Urinalysis in the Dog and Cat

Description:

Urinalysis in the Dog and Cat

A comprehensive up to date textbook for performing and interpreting urinalysis in dogs and cats with content that remains accessible to those in primary care and specialty practices.

In Urinalysis in the Dog and Cat, a logical sequence to collection of urine, performing the complete urinalysis (physical and chemical properties along with urinary sediment microscopy), and interpretation of results is presented. The FAQ chapter and the chapter on urinalysis case examples provide easily accessible information for primary care veterinarians and technicians as well as veterinary students. Each didactic chapter is designed to provide basic information first and then more advanced materials deeper into each chapter. Some materials will also be useful to specialists and those in advanced training. An extensive review of proteinuria is included as a separate chapter. Automated urine chemistry by dipstrip and automated urinary sediment microscopy are discussed in some detail as this technology increasingly will be incorporated in veterinary laboratory practice.

The text is accompanied by hundreds of high-quality photographs and medical illustrations that highlight common and rare findings from the urine of dogs and cats. Numerous algorithms suggest possible pathways for the diagnosis and treatment of urinary disorders.

This book is destined to be widely used in veterinary hospitals by seasoned and young attending veterinarians seeking to know more about urinalysis, as well as by veterinary laboratory technicians. Several sections of this book will be useful in the teaching of basic concepts to veterinary students.

The authors have also included:

• An introduction to the philosophy of urinalysis and the detailed information about collection of urine from dogs and cats.
• Comprehensive explorations of urine sample handling, preparation, and analysis.
• Detailed aspects of USG as the most important physical property of canine and feline urine
• In-depth discussions of urine chemistry dipstrip evaluation for pH, protein, occult blood, glucose, ketones, and bilirubin.
• Extensive detailing of urinary sediment microscopy.
• Sections on FAQ and urinalysis case examples allow the reader to test their knowledge about urinalysis.

Urinalysis in the Dog and Cat is an essential reference for primary care veterinarians, veterinary technicians, veterinary students, those in advanced training programs, and specialists interested in learning more about disorders of the urinary tract.

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Preface

“Superficially it might be said that the function of the kidneys is to make urine, but in a more considered view one can say that the kidneys make the stuff of philosophy itself.” Homer William Smith: A Memoir, New York University Press 1965; Homer Smith: The Evolution of the Kidney, Lectures on the Kidney 1943.

The initial impetus for writing this book was the desire to share my extensive collection of urinary sediment images, originally captured as Kodachrome slides and then with digitally acquired photomicrographs, collected over a period of nearly 40 years. These images provide multiple examples of common abnormal urinary elements, which show the many slight variations in appearance that are possible. Many of the urine microscopy images are designed to show routine abnormalities, whereas other images feature uncommonly described or rarely recognized elements. Though these images, with their legends can often stand alone, I believe there is more value when the images are combined with the fuller explanations provided in the various chapters.

Thus, the scope of this book grew and became an effort to provide a comprehensive look into the complete urinalysis, emphasizing integration of findings from physical properties (e.g. USG), urine chemistry by dipstrip, and urine microscopy (evaluation of urinary sediment). The Renal Anatomy and Applied Renal Physiology (Chapter 1) provides the backdrop showing how urine is formed by a combination of glomerular filtration and then extensive modification of that initial fluid by tubular secretion and/or reabsorption of water and small molecules. Proteinuria (Chapter 7) provides a more detailed look into the world of proteinuria than that provided in the Chemical Properties of Urine (Chapter 5) that emphasized measurement by dipstrip.

The primary intent for this book “Urinalysis in the Dog and Cat” is for it to be a useful reference which will allow practicing veterinarians to more fully recognize abnormal findings, and to understand, integrate, and interpret the results from a urinalysis to improve their understanding of their patient’s illnesses. Except for guidelines on how to mitigate renal proteinuria (Chapter 7), the treatment of specific conditions is not the goal of this book. Rather, the numerous images of urinary sediment in Urinary Microscopy (Chapter 6) and Atlas (Chapter 8) along with their detailed legends are presented to help veterinary technicians and attending veterinarians more accurately identify abnormal elements, from both manual and automated in-house urinalysis. Similarly, veterinary students should find these images useful, allowing them to more confidently identify elements during urine microscopy. There is additional value to this book when it is read by clinicians wanting a greater understanding of their patients by revealing how findings from urinalysis could help improve the diagnosis and management of cases in primary care and specialty practices. This book should also prove useful during clinical training of residents in internal medicine and in clinical pathology.

In addition to detailed pathophysiology, I provide nuggets of clinically useable information throughout the chapters. When appropriate, nuts and bolts technical information has been provided (e.g. how to set up for urine microscopy). Pitfalls are also identified, explaining what can go wrong when performing or evaluating the results of a urinalysis, whether considering physical, chemical, and/or microscopic properties.

Extensive referencing has been provided for those wanting to know where this content arose and for those in academia wanting to dive deeper. The Frequently Asked Questions (Chapter 9) and Urinalysis Case Examples (Chapter 10) provide clinical details appropriate for veterinary students as well as for graduate veterinarians who want a hook that will encourage them to read the more formal chapters. See “How to Read/Use This Book” (front matter below) for suggestions on how those with different learning styles might gain the information they are seeking more readily.

Ultimately, I hope this book sparks some excitement that shows the ultimate value of routinely performing urinalysis on patients that allows that component of the diagnostic testing profile to achieve the respect it deserves. If that happens, I believe our canine and feline patients, and you – my colleagues – will benefit from more accurate diagnoses and treatment plans. You can expect to gain increasingly nuanced interpretation of urinalysis results after reading and processing the information in this book. I am also hopeful that the ability of our technicians to generate increased accuracy of their results when performing in-house urinalyses will result from the lessons presented in this book. Performing automated (microscopy, urine chemistry dipstrip) or manual urinalysis in-house provides increased value to your practice, your patients, and your clients when the highest standards for urine handling and technical performance are in place.

“Go for THE GOLD” (Dr. Craig Greene).
“Learn to Love the Secret Language of Urine.” (Dr. Jonathan Reisman Opinions, Washington Post November 23, 2016)

Table of contents :

Cover
Title Page
Copyright Page
Brief Contents
Table of Contents
How to Read and Use this Book
Foreword
Preface
Acknowledgements
Abbreviations
Chapter 1 Renal Anatomy, Physiology, and Evaluation of Function
GENERAL FUNCTIONS OF THE KIDNEY
ANATOMY OF THE KIDNEY
Renal Blood Supply
Anatomy of the Nephron
URINE
Urine Formation
Urinary Concentration and Dilution
RENAL FUNCTION ASSESSMENT
Fractional Clearance of Electrolytes
Glomerular Filtration
Renal Clearance
Blood Urea Nitrogen/Serum Urea Nitrogen
Serum Creatinine
Symmetric Dimethylarginine
Cystatin C
INTERPRETATION OF RENAL FUNCTION TESTS
Interpretation of Renal Function Tests in Renal Disease
Interpretation of Renal Function Tests in Nonrenal Diseases
REFERENCES
Chapter 2 Introduction to Urinalysis
INTRODUCTION
WHEN TO PERFORM URINALYSIS
PERFORMING A URINALYSIS
REFERENCES
Chapter 3 Urine Sample Collection and Handling
INTRODUCTION
COLLECTION OF VOIDED AND POST-VOID URINE SAMPLES
Urine Collected by Voiding
Manual Expression of Urine by Digital Palpation and Compression of the Bladder
Collection of Post-Voiding Urine Samples
URINE COLLECTED BY URINARY CATHETERIZATION
Catheter Types
Specula Types
Chemical Restraint
Preparation and Positioning
Catheterization
Complications of Urethral Catheterization
Traumatic Urinary Catheterization
URINE COLLECTED BY CYSTOCENTESIS
Preparation of the Cystocentesis Site
Bladder Palpation and Immobilization for Cystocentesis
Cystocentesis Technique
Blind Cystocentesis
Ultrasound Guidance for Cystocentesis
Contraindications/Complications of Cystocentesis
REFERENCES
Chapter 4 Physical Properties of Urine
INTRODUCTION
URINE COLOR
Pink, Red, or Brown Urine
Very Dark Brown or Black Urine
Deep Amber (Yellow–Brown or Green–Brown) Urine
Yellow–Orange Urine
Yellow–Green Urine
Blue, Blue–Green, and Green Urine
Bright Yellow Urine
Pale to Colorless Urine
White Urine
Purple Urine
CLARITY (TRANSPARENCY AND TURBIDITY)
ODOR
URINE CONCENTRATION
General Concepts
Urine Specific Gravity
Urine Osmolality
Polyuria/Polydipsia
Endocrine Disorders
Categorization and Interpretation of the Degree of Urine Concentration
REFERENCES
Chapter 5 Chemical Properties of Urine
INTRODUCTION
USING THE DIPSTRIP
READING THE DIPSTRIP
Automated Urinary Dipstrip Readers
DIPSTRIP REAGENT PAD COLOR REACTIONS
Urine pH
Urinary Protein
Urinary Glucose
Ketones
Occult Blood
Bilirubin
Urobilinogen
Leukocyte Esterase
Nitrite
Urine Specific Gravity by Dipstrip
Ascorbic Acid
REFERENCES
Chapter 6 Examination of Urinary Sediment
INTRODUCTION
METHODOLOGY
Preparing Urine Sediment for Examination
Examination of Urinary Sediment
ELEMENTS IN URINE SEDIMENT
Cellular Elements
Casts
Crystals
Miscellaneous Elements and Artifacts
REFERENCES
Chapter 7 Proteinuria
INTRODUCTION
GLOMERULAR AND TUBULAR HANDLING OF PROTEIN IN HEALTH
LOCALIZATION AND CLASSIFICATION OF PROTEINURIA
Prerenal Proteinuria
Postrenal Proteinuria
Renal Proteinuria
DEVELOPMENT OF RENAL PROTEINURIA
MEASUREMENT OF PROTEINURIA
Dipstrips
Precipitation Testing for Urinary Proteins
Urinary Protein-to-Creatinine Ratio
Microalbuminuria
Urinary Protein Electrophoresis
INTERPRETATION AND MONITORING OF RENAL PROTEINURIA
DISORDERS CHARACTERIZED BY RENAL PROTEINURIA
Genetic Disorders
Hereditary Nephropathy
Podocytopathy
Immune Complexes, Glomerular Disease, and Renal Proteinuria
Acute Kidney Injury
Other Familial Glomerulopathies
Renal Dysplasia
Renal Amyloidosis
CONSEQUENCES AND PROGRESSION OF GLOMERULAR PROTEINURIA
Fibrosis
SPECIFIC DISEASE SYNDROMES AND PROTEINURIA
Systemic Hypertension
Congestive Heart Failure (CHF)
Critical Care
Neoplasia
Exercise
Hyperthermia and Hypothermia
Endocrine Disorders
Idiopathic Hypertriglyceridemia
Systemic Lupus Erythematosus (SLE)
Cyclic Hematopoiesis (Gray Collie Syndrome)
Pyometra
Infectious Causes
Nephrotic Syndrome
TREATMENT OF RENAL PROTEINURIA
Introduction and Goals
Dietary Therapy
Pharmaceutical Therapy
CONCLUSION
REFERENCES
Chapter 8 Atlas
CELLULAR ELEMENTS
Red Blood Cells
White Blood Cells
Organisms (Including Parasites)
Epithelial Cells
CASTS
Hyaline
Granular Casts – Degenerating Cellular, Coarse, Fine
Waxy Casts
Cellular Casts
CRYSTALS
Struvite Crystals
Calcium Oxalate Crystals
Urate Crystals
Unusual or Rare Crystals
ARTIFACTS AND MISCELLANEOUS ELEMENTS
REFERENCES
Chapter 9 Frequently Asked Questions (FAQ)
Chapter 1 – Renal Anatomy and Renal Functions
Chapter 2 – Introduction to UA
Chapter 3 – Collection and Handling
Chapter 4 – Physical Properties
Chapter 5 – Chemical Properties
Chapter 6 – Urinary Sediment/Microscopy
Chapter 7 – Proteinuria
Chapter 10 Case Studies
case example: Urinalysis Case Number: 1
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Glossary
Index
EULA