156
Casts
Casts are formed in the renal tubules from Tamm
Horsfall mucoprotein secreted by renal tubular epithelial cells. These condense to form hyaline casts (Figure
10.10a). The hyaline casts may then acquire cellular
debris and become granular casts (Figure 10.10b) or
Fat droplets
Yeast
RBCs (unstained)
Transitional cells
Fat droplets
Refractile
Brownian motion
Yeast
Stain precipitate
Variable sizes
Starch granules
Glass fragments
Muscle fibres
Internal striations
Cotton fibres
Internal striations coarse, cells usually attached to surface and not incorporated as in a true cast
(a)
(b: i)
(b: ii)
(c: i)
(c: ii)
(d: i)
(d: ii)
(e)
Urine sediment casts. (a) Hyaline cast with little structure and a faint light appearance. An occasional hyaline cast
may be found in normal urine. These are the earliest casts formed in renal disease. They are very fragile and easily
destroyed in urine. (Unstained sediment.) (b) Granular casts (i) unstained and (ii) stained with Sedistain. These casts can be
seen with toxic injury to the renal tubules, and with haemoglobinuria (as well as red cell casts) and myoglobinuria. (c) Waxy
casts (i) unstained and (ii) stained with Sedistain. These develop from the disintegration and consolidation in casts as they
mature in the damaged tubules. When found in urine they indicate chronicity of the renal condition. (d) Mixed cellular casts (i)
unstained and (ii) stained with Sedistain. These casts can be found with acute renal damage, trauma and in inflammation of
the kidney. They are very fragile and readily disintegrate with rough handling and storage of urine. (e) Histology section from
a kidney, stained with H&E, showing a large mixed cellular and waxy cast within a renal tubule. (Original magnification X400.)
10.10
Type of cast
Normal findings
Hyaline
None or rare
None or rare
None
None
Fatty
None
Granular/waxy
Waxy
None
These develop from degenerating granular or cellular casts and indicate duration/chronicity
of disease
Haemoglobin
Myoglobin
None
10.11
157
Crystals
The presence of crystals in urine (Figure 10.12) can be
of no clinical significance in health, but in animals with
histories of urolithiasis or relevant clinical signs they
may be significant (Figure 10.13). A knowledge of
underlying causes or predisposing factors to the formation of various crystals can help direct further investigations. Both struvite and calcium oxalate crystals
may be present in healthy dogs and cats and are the
most common types of crystals found. Struvite crystals
(Figure 10.12a) form in alkaline urine, which may arise
(a)
(b)
(c: i)
(c: ii)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
Urine sediment crystals. (a) Struvite (magnesium ammonium phosphate) crystals with a typical coffin lid
structure. These crystals can have various structures depending on conditions during formation and growth.
(b) Calcium oxalate dihydrate crystals are the most common form of calcium oxalate crystal found. They have a typical
Maltese cross structure. (c) Calcium oxalate monohydrate crystals. Large quantities are frequently associated with
ethylene glycol toxicity. The structure is distinctive and different: (i) in dogs they are elongated and needle shaped; (ii) in
cats they have rounded ends and internal structure. (d) Calcium phosphate crystals are small, needle shaped and may
form clusters. (e) Uric acid crystals are most commonly diamond shaped but can take other forms and are clear or pale
yellow. (f) Ammonium biurate crystals are usually pale yellow to brown and may aggregate to form clusters; the typical
thorn apple appearance. (g) Cystine crystals have a typical hexagonal shape. (h) Drug-associated crystals. Many drugs
and their metabolites may crystallize in urine. This is an example of crystal formation from sulphonamide drugs and their
metabolites in urine, which is not uncommon. (i) Cholesterol crystals are very thin, flat and rectangular. (j) Bilirubin crystals
usually are in the form of yellow to red fine needles. (Unstained sediment; original magnification X400.)
10.12
158
Type of crystals
Normal findings
Struvite (magnesium
ammonium phosphate)
Calcium phosphate
Ammonium urate/biurate
Uric acid
Bilirubin
Cystine
Leucine/tyrosine
Cholesterol
Amorphous material
(variable content)
Common in concentrated
urine
10.13
Cells
Red and white blood cells may be seen in low numbers
in normal urine. Red cells (Figure 10.14a) may be
confused with fat droplets or yeast (Figure 10.9). White
Miscellaneous findings
Bacteria may reflect contamination or infection; an
associated inflammatory response would support the
latter (Figure 10.16a), but is not always present. Other
organisms, such as nematodes, yeast and fungi, may
occasionally be identified (Figures 10.16be) and their
significance is summarized in Figure 10.17. Sperm,
mucus strands and cotton fibre contaminants are shown
in Figure 10.16(fh).
159
(a)
(c: ii)
(b)
(d)
(c: i)
(e)
(a) Red cells in urine sediment showing crenation, giving them an irregular slightly spiky appearance. Crenation
10.14
is common when cells are in urine for a prolonged period. (Unstained sediment.) (b) RBC, WBC and bladder
epithelial cells in sediment. Two large epithelial cells are seen on the left, three neutrophils on the right. Just to the left of
the neutrophils there are two crenated RBCs. (Unstained sediment.) (c) Cluster of bladder epithelial cells (i) unstained and
(ii) stained with Sedistain. Bladder mucosa cells will exfoliate forming clusters and rafts in urine with inflammation/irritation.
(d) Unstained preparation mature squamous epithelial cells and bacteria which could be contaminants from the distal
urethra/genital tract. (e) Unstained preparation of urothelial cells. Elongated pear shaped cells are believed to originate
from the ureters and renal pelvis. (Original magnification X400.)
Normal findings
RBCs
Cell type
WBCs
<5/hpf
Usually neutrophils,
occasionally eosinophils
Epithelial cells
02/hpf
Small cells from kidney/upper
tract
Large cells from bladder or
urethra
10.15
160
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Urine sediment: miscellaneous. (a) Sediment containing degenerate neutrophils and numerous bacteria
consistent with urinary tract infection. (Unstained.) (b) Aspergillus spp. Fungal contamination, especially in freecatch and old urine, is common. (Sedistain.) (c) Alternaria spp, a contaminant especially in free-catch urine. (Sedistain.)
(d) Parasite eggs can be found if there is faecal contamination of the sample or, rarely, when organisms are present in the
kidney itself. (Sedistain.) (e) Mites are rare contaminants in free-catch urine. (Sedistain.) (f ) Sperm are found in entire
male dog urine. (Sedistain.) (g) Mucus strands. Variable amounts of fine material float on the surface of urine preparations
and are normal. (Sedistain.) (h) Cotton fibre common contaminant, not to be confused with casts (Sedistain.) (Original
magnification (a) X1000, (b,c,d,e) X200, (f,g,h) X400.)
10.16
Component
Normal findings
Bacteria:
>13x104/ml rods or >1x105/ml
cocci must be present to be
detectable in urine sediment
None
Mucin
Fat droplets
Normal in cats
Sperm
Normal in males
Yeasts
None
Fungi
None
Nematodes
None
Starch granules
Pollen grains
None
Contaminants
10.17
161
Urine cytology
When abnormal or increased numbers of epithelial
cells are seen on a standard sediment examination,
cytological examination of a stained smear should be
performed. A fresh sample of urine should be concentrated (preferably using a slower centifugation speed to
minimize cell damage) and the sediment placed on a
slide precoated with serum (to ensure attachment of
cells). The cells should be gently spread into a monolayer and the preparation air dried before staining with
a Romanowsky type stain (Wrights Giemsa or a related rapid stain).
The pH, SG and ageing of urine has a profound
effect on cell morphology and causes swelling and loss
of internal morphological detail, so urine for special
cytological analysis should be as fresh as possible. If a
delay in making smears is anticipated, boric acid may
help preserve cellular morphology. However, if samples are to be mailed out to an external laboratory,
centrifuged smears should be prepared in house whenever possible, air dried or wet fixed with a spray fixative
and mailed along with a urine sample. Smears made
from 24-hour-old urine are often impossible to interpret
due to cell deterioration.
Normal urine sediment contains small numbers of
epithelial cells (described above) seen singly or in
small clusters. Chronic infection or inflammation related to urolithiasis and certain drugs can cause
increased exfoliation of lining epithelial cells into the
urine. There may be marked morphological hyperplastic or dysplastic changes of these cells which can
(a)
(b)
(c)
(d)
(e)
(f)
Urine sediment cytology. (a) Clusters of epithelial cells showing squamous metaplasia which can occur in
chronic conditions with irritation/inflammation. (Wrights Giemsa stain.) (b) Sediment containing a mixture of
bladder epithelial cells, neutrophils, erythrocytes and bacteria. If the sample was aseptically collected this would indicate
pyuria urinary tract infection (UTI). This kind of sediment is some times referred to as active sediment. (Giemsa stain.)
(c) Transitional cell carcinoma of the bladder. The cells exhibit many criteria of malignancy: variation in cell and nuclear
size, multinucleated cells, coarse nuclear chromatin and high nuclear:cytoplasmic ratio. (Wrights Giemsa stain.)
(d) Transitional cell carcinoma of the bladder. Cells are stained with Papanicolaou stain which highlights nuclei and
particularly size and shape of nucleoli. (Papanicolaou stain.) (e) A cluster of cells from an urothelial carcinoma. The cells
are smaller than those in the transitional cell carcinoma with foamy cytoplasm and large nuclei with multiple nucleoli.
(Giemsa stain.) (f) Raft of cells from a squamous cell carcinoma of the bladder. These cells are large with an angular
outline and sparse cytoplasmic vacuoles around the nucleus. (Wrights Giemsa stain.) (Original magnification (a,c,e,f)
X1000, (b,d) X500.)
10.18
162
Uroliths (calculi/stones)
Uroliths (the preferred term) or crystals can be analysed for mineral content using semiquantitative chemical analysis kits. The following constituents can be
measured:
Calcium
Oxalate
Phosphate
Magnesium
Ammonium
Uric acid
Cystine.
years there has been a change in the relative proportion of these uroliths, with a increase in incidence of
calcium oxalate urolithisis and a decrease in struvite
(Ling et al., 2003). This is likely to be related to the
widespread use of manufactured urinary acidifying
diets with restricted magnesium content. In one study
in dogs analysing urolith submissions, approximately
44% were struvite and 42% were calcium oxalate
(Houston et al., 2004). Struvite were most common in
female dogs and calcium oxalate in male dogs. In cats
50% of urolith submissions were calcium oxalate and
44% were struvite, while the majority of urethral plugs
(81%) were struvite (Houston et al., 2003).
Clues to the type of urolith present are the breed,
urine pH, urolith radiodensity (calcium oxalate, calcium
phosphate, cystine and struvite uroliths are radiodense,
whilst urates are radiolucent) and the type of crystals
seen in urine sediment. However the type of crystal
present is not always the same as the type of urolith. All
types of uroliths in the bladder may lead to a secondary
urinary tract infection, and, if the organism produces
urease, urine pH increases leading to struvite crystal
formation.
Struvite uroliths
Struvite uroliths (Figure 10.19) may form in sterile urine
that contains high concentrations of magnesium, phosphorus and ammonium ions and is of neutral to alkaline
pH. In dogs, they are formed more frequently, and
more rapidly, when there is also a co-existing infection,
particularly with urease-producing bacteria (Staphylococcus and Proteus). This enzyme can split urea
(abundant in urine) to produce ammonium ions and
CO2, which forms bicarbonate and increases urine pH.
The ammonium ions become part of the struvite crystals. Increased concentrations of these ions are also
reported to affect the mucins glycosaminoglycans produced by the bladder mucosal lining cells, reducing
their protective ability. Struvite calculi are most common in young female dogs and in the following breeds:
mixed breeds, Miniature Schnauzers, Shih Tzu and
Bichon Frise.
10.19
163
Cystine uroliths
These form due to an inborn error of amino acid
metabolism which leads to reduced tubular resorption
of cystine and consequent increased urinary cystine
accumulation. This results in cystine crystalluria and, in
some cases, urolith formation. The condition is rare but
is reported usually in young male dogs of the English
Bulldog, Dachshund and Bassett Hound breeds. It is
rarely reported in cats.
Silica uroliths
These are rare but their formation in acid to neutral
urine, in association with acidifying diets, has been
reported. Many of these diets contain large amounts of
plant gluten, soya bean and maize hulls which are high
in silica. They have been found in middle-aged male
dogs of the German Shepherd Dog, Golden Retriever
and Labrador Retriever breeds.
164
Assessment of polyuria/polydipsia by
water deprivation testing
Water deprivation tests (WDT) are used in patients with
hyposthenuria (i.e. SG <1.007) to differentiate between
central diabetes insipidus (CDI), nephrogenic diabetes
insipidus (NDI) and psychogenic polydipsia (PP). However, animals with hypercalcaemia, hyperadrenocorticism, hypoadrenocorticism, pyometra and urinary tract
infections may occasionally have hyposthenuria, and
Case examples
Case 1
Signalment
2-year-old entire female Boxer
History
2-month history of PD/PU with a sudden onset. Cystitis had been
diagnosed and treated but the PD/PU persisted. The dog was drinking
180280 ml of water/kg/day, but was otherwise bright and well. There
were no abnormalities detected on clinical examination.
Case 1 continues
165
Case 1 continued
Reference interval
RBC (x 1012/l)
7.7
5.58.5
Hb (g/dl)
17.2
1218
HCT (l/l)
0.53
0.370.55
MCV (fl)
69.8
6077
MCH (pg)
22.3
19.524.5
MCHC (g/dl)
32.0
3137
Haematology and biochemistry results are all within reference intervals. This rules out several important causes of PD/PU, such as renal
failure, diabetes mellitus, liver disease, hypoadrenocorticism and hypercalcaemia. Hyperadrenocorticism (HAC) cannot be completely excluded but most cases would have at least one of the following:
elevated cholesterol, elevated ALP, or stress leucogram; these are not
seen in this case. Other than PD/PU there were no clinical findings
suggestive of HAC and so this was excluded from the differential
diagnosis list. The urine analysis shows a marked hyposthenuria with
no evidence of inflammation. These findings are suggestive of diabetes
insipidus or psychogenic polydipsia.
WBC (x 109/l)
6.2
617.1
Neutrophils (x 109/l)
4.4
311.5
Haematology
Lymphocytes (x 10 /l)
1.2
14.8
Monocytes (x 109/l)
0.2
0.151.5
Gradual water deprivation over 48 h was followed by a water deprivation test. The water intake was reduced to 100 ml/kg/day and then
the dog was abruptly deprived of water. Body weight, urine SG, and
urine and plasma osmolality were recorded. Plasma urea and creatinine were 3.76 mmol/l and 81 mol/l at time 0 and 4.62 mmol/l and
86 mol/l at T + 12 h.
Eosinophils (x 10 /l)
0.37
01.3
Basophils (x 109/l)
0.00
00.2
Platelets (x 109/l)
212
150900
Biochemistry
Result
Reference interval
Sodium (mmol/l)
149.6
136155
Potassium (mmol/l)
4.07
3.55.8
T=0h
Chloride (mmol/l)
116
107120
T+4h
23.6 kg (0.8%)
1.004
132 mmol/kg
312 mmol/kg
23.2 kg (2.5%)
1.005
165 mmol/kg
326 mmol/kg
Time
Body weight
(% reduction)
Urine
SG
Urine
osmolality
Plasma
osmolality
23.8 kg
1.002
100 mmol/kg
282 mmol/kg
Glucose (mmol/l)
5.6
3.45.3
T + 10 h
Urea (mmol/l)
4.5
3.38.0
T + 12 h
22.8 kg (4.2%)
1.004
22.5 kg (5.4%)
1.004
Creatinine (mol/l)
103
45150
T + 13 h
Calcium (mmol/l)
2.73
2.22.9
Inorganic phosphate
(mmol/l)
1.46
0.82.0
TP (g/l)
62.3
6080
Albumin (g/l)
31.5
2545
Globulin (g/l)
30.8
2141
ALT (IU/l)
17
2159
ALP (IU/l)
83
3142
<10
1.026
772 mmol/kg
321 mmol/kg
Gross appearance
SG
1.002
Case outcome
Dipstick results
The clinical signs were well controlled with DDAVP drops administered
into the conjunctival sac. The dog was lost to follow-up after 6 months.
Sediment examination
Urine analysis
Case 2
Signalment
13-year-old female Bearded Collie.
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Case 2 continued
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Dipstick results
Sediment examination
Urine cytology
Mixed population of cells, consisting of neutrophils and epithelial
cells
Neutrophils are degenerate and show karyolysis. Intracellular bacteria are seen. Both rods (likely to be Escherichia coli in this site) and
cocci are present
Epithelial cells are pleomorphic, with some very large cells with high
nuclear:cytoplasmic ratio and open chromatin. Binucleate cells are
also seen. Cytoplasm is variably basophilic but in some cells shows
increased basophilia, and vacuolation is also apparent
Numerous background RBCs and free bacteria.
10.21
Pneumocystogram.
The cytological findings confirm that the dog has bacterial cysititis. The
transitional epithelial cells show features suggestive of malignancy but,
in the presence of a florid inflammatory response (and with the very long
history of urinary tract disease), these changes must be interpreted with
caution, as dysplastic cells may mimic neoplasia.
10.23
Case outcome
The dog was treated palliatively with piroxicam, and survived for a further
6 months.
(Case 2 courtesy of L Blackwood.)
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