COMPLETE URINALYSIS PANEL INTERPRETATION GUIDE Scrll dwn r click n the fllwing parameters t quickly access cntent A Cmplete Urinalysis is threefld: Physical exam Clr Clarity - Turbidity Urine specific gravity Chemical exam ph PRO (prtein) GLU (glucse) KET (ketnes) UBG (urbilingen) BIL (bilirubin) Bld LEU Sediment exam (see urine sediment guide) Cells, bacteria, casts, crystals and miscellaneus elements
Urine Clarity Descriptin In mst animals, nrmal urine is clear t slightly cludy. In hrses, nrmal urine is cludy due t the presence f calcium carbnate crystals and mucus. Values Belw Reference Range Cmmn Causes In an animal that typically shws cludy urine, a clear urine wuld suggest absence f crystalluria. Values Abve Reference Range Cmmn Causes Excessively cludy urine can be the result f high numbers f crystals, leukcytes, erythrcytes, bacteria, mucus, casts, lipids, r pssibly sperm. Other Labratry Tests Micrscpic examinatin f the urine sediment is advised. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994.
Urine Specific Gravity Descriptin Specific gravity is a reflectin f slute cncentratin. It shuld be determined by refractmetry as dipsticks are inaccurate. Assuming nrmal hydratin status and n treatments that alter water resrptin by the kidneys, expected specific gravity results are: Dgs: 1.015 1.045 Cats: 1.035 1.060 Hrses: 1.020 1.050 The amunt f ther substances in urine shuld be interpreted in cnsideratin f the specific gravity. Values Belw Reference Range Cmmn Causes Hypsthenuria indicates that the kidney can dilute the glmerular filtrate, but cannt cncentrate it. Hypsthenuria can be indicated by: Lack f ADH (primary diabetes insipidus) Resistance t ADH (renal diabetes insipidus) Increased water cnsumptin (primary plydipsia) Lack f medullary cncentrating ability Issthenuria indicates that the kidney can neither dilute nr cncentrate the glmerular filtrate. Specific gravity abve issthenuria but belw nrmal specific gravity reflects inadequate renal tubular functin. Related Findings Lw specific gravity can be caused by diuretics, gluccrticids and fluid therapy. It is imprtant t check specific gravity befre administratin f any f these treatments. Other Labratry Tests Use f dipsticks t evaluate urine specific gravity is nt recmmended. Further testing is indicated in a patient with persistently hypsthenuric r issthenuric urine. These tests shuld include bichemistry prfile, CBC, serum T4 and urinalysis t start. Urine cncentratin tests may als be indicated. Values Abve Reference Range Cmmn Causes Elevated specific gravity must be interpreted in light f BUN, creatinine cncentratins and hydratin status. High specific gravity des nt rule ut the presence f diseases assciated with PU/PD, such as: Hepatic insufficiency Hyperadrencrticism Hyperthyridism
Related Findings Very cncentrated urine is ften assciated with dehydratin. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994. Stckham SL and Sctt MA. Fundamentals f Veterinary Clinical Pathlgy, 2nd ed. Ames, Iwa: Blackwell Publishing, Jhn Wiley & Sns, Inc.; 2008.
Urine ph Descriptin Urine ph is a measure f the hydrgen in cncentratin in urine. Urine ph is determined by the kidney's ability t regulate hydrgen in and bicarbnate cncentratins within the bld. In fresh urine samples frm healthy dgs and cats, the ph range is 5.5 8.5. This parameter is specific fr the detectin f hydrnium ins, with the ph being the negative cmmn lgarithm f the hydrnium in cncentratin. The test pad cntains the indicatrs methyl red, phenlphthalein and brmthyml blue. Reactive cmpnents per cm 2 : brmthyml blue 13.9 µg, methyl red 1.2 µg, phenlphthalein 8.6 µg Values Belw Reference Range Cmmn Causes Respiratry acidsis Metablic acidsis High prtein diet Vmiting with chlride depletin Severe diarrhea Fever Starvatin Prlnged exercise Urinary acidifiers Values Abve Reference Range Cmmn Causes Recent meal Metablic alkalsis Respiratry alkalsis Bacterial infectin Renal tubular acidsis Purely vegetable diet Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, and Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994.
Urine Leukcytes Descriptin The reactin detects the presence f esterases that ccur in granulcytes. These enzymes cleave an indxyl ester, and the indxyl reacts with a diaznium salt t prduce a vilet dye. Bth intact and lysed leukcytes are detected. The reactin is nt affected by bacteria, trichmnads r erythrcytes present in the urine. Frmaldehyde (stabilizer) and medicatin with antibitics cntaining imipenem, merpenem r clavulanic acid may cause false-psitive reactins. If the urine specimen is strngly clred (fr example, due t the presence f bilirubin r nitrfurantin), the reactin clr may be masked. Urinary prtein excretin in excess f 500 mg/dl and urinary glucse excretin in excess f 2 g/dl may diminish the intensity f the reactin clr, as can medicatin with antibitics cntaining cephalexin r gentamicin if administered in high daily dses. NOTE: The leukcyte parameter shuld nt be used t test urine frm cats. All test results fr dgs shuld be cnfirmed with micrscpy due t a high number f false-negatives. Evaluatin f urine WBC is part f the sediment exam. Numbers f WBC are reprted per high pwer field (hpf). Nrmal values are dependent n methd f urine cllectin. Nrmal values are 0 8/hpf fr vided sample, 0 5/hpf fr catheterized sample and 0 3/hpf fr cystcentesis sample. When excessive numbers f WBC are present, it indicates inflammatin smewhere in the urinary tract. Reactive cmpnents per cm 2 : indxyl ester 15.5 µg, methxy-mrphlinbenzene diaznium salt 5.5 µg Values Belw Reference Range Cmmn Causes Nrmal The nrmal range includes zer. Artifact due t lysis Alkaline urine, dilute urine r prlnged expsure t rm temperature will cause WBC lysis. Values Abve Reference Range Cmmn Causes Urinary tract infectin (kidney r urinary bladder) Patients with diabetes mellitus r hyperadrencrticism may have urinary tract infectins but nt shw pyuria. Genital tract cntaminatin (vided r catheterized samples) Calculi Neplasia Related Findings Signs f urinary tract infectin Dysuria, pllakiuria, ful-smelling urine, hematuria Signs f pyelnephritis Fever, depressin, anrexia, plydipsia, plyuria Casts WBC casts are almst pathgnmnic fr pyelnephritis.
Other Labratry Tests Urine culture and sensitivity Radigraphs, cntrast studies and ultrasund Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994.
Urine Prtein Descriptin Trace amunts f prtein (50 mg/dl r less) can nrmally be fund in urine. Dipsticks shw a negative, trace, 1+ 3+ reactin that crrelates t 30, 100, r 500 mg/dl prtein. This test is based n the principle that prteins bind t an acid-base indicatr dye. The test is particularly sensitive t albumin, but may react with hemglbin and glbulins. Quinine, quinidine, chlrquine and tlbutamide d nt affect the test, nr des a high ph (up t ph 9). False-psitive results may ccur after infusin f hemglbin-based xygencarrying slutins (bld substitute), r if the urine specimen cllectin vessel cntains residues f disinfectants based n quaternary ammnium cmpunds r chlrhexidine. Expected prtein results in dgs can be negative 1+, with trace and 1+ reactins fund in mre cncentrated samples. Urine prtein precipitatin (sulfsalicylic acid, nitric acid) methds are als graded 1+ 4+ and may detect prteins nt appreciated by the dipsticks. Reactive cmpnents per cm 2 : tetrachlrphenltetrabrmsulfphthalein 13.9 µg Values Belw Reference Range Cmmn Causes Values belw reference range are nt clinically significant. Values Abve Reference Range Cmmn Causes Prteinuria can be classified accrding t surce as fllws: Inflammatin Invlvement f upper r lwer urinary tract Reflected in an active urinary sediment (leukcytes, pssibly bacteria) Hemrrhage Psitive fr urine ccult bld and pssibility f sediment with erythrcytes Renal glmerular disease Glmerulnephritis Amylidsis Prerenal Occasinal mild prteinuria may be secndary t increased glmerular permeability (shck, heart disease, fever, CNS disease, increased physical exercise). Overflw prteinuria [high cncentratins f lw mlecular weight prteins (myglbin, Bence Jnes prtein)] in the peripheral bld that can be filtered and fail t be resrbed ttally by the tubules. Related Findings Urine specific gravity must be taken int accunt when interpreting prteinuria. Other Labratry Tests Urine prtein:urine creatinine rati is used t determine if prteinuria is significant. Urine prtein:urine creatinine rati can replace the 24 hur urine cllectin. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999.
DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994. Stckham SL and Sctt MA. Fundamentals f Veterinary Clinical Pathlgy, 2nd ed. Ames, Iwa: Blackwell Publishing, Jhn Wiley & Sns, Inc.; 2008.
Urine Glucse Descriptin Glucse is nt nrmally fund in the urine f dgs and cats. The glucse present in the glmerular filtrate is almst cmpletely reabsrbed in the prximal tubules. The determinatin f glucse is based n the specific glucse-xidase/perxidase reactin. This test is independent f ph and specific gravity f the urine and is nt affected by the presence f ketne bdies. The effect f ascrbic acid has been largely eliminated, such that false negatives are unlikely t ccur at glucse cncentratins f 100 mg/dl (5.5 mml/l) and abve. Reactive cmpnents per cm 2 : tetramethylbenzidine 103.5 µg, GOD 6 U, POD 35 U Values Belw Reference Range Cmmn Causes Nt applicable. Glucse is nt present nrmally in urine. Values Abve Reference Range Cmmn Causes Glucsuria ccurs when bld glucse exceeds the renal threshld. Diabetes mellitus Stress r excitement (cats) Infusin f fluid rich in dextrse Occasinally in hyperadrencrticism, phechrmcytma Renal threshld is reached in dgs when bld glucse is >180 mg/dl and in cats when bld glucse is >300 mg/dl. Glucsuria als ccurs when there is abnrmal prximal tubular functin. Acute renal failure Fancni s syndrme Primary glucsuria Secndary t aminglycside txicity Rarely in familial renal disease Other Labratry Tests Analytical methds include glucse xidase methd (urine dipstick, paper test strip) and test fr reducing substances (Clinitest ). Clinitest is nt specific fr glucse and will reflect lactse, fructse, penicillins, salicylates, few f the cephalsprins, ascrbic acid, sulfnamides and radigraphic cntrast media. Fllw up tests fr true glucsuria shuld include bld glucse, BUN, and creatinine. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine Ames, Iwa: Iwa State University Press; 1994. Clinitest is a registered trademark f Ames Cmpany, Inc.
Urine Ketnes Descriptin Ketnes, such as beta-hydrxybutyrate, acetacetate and acetne, are prduced by liplysis and are filtered by the glmerulus. Nrmally, ketnes are cmpletely resrbed by the prximal tubules. This test is based n the reactin f nitrprusside with acetacetic acid and acetne. This test des nt detect betahydrxybutyric acid. Captpril, mesna (2-mercaptethanesulfnic acid sdium salt) and ther substances cntaining sulfhydryl grups may prduce false-psitive results. Reactive cmpnents per cm 2 : nitrprusside sdium 157.2 µg, glycine 4.2 mg Values Belw Reference Range Cmmn Causes Urine shuld be negative fr ketnes. Values Abve Reference Range Cmmn Causes Diabetic ketacidsis Prlnged fasting Starvatin Lw carbhydrate diet Glycgen strage disease Persistent fever Persistent hypglycemia Related Findings Ketnuria Test pad n urine dipstick r tablets (Acetest ) detect acetacetate and acetne; but, they d nt detect betahydrxybutyrate. Beta-hydrxybutyrate is respnsible fr prducing acidsis. The severity f ketacidsis cannt be crrelated with the degree f ketnuria. The test pads r tablets emply the nitrprusside reactin. Ketnuria is present befre ketnemia can be detected. Other Labratry Tests Bld and Urine glucse If ketnuria is present with glucsuria and hyperglycemia, diabetes mellitus is diagnsed. Further tests include electrlytes, phsphrus, ttal CO2, and bld gases. If ketnuria is present withut glucsuria, excessive lipid metablism is likely, especially in anrexic animals. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia: W.B. Saunders Cmpany, 1995 Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994. Acetest is a registered trademark f the Ames Cmpany, Inc.
Urine Urbilingen Descriptin Intestinal bacteria cnvert cnjugated bilirubin t urbilingen. Mst is excreted in the feces. A small amunt is delivered back t the liver via the prtal system where the urbilingen is then remved by the liver r excreted int the urine. A fresh sample is necessary as urbilingen can be catablized int urbilin while standing within the bladder. Nrmal values are 0.1 1.0 Ehrlich units. The crrelatin between elevated urine urbilingen and liver disease in animals is pr. A stable diaznium salt reacts almst immediately with urbilingen t give a red az dye. N disclratin f the test pad r clrs lighter than that shwn fr 1 mg/dl (17 µml/l) cnstitute a nrmal finding. The test is specific fr urbilingen and is nt susceptible t the interfering factrs knwn t affect Ehrlich s test. Larger amunts f bilirubin prduce mmentary yellw clratin f the test pad that may turn green t blue after abut 60 secnds. Expected results range between 0.2 1.0 mg/dl r nrmal t 1.0 mg/dl n urine strips. Reactive cmpnents per cm 2 : methxybenzene diaznium salt 67.7 µg Values Belw Reference Range Cmmn Causes Reagent strips are semiquantitative but cannt detect the absence f urbilingen. Urbilingen is unstable while in the bladder; many nrmal animals have n detectable urbilingen. True absence f urbilingen wuld indicate an bstructed bile duct. Values Abve Reference Range Cmmn Causes Hemlytic disease Liver disease There is a pr crrelatin between high urine urbilingen and liver disease in animals. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald, GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999. DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994. Stckham SL and Sctt MA. Fundamentals f Veterinary Clinical Pathlgy, 2nd ed. Ames, Iwa: Blackwell Publishing, Jhn Wiley & Sns, Inc.; 2008.
Urine Bilirubin Descriptin Cnjugated bilirubin will readily travel thrugh the glmerulus int the filtrate. It is nt absrbed by the tubules, and therefre it passes int the urine. Uncnjugated bilirubin is bund t albumin and will nt pass thrugh the glmerulus. Dgs have a lw renal threshld fr bilirubin; trace amunts may be fund in very cncentrated urine, especially in male dgs. Bilirubin in urine is ultravilet-light sensitive and delay in perfrming urinalysis may cause false-negative results. Standing at rm temperature expsed t air can als cause a false-negative result. The test fr bilirubin is based n the cupling f bilirubin with a diaznium salt t prduce a clr change. Even the slightest pink clratin cnstitutes a psitive result. Large quantities f ascrbic acid can lead t lw r false-negative results fr bilirubin. Urine disclratin may interfere with an accurate reading f the test strip. Expected bilirubin results in dgs can be negative t 1+, with trace and 1+ reactins fund in mre cncentrated samples. Reactive cmpnents per cm 2 : Bilirubin: dichlrbenzene diaznium salt 16.7 µg Values Belw Reference Range Cmmn Causes Nt applicable. Zer bilirubin in urine is clinically nt significant. Values Abve Reference Range Cmmn Causes In dgs (especially male dgs), trace amunts f bilirubin may be seen in very cncentrated urine. Any bilirubinuria in cats is significant. Bilirubinuria usually precedes bilirubinemia. May be present when serum bilirubin cncentratin is within nrmal limits. Intrahepatic r extrahepatic biliary bstructin with subsequent regurgitatin f cnjugated bilirubin int the bld. Intravascular hemlysis and hemglbinuria Cnjugated bilirubin is increased and readily passes int glmerular filtrate. Renal tubular cells can frm cnjugated bilirubin frm absrbed hemglbin. Fever r starvatin Related Findings Elevated liver enzymes and increased serum bilirubin supprts hepatic disease, while regenerative anemia with sphercytes supprts hemlytic disease. Other Labratry Tests If bilirubinuria is evident, fllw-up tests include serum bilirubin, alanine amintransferase (ALT), alkaline phsphatase, and CBC. If CBC indicates anemia, reticulcyte cunt is indicated. Barsanti JA, Lees GE, Willard MD, Green RA. Urinary disrders. In Small Animal Clinical Diagnsis by Labratry Methds. Willard MD, Tvedten H, Turnwald GH, eds. Philadelphia, Pa: WB Saunders Cmpany; 1999.
DiBartla SP. Clinical apprach and labratry evaluatin f renal disease. In Textbk f Veterinary Internal Medicine. Ettinger SJ, Feldman EC, eds. Philadelphia, Pa: WB Saunders Cmpany; 1995. Duncan JR, Prasse KW, Mahaffey EA. Veterinary Labratry Medicine. Ames, Iwa: Iwa State University Press; 1994. Stckham SL and Sctt MA. Fundamentals f Veterinary Clinical Pathlgy, 2nd ed. Ames, Iwa: Blackwell Publishing, Jhn Wiley & Sns, Inc.; 2008.
Urine Bld Descriptin Hemglbin and myglbin catalyze the xidatin f the indicatr by an rganic hydrperxide cntained in the test pad. The values appearing n the reprt refer t intact erythrcytes, r, when free hemglbin is present, the apprximate density f RBCs that might have cntributed a similar hemglbin cncentratin. In ther wrds, the value f 50 RBCs/µL als applies t hemglbin fr 50 RBCs/µL. Separate clr scales fr erythrcytes and hemglbin are given n the label f the test strip cntainer. Individual t clsely packed green dts n the yellw test pad are indicative f intact erythrcytes. Hemglbin r hemlyzed erythrcytes and myglbin are indicated by a unifrm green clratin f the test pad. Cncentratins f 20 30 RBCs/µL and abve lead t values that are higher than the crrespnding cncentratins given fr intact erythrcytes. Ascrbic acid has virtually n effect n the test. Reactive cmpnents per cm 2 : tetramethylbenzidine 52.8 µg, dimethyldihydrperxyhexane 297.2 µg