How to perform a urinalysis in small animal practice using urine dipsticks and a refractometer

1. Training Module III Urinalysis

2. The Urinalysis

3. What You Will Need (and where to find it) Urinalysis Stickers-upper cabinet to the left of the refrigerator Pipettes (droppers) – in the clear plexiglass shelves on counter behind fecal workstation Urine Dipsticks-cabinet above fecal workstation Refractometer-cabinet above fecal workstation V-shaped tube-first drawer left of microscope Glass slides and cover slips-fecal workstation

4. Urinalysis An important test for several organ systems. For some things, as important as blood tests or more important than blood tests!!! Tests for Urinary Tract Infection Diabetes screening test Renal (Kidney) Disease Rule in or out UTI in dog’s with incontinence Endocrine Disease Cushing’s Disease Diabetes Mellitus Diabetes Insipidus

5. Patient selection Senior Wellness Screening Polyuria/Polydipsia Urinating outside the litter box or well-trained dog urinating in house Urine spraying in cats Frequent urination, straining to urinate, painful urination Visibly discolored or bloody urine Incontinence

6. Signs of Urinary Tract Disease Straining to urinate Frequent urination or frequent attempts to urinate Repeatedly assuming a urination posture Discomfort on urination Visible blood in urine Urinating in the house when well house-trained Urinating outside the litter box (cat) Visibly abnormal urine color Urinating large volumes and drinking excessive amounts of water (polyuria/polydipsia) Passing a visible bladder stone!

7. Urinary Tract Infection Could be anywhere in urinary tract Urethritis/Vaginitis/Balanoposthitis Bladder Infection Prostate Infection Kidney Infection (pyelonephritis) Of the above, the bladder is the most common. Kidney infections in dogs and cats are rare

8. Indicators of UTI High urine pH Carnivores should be less than 7 High pH may mean there is an infection or that the patient is predisposed to infection or to struvite stones Proteinuria (elevated protein level) on dipstick Hematuria (blood in urine) on dipstick White Blood Cells on sediment exam Red Blood Cells on sediment or + blood on dipstick Bacteria on sediment exam

9. Other things that can mimic UTI Hematuria, Pyuria, Proteinuria and High pH can also occur in a bladder with stones Animals tend to form stones in the urinary bladder, not in the kidneys Bladder stones are very common in dogs; less so in cats Struvite bladder stones are most often associated with high pH and UTI Hematuria, Pyuria, Proteinuria can also occur in cases where there are tumors in the urinary tract Prostate Cancer, Prostatitis or Prostate Cysts in intact male dogs Intact female dogs in heat will have hematuria and proteinuria

10. Sample Collection Methods Be sure to record the method of collection Voided Collected in a cup or tray by the owner or veterinary staff member Clean catch, for our purposes, means it was not collected off the floor nor did it splash off leaves or grass nor was it stepped in by the patient Special cat litter for urine collection (Kit4Cat) Catheterized Cystocentesis Collected usually by the veterinarian by tapping the bladder with a 22gauge 1½ inch needle on a 6 cc syringe Most accurate method, especially if doing a culture and sensitivity

11. Owner Psychology & Voided Specimens A urine specimen is often every bit as important as blood tests in determining general health, especially with senior pets If the veterinarian has recommended a urinalysis and the owner is going to attempt to collect it, it is best if the owner pre-pays for the test. They are much more likely to comply if it is something for which they have already paid. It doesn’t have to be a “first morning” urine, but that is the time at which most pets need to urinate somewhat urgently Sometimes they’ll need to confine pets overnight to keep them from urinating on their wee-wee pads or in the litter box. Sometimes we need to keep pets caged here for several hours to allow their bladders to be full so that we can collect a voided sample or can do a cystocentesis

12. Sample Handling If collected by owner, it should be brought in as soon as possible Refrigerated if there is any time lapse in getting it to us. Ideally less than 12 hours old (much less preferred) Ask the owner how and when it was obtained Is there a chance it may’ve splashed off grass or leaves”? Is there a chance it was stepped in? Could there be fecal contamination?

13. Performing the Urinalysis Color Turbidity Specific Gravity Dipstick Sediment

14. Color Observe the urine grossly Write down an easily understandable color: Yellow Pale Yellow Dark Yellow Goldenrod (a very deep gold color) May contain Bilirubin Pink Red Port wine May contain myoglobin, a protein that indicates muscle breakdown Greenish May contain deteriorated blood

15. Turbidity Clear Can see through it like tap water Hazy A tiny bit murky but easy to see through Cloudy Somewhat opaque but you could still read a newspaper through it Opaque You can’t read a newspaper through it

16. Specific Gravity A measure of how concentrated urine is Urine color can be misleading here! Read with a hand-held device called a refractometer Based on distilled water having a specific gravity of 0.000 Tells a lot about how well the kidneys are functioning Normal kidneys are capable of both diluting and concentrating urine High Specific Gravity is a good thing Cats > 1.040 Dogs >1.030

17. Refractometer

18. Measuring the specific gravity Lift the cover flap on the refractometer Place 2 or 3 drops of urine on the stage Lower the cover flap and gently press it down Aim the device up at the light and look through the viewfinder Read the scale on the right of the viewfinder It will read in four digits, the first two being 1.0__ If it is off the scale high, record it as >1.040 Hyposthenuria = <1.012 Isosthenuria = 1.012-1.018

19. The Urine Dipstick Commercially made test strips Color pads are exposed to urine and compared to a chart on the test strip bottle In our office, kept in the cabinet above the fecal workstation

20. The Urine Dipstick Designed to be dipped into a specimen in a cup Here, we hold the strip horizontally and drip the urine onto each color pad with a dropper When all color pads are saturated with urine, begin timing and compare to the color pads on the side of the bottle of test strips at specified time Record the results on a Urinalysis sticker Some things are recorded as “normal” and some “negative” Some can be given a number of + signs or a numeric result Record pH Protein Glucose Ketones Bilirubin Urobilinogen Blood Here, We Do Not record Specific Gravity Nitrite White Blood cells The test strips are designed for humans. These tests are inaccurate in animal medicine

21. The Urine Sediment You will: Place about 1 ml of urine in a v-shaped centrifuge tube Spin in the Statspin Centrifuge on the Urine setting Have a dropper, a glass slide and coverslip ready The vet or tech will Discard most of the top layer of urine (called the supernantent) Tap the tube to suspend sediment in the urine that remains Place one drop on a slide and cover Read under the microscope

22. Statspin Centrifuge and tube Kept in first drawer to left of centrifuge On counter to right of microscope

23. Urine Sediment Results RBCs = red blood cells Unit of “measure”is /hpf, meaning per high power field WBCs = white blood cells Unit of “measure” is /hpf, meaning per high power field Crystals Struvite Oxalate Urate Casts Other Lipid globules Epithelial cells Bacteria Spermatozoa Amorphous or trash – debris that cannot be categorized

24. Completed Urinalysis Record

25. Special Circumstances Bashful dogs - urine collecting stick “Olympic Clean Catch” The urine is so badly discolored that it is hard to read the test strips Spin the urine and run the test on the clearer supernatant (the urine that rises to the top after spinning) The patient is a cat! Collection litter (Kit4Cat) Styrofoam peanuts in a clean litter box Peeing on plastic!!! Some cats will urinate on grocery bags or saran wrap placed in or beside the litter box Sometimes owners can actually catch it in a cup! If we need to do a culture and sensitivity Only choice is cystocentesis

26. Olympic Clean Catch An ingenious tool!!! Generally kept between the refrigerator and the lab counter Collection cups are in the exam table cabinet in Exam Room 2

27. Kit4Cat Urine Collection Set Contains Non-absorbent litter Pipette Sample vial Kept in the exam table cabinet in Exam Room 2

28. What we mean by “Collection Set” A flat tray to slide under the dog Very useful for “low rider” dogs We use recycled vaccine trays! A pipette to transfer the urine from tray to urine specimen cup A urine specimen cup Beggars can’t be choosers, we will take urine in any container it can be caught in

29. Other Tests Run On Urine at AViD Labs Culture and Sensitivity Run on Cystocentesis samples only Cortisol:Creatinine Ratio A screening test for Cushing’s disease Protein:Creatinine Ratio To assess urine protein loss

30. Bladder Stone Analysis Sent to Minnesota Urolith Center We now have a practitioner portal to submit and receive information from MN Urolith Center Can go to the portal to submit a case and print an address label Doesn’t take six to eight weeks like it used to!! Alternately, can send to AViD Labs

33. Quiz, continued Which of the following is not a component of the urinalysis? a. Specific Gravity b. Color c. Odor/Smell d. Turbidity e. Dipstick Turbidity means Bacteria in the urine Red blood cells in the urine The clarity of the urine Abnormal urine pH

34. Quiz, continued 5 Urine from cats may be collected by all of the following except: Emptying the litter box and putting Styrofoam peanuts in it Kit4Cat collecting litter Urine collected on plastic bags in or near the litter box Following the cat around with a cup 6. Which of the following is/are not a useful parameter to record from the urine dipstick? a. Blood b. pH c. Nitrite d. Ketones e. Specific Gravity f. C & E g. A & D

35. Quiz Which of the following can be assessed with urine Vestibular disease Kidney disease Addison’s disease Heart disease Which of the following is an acceptable color to record for the urinalysis Fuschia Burnt Sienna Goldenrod Crimson

36. Quiz, continued Dr. Burns likes to recheck urine after a UTI Before the last antibiotic has been given. In two months Two to three weeks after the last antibiotic A & B A &C The Urinalysis can be used to a. Screen for diabetes b. Check for bladder stones c. Test for urinary tract infection d. A & C e. All of the Above