Assessment of urine of a bovine patient

Transcription

1 Commonwealth of Australia Copyright regulations 1969 WARNING This material has been copied and communicated to you by or on behalf of the University of Adelaide pursuant of Part VB of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice AVA conference Adelaide Assessment of urine of a bovine patient Kiro R Petrovski DVM, MVSc, PGDipVCSc, PhD Senior Lecturer May 2016 kiro.petrovski@adelaide.edu.au

2 Learning objectives Collection and handling of urine sample Urinalysis Physical characteristics Chemical characteristics (field only) Urine sediment Culture Common abnormalities and causes

3 Why assessment of urine? Large amount of information Urinary system Others Endocrine system Metabolic balance Hydration status Electrolyte status Essential in assessment of kidney disorders

4 Collecting urine sample Method of Collection Spontaneous micturition / Free catch /Stimulation Manual compression of urinary bladder Catheterisation (Female only) Cystocentesis (Only neonates) Off-surface From the ground Advantages Disadvantages Prevention of problems No risk to patient. Avoids iatrogenic haematuria. Obtaining urine sample when no voluntary micturition. Neonatal calves. In mature cattle, manual compression of the bladder rectally. Preferred method of collection for urine culture for mature cattle. Preferred method of collection for urine culture in neonatal cattle. The easiest way to collect sample in range cattle. Debris from urinary and genital tract and skin. In female faecal material. Culture not definite. Trauma. stressful, especially if bladder is painful. Culture not definite. Trauma to urinary tract, especially bladder. Excess in epithelial and blood cells. Risk of introducing bladder infection. Trauma (e.g. iatrogenic haemorrhage). Faecal contamination of sample if needle penetrates colon. Risk of peritonitis. Contamination. Collection of mid-stream urine sample. Discard the first ml to avoid contaminants. Moderate pressure only to avoid bladder rupture. Clean external urethral orifice. Ultrasound-guided cystocentesis. Should be collected and analysed while still very fresh.

5 Handling of urine samples Collection vessels Properly labelled Include time and method of collection Sterile Air tight lid Urinalysis carried out within 30 minutes If not Sample refrigerated (not frozen) Protected from exposure to UV light Delays in urinalysis Can result in artefactual changes e.g. changes in urine ph, formation of crystals

6 Physical assessment Before centrifuging Colour Clarity Viscosity Odour Foaming After centrifuging Specific gravity Techniques and equipment Inspection Refractometer UV lamp Colour Narrow column transparent container Foam UV light Clarity Narrow column transparent container against grid or text Foaming USG As urine flows Refractometer

7 Characteristic Normal Common abnormalities Causes Colour Clarity Viscosity Odour Foaming Straw to amber (Golden) Clear and transparent Low viscosity Non-offensive Low ammonia (Not unpleasant) Small amount Disappearing <1 minute Specific gravity Red Brown Yellow Green Cloudy High viscosity Very low Foetid Acetone High ammonia Foul smell Foamy Foamed for minutes Low and polyuria/ Isosthenuria/ Hyposthenuria High/ hypersthenuria Haematuria, Haemoglobinuria, Iatrogenic, (Beetroot in diet) Myoglobinuria, Methaemoglobinuria Bilirubinuria Biliverdin, (Methylene blue administration) Inflammation, Bacteriuria, Pigmenturia, Crystalluria, Proteinuria, (Admixtures) Inflammation, (Admixtures) Low USG Retention Ketosis Infection, (Concentrated) Infection, (Decomposition) Proteinuria, Bilirubinuria, Pneumaturia, (Some feedstuffs and drugs) Nephropathies, Pyelonephritis, (Diet rich in water content, Neonatal patients) Dehydration, Renal ischaemia, Acute renal failure, Shock, Liver and heart disorders, (Admixtures)

8 Chemical and sediment assessment Non-centrifuged sample Dipstick (field test) Laboratory Urine ph Presence and/or concentration Protein Glucose Ketones Pigments Blood Pus Urine ph ph meters Ketones Ketone meters Powders, tablets Glucose Ketone/glucose meters Protein, Pigments, Blood, Pus Final in lab

9 Sediment assessment Centrifuged sample Laboratory Presence and/or concentration Blood Pus Bacteria Casts Crystals Epithelial cells Bacteriuria Sediment Culture

10 Normal urine dipstick results Bovine/Human Quantity (SG) (ph) (Protein # ) Glucose 16-50mL/kg BW/day ph Negative Negative to weak positive 1-2mL/kg (6.7) Negative Negative (Ketones*) Bilirubin Urobilinogen RBC (WBC) Negative Negative Negative to weak positive Negative Negative Negative Negative 0.2-1mg/dL Negative 0-2 NOTE: Brackets indicate potential problem on dipstick testing of a particular characteristic # Alkaline or concentrated urine may result in false-positive test (up to ++) *Slight positive common in peri-calving period and anorexic patient

11 Common abnormalities and causes Parameter Aciduria Alkaliuria Proteinuria Glucosuria Ketonuria Pathophysiological diagnosis Some toxicities, ketosis, rumen acidosis, (Dietary manipulations [DCAD]) Blockage of urinary outflow, Infection, Metabolic alkalosis Pre-renal, renal, post-renal; Infection, (Neonatal colostrum-induced; Admixtures) Intravenous administration, Stress, Acute tubular necrosis, Enterotoxaemia, (Beta-lactams treatment) Ketosis, Starvation, Generalised conditions Bilirubinuria Hepathopathies Haematuria Pyuria Bacteriuria Creatinuria Faecaluria Kidney disease, Infections, Urinary neoplasia, (Admixtures) Pyelonephritis, Inflammation, (Admixtures) Pyelonephritis, Cystitis, Ureteritis, Urethritis, (Admixtures) Excessive endogenous breakdown of protein Trauma to the dorsal vaginal wall during calving, (Admixtures)

12 Improving value of urinalysis Parameter Colour Clarity Foaming Urine specific gravity Protein Glucose Ketones Relate to Urine volume, Urine specific gravity Sediment Protein, White blood cells Hydration status, Water consumption, Serum urea and creatinine Sediment, Creatinine, Urine specific gravity, Protein to creatinine ratio Blood glucose History, Clinical findings, Blood ketones

13 Take home messages Urinalysis is informative Samples should be purposively taken and carefully handled Large amount of information in filed conditions Dipsticks not very reliable Findings should be interpreted holistically