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10
Urine analysis
Joy Archer
Sediment Crystals and amorphous material Storage at low temperature; evaporation; pH change
Epithelial cells Morphological change, disintegration Low SG and osmolality
White blood cells Swelling, lysis, vacuolation Low SG and osmolality
Red blood cells Crenation, lysis Low SG and osmolality
Bacteria Growth Long-term storage at high temperatures, especially voided samples
and in plain (not boric acid) tubes
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Chapter 10 Urine analysis
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Chapter 10 Urine analysis
SG is a valuable test for evaluating kidney diluting Polyuria can result from:
and concentrating ability, as the loss of concentrating
ability is amongst the first signs of renal tubular disease. • Osmotic diuresis
• Loss of medullary tonicity (renal medullary
• SG values >1.030 in the dog and >1.035 in the washout)
cat are indicative of adequate renal concentrating • Deficiency in anti-diuretic hormone (ADH)
ability and, if found in an azotaemic animal, • Resistance to ADH.
would indicate prerenal azotaemia.
• Isosthenuric urine in an azotaemic animal Assessment of polyuria and polydipsia by water
indicates intrinsic renal failure. deprivation testing is discussed at the end of the chapter.
• SG values between 1.015 and 1.030 (dog) or
1.035 (cat) indicate that some urine Osmotic diuresis
concentration has occurred but do not confirm This occurs in diabetes mellitus, Fanconi syndrome
adequate renal concentrating ability and so, in an (see Chapter 11) and primary renal glucosuria, where
azotaemic animal, would suggest early renal an excess amount of glucose in the glomerular filtrate
failure (see Chapter 11). prevents water being reabsorbed in the distal tubule.
• SG values persistently less than 1.020 support
the presence of polyuria and consequent Loss of medullary tonicity (medullary washout)
polydipsia. In health, high concentrations of urea and sodium in the
interstitial fluid of the renal medulla lead to an area of
The approach to differentiation of causes of altered hypertonicity which is crucial for effective water
urine SG is summarized in Figure 10.5. resorption in the renal tubules. Loss of hypertonicity in
the renal medulla may result from hypoadrenocorticism
Common causes of low urine SG and (loss of sodium), liver disease (reduced urea), pro-
polyuria longed or vigorous fluid therapy or prolonged poly-
Renal dysfunction is an important cause of polyuria dipsia, e.g. due to psychogenic polydipsia (PP). SG
leading to isosthenuria, and is discussed in Chapter 11. values may be isosthenuric or hyposthenuric.
1.012–1.035 cat
1.020–1.030 Polyuria/ polydipsia Blood glucose Diabetes mellitus
➞
Hyperadrenocorticism
1.008–1.012 Polyuria/ polydipsia Urea, creatinine ± phosphate, K+ With oliguria: acute renal failure
➞
cholesterol, glucose
Calcium Hypercalcaemia
➞
T4 Hyperthyroidism (cats)
➞
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Chapter 10 Urine analysis
These are a qualitative to semiquantitative method of Practical guidelines for dipstick use are summar-
monitoring the major chemicals of interest in urine. The ized in Figures 10.6 and 10.7.
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Chapter 10 Urine analysis
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Chapter 10 Urine analysis
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Chapter 10 Urine analysis
N.B. Microscopic haematuria has little impact on the Haematuria, haemoglobinuria and
UPC, and only gross haematuria leads to significant myoglobinuria
alteration of the ratio (Vaden et al., 2004). The dipstick pads for blood and haemoglobin both use
the same chemical method, but a speckled appear-
Albumin and globulin ance to the dipstick pad is indicative of haematuria,
The dipstick mainly detects albumin and is insensitive whilst a diffuse colour change suggests haemoglob-
to globulin or Bence Jones proteins (light chain frag- inuria (or myoglobinuria). However, a diffuse colour
ments of immunoglobulin which may be present in change may also be seen with severe haematuria and
urine of animals with multiple myeloma (see Chapter the pads do not reliably differentiate haematuria and
7)). Albumin, globulin and Bence Jones proteins are all haemoglobinuria. Sediment examination is useful for
detected using the sulphasalicylic acid (SSA) method: making the distinction, although red cells may lyse in
when SSA is added to urine, proteins are denatured vitro, especially in dilute urine, resulting in the false
and form a precipitate which makes the sample turbid. impression of haemoglobinuria rather than haema-
The turbidity can be assessed visually or more accu- turia. True haemoglobinuria results from intravascular
rately using spectrophotometry, comparing the sample haemolysis (e.g. due to immune-mediated haemolytic
turbidity with that of a set of standards. The SSA anaemia) and is accompanied by haemoglobinaemia
method is not widely used in commercial laboratories. and anaemia. Haemoglobinaemia can be identified by
centrifuging a blood sample and examining the plasma
Microalbuminuria (which is pink/red). Myoglobinuria is seen uncommonly
Persistent microalbuminuria (MA) is an indicator of in small animals, but may result from severe muscle
glomerular damage associated with early progressive damage due to trauma or ischaemia (e.g. associated
renal disease in humans. Such low level albumin loss is with aortic thromboembolism in cats). The muscle
not detected by routine dipstick analysis. Recently new, enzymes creatine kinase (CK) and aspartate transami-
very sensitive, separate dipsticks for urine microalbumin nase (AST) are usually markedly elevated in serum/
have become available for use in dogs and cats. These plasma. Myoglobin is a small protein which is rapidly
are immunological tests using a monoclonal antibody cleared from the circulation, so myoglobinuria is not
specific for canine or feline albumin. Studies have shown accompanied by pigmented plasma.
that 20–25% of healthy dogs and 13% of healthy cats
have MA, whilst approximately 40% of dogs and cats
with a medical condition have MA (Jensen 2001; Urine sediment analysis
Wisnewski et al., 2004). The prevalence of MA in- The third and perhaps most important component of a
creases with age (Radecki et al., 2003). Diseases that complete routine urinalysis is the microscopic exami-
have been associated with MA include cardiovascular nation of the sediment. A consistent volume of urine
disease, urogenital disease, dental disease, airway should be used for preparing the sediment for analysis.
disease, pyoderma, inflammatory bowel disease, hyper- Laboratories use volumes that vary (10 ml, 5 ml, 3 ml)
thyroidism, hyperadrenocorticism, diabetes mellitus, to produce a semiquantitative result. Larger laborato-
infectious diseases and neoplasia (Grauer et al., 2001; ries also use disposable microscope slides, with a grid,
Vaden et al., 2001; Pressler et al., 2003; Wisnewski et which hold a set volume of sediment (usually 0.5 ml).
al., 2004). Prednisolone therapy may also lead to MA. Experienced microscopists use unstained sediment
Thus it appears that a significant proportion of normal and a phase contrast microscope. Less confident per-
animals and animals with diseases unrelated to the sons may elect to stain the sediment before microscopy
renal system may have MA. It is not clear at this time to facilitate cell identification. A regular microscope with
what proportion of animals with MA will develop renal the condenser lowered can be used to identify cells in
disease or protein-losing nephropathy. Animals with unstained sediment if phase contrast is not available.
end-stage renal disease may test negative for MA. The The microscope should be kept clean and in good
diagnostic usefulness of this test is still under evaluation. working order, with lens and condenser alignment main-
tained for the best possible visible field and resolution. If
Bilirubinuria an oil immersion (100X) objective is used for identifying
There is a low renal threshold for bilirubin and even small bacteria or assessing cell morphology, the lens should
increases in plasma bilirubin can lead to bilirubinuria. be wiped clean after each use to prevent oil dripping into
Thus bilirubinuria is detected prior to hyperbilirubinae- the condenser and seeping into the objective. It is also
mia or jaundice. Bilirubin in urine is in the form of advisable to place a coverslip on the sample to protect
conjugated bilirubin, since unconjugated bilirubin is bound the objective lens from damage.
to albumin, which does not usually pass through the A suggested method for preparation and analysis is
glomerular barrier in significant amounts unless glomeru- as follows:
lar disease is present. Bilirubinuria is not seen in healthy
cats but a small amount of bilirubin may be found in the 1. Fresh urine or warmed previously refrigerated
urine of normal dogs (see Figure 10.7). This is in part urine should be used.
because they have a very low renal threshold, and in part 2. The sample is mixed well but gently to prevent
because canine renal tubular cells are able to catabolize cast destruction.
haemoglobin to unconjugated bilirubin, conjugate it and 3. A constant volume (10, 5 or 3 ml, often 3 ml is
then secrete it into the urine. Increased bilirubinuria may used for cat urine), is placed in a conical
be caused by cholestasis or haemolytic anaemia. centrifuge tube.
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Chapter 10 Urine analysis
4. The urine is centrifuged gently (suggested 1,000 13.For further identification of cell types or to
rpm for 5 minutes; this will vary with the type of differentiate bacteria from particles the 100X oil
centrifuge used). If a smaller volume of urine (i.e. immersion objective can be used.
<3 ml) is used with high speed centrifugation the 14.Fat and air bubbles can usually be distinguished
amount of sediment obtained may be too small by fine focusing and moving the condenser.
especially if the urine is very dilute. The high 15.Brownian motion of particles can usually be
speed may also damage cells and destroy casts. distinguished from motile bacteria at 100X power.
5. The supernatant is decanted (this can be used in
the refractometer for SG or for dipstick analysis, Urine sediment results should be interpreted with a
especially if only a small volume of urine is available). knowledge of how the sample was collected, its chemi-
6. A few drops of liquid will remain in the tube. cal composition (dipstick analysis) and its SG. Most
Sediment is mixed in this to resuspend it, either by importantly the clinical condition of the animal and any
gently tapping the tube or pipetting up and down. haematology and biochemistry results (if available)
7. If a specialized urine stain, such as Sedistain, is should also be taken into account. The presence of
being used, 1 drop is added to the sediment and increased leucocytes and bacteria in a cystocentesis
mixed. (N.B. Stain will develop precipitate with sample from an animal with urinary frequency and an
time and needs to be discarded or filtered before inflammatory leucogram would confirm the need for
use because stain precipitate can be mistaken culture and sensitivity and appropriate antibiotic therapy,
for bacteria). whereas a similar free-catch sample from a bitch
8. A drop of sediment is placed on a clean glass slide during oestrus would not elicit the same response.
and a coverslip is placed on it avoiding air bubbles. Similarly, cells with an abnormal appearance in urine
9. The slide is placed on the microscope stage and from an animal with painless haematuria would sug-
the whole area is scanned on low power (10X gest further cytological analysis and investigation, un-
objective). If unstained sediment is being used, less it were known that the animal had received drugs
the condenser should be lowered until there is known to be toxic/irritant to urinary bladder cells. Like-
good resolution. wise further investigation of proteinuria after positive
10.The presence of crystals is reported at this dipstick protein is not indicated where sediment con-
magnification. A consistent scheme is used, i.e. tains large numbers of red and white blood cells and
1+, 2+, 3+ or light, moderate, heavy. Identification bacteria. If large numbers of epithelial cells and/or cells
of crystal types should be attempted. with abnormal morphology are found during routine
11.The objective is changed to high power (40X) sediment analysis further cytology is advisable, espe-
and the area is rescanned. The numbers of cially if there is a history of haematuria and a suspicion
erythrocytes, leucocytes and epithelial cells, of neoplasia in the urinary tract (see Cytology, below).
casts, crystals and bacteria seen per high power
field are counted and recorded (Figure 10.9). It is Casts
advisable to count in 5–10 different fields and Casts are formed in the renal tubules from Tamm–
then average the numbers unless there are very Horsfall mucoprotein secreted by renal tubular epithe-
large numbers seen. lial cells. These condense to form hyaline casts (Figure
12.Other constituents are reported, e.g. sperm, mucus 10.10a). The hyaline casts may then acquire cellular
strands, yeast, fungi, nematode eggs, fat droplets. debris and become granular casts (Figure 10.10b) or
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Chapter 10 Urine analysis
trap lipid droplets to become fatty casts. When these white or red cell casts, respectively (Figure 10.10d),
casts age and/or deteriorate and solidify in the tubules whilst epithelial cell casts (Figure 10.10e) occur due to
they form waxy casts (Figure 10.10c). Normal urine severe damage to the renal tubule leading to sloughing
may contain a few hyaline or granular casts, but of cells. Casts may be flushed into the bladder urine
increased numbers reflect renal pathology, usually intermittently, and they also disintegrate rapidly in
acute tubular disease (Figure 10.11). Inflammation or alkaline or old urine, so the absence of casts does not
haemorrhage in the kidney may lead to the formation of exclude renal tubular disease.
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Chapter 10 Urine analysis
(i) (j)
Urine sediment crystals. (a) Struvite (magnesium ammonium phosphate) crystals with a typical ‘coffin lid’
10.12
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.)
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Chapter 10 Urine analysis
and some other breeds. Large numbers of crystals in cells (usually neutrophils) are larger than red cells, and
dilute urine, persistent crystalluria and large crystals are round with granular cytoplasm and often an indis-
have greater significance in relation to stone formation. tinct nucleus (Figure 10.14b). Normal urine sediment
If large numbers of calcium oxalate monohydrate contains small numbers of transitional epithelial cells
along with dihydrate crystals are found in urine, inges- from the bladder; increased numbers are seen second-
tion of toxic substances, particularly ethylene glycol ary to bladder inflammation/irritation. Transitional cells
(antifreeze) and certain toxic plants, should be sus- are large and round to oval, with a central round
pected. High concentrations of these substances can nucleus and abundant cytoplasm (Figure 10.14c).
be metabolized to produce oxalates, which precipitate Voided urine may also contain squamous epithelial
in the renal tubules as calcium oxalates and can cause cells from the urethra and vagina which are also large
irreversible renal failure (see Chapter 11). but have an angular polyhedral shape and a small
Unusual crystals may be formed if large quantities round nucleus (Figure 10.14d). A rare renal and ureteral
of drug or drug metabolites concentrate in urine, e.g. epithelial cell may also be found. These are small with
sulphonamide drugs frequently form crystals (Figure a relatively large round nucleus and less cytoplasm
10.12h). Unusual, difficult to identify crystals can (Figure 10.14e). The significance of increased num-
often be drug-derived. Cholesterol crystals (Figure bers of red and white blood cells and epithelial cells is
10.12i) may be seen in normal animals or in nephrotic summarized in Figure 10.15.
syndrome. Bilirubin crystals (Figure 10.12j) may be
seen when there is marked bilirubinuria, due to Miscellaneous findings
cholestasis or haemolytic anaemia, and may occa- Bacteria may reflect contamination or infection; an
sionally be seen in concentrated urine from normal associated inflammatory response would support the
dogs (especially males). latter (Figure 10.16a), but is not always present. Other
organisms, such as nematodes, yeast and fungi, may
Cells occasionally be identified (Figures 10.16b–e) and their
Red and white blood cells may be seen in low numbers significance is summarized in Figure 10.17. Sperm,
in normal urine. Red cells (Figure 10.14a) may be mucus strands and cotton fibre contaminants are shown
confused with fat droplets or yeast (Figure 10.9). White in Figure 10.16(f–h).
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Chapter 10 Urine analysis
(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.)
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Chapter 10 Urine analysis
(g) (h)
Urine sediment: miscellaneous. (a) Sediment containing degenerate neutrophils and numerous bacteria
10.16
consistent with urinary tract infection. (Unstained.) (b) Aspergillus spp. Fungal contamination, especially in free-
catch 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.)
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Chapter 10 Urine analysis
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Chapter 10 Urine analysis
urine. Renal or bladder lymphoma can result in exfolia- years there has been a change in the relative propor-
tion of large numbers of often abnormal lymphocytes tion of these uroliths, with a increase in incidence of
into the urine. calcium oxalate urolithisis and a decrease in struvite
Cytological diagnosis of bladder tumours is particu- (Ling et al., 2003). This is likely to be related to the
larly difficult as polyps and epithelial hyperplasia may widespread use of manufactured urinary acidifying
exfoliate similar cells. If a cytological diagnosis of diets with restricted magnesium content. In one study
malignant tumour is made, follow-up biopsy and histo- in dogs analysing urolith submissions, approximately
logy are advisable, particularly in the case of bladder 44% were struvite and 42% were calcium oxalate
mucosal tumours, to confirm malignancy and the de- (Houston et al., 2004). Struvite were most common in
gree of invasiveness of the tumour. 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
Uroliths (calculi/stones) (81%) were struvite (Houston et al., 2003).
Clues to the type of urolith present are the breed,
Uroliths (the preferred term) or crystals can be ana- urine pH, urolith radiodensity (calcium oxalate, calcium
lysed for mineral content using semiquantitative chemi- phosphate, cystine and struvite uroliths are radiodense,
cal analysis kits. The following constituents can be whilst urates are radiolucent) and the type of crystals
measured: seen in urine sediment. However the type of crystal
present is not always the same as the type of urolith. All
• Calcium types of uroliths in the bladder may lead to a secondary
• Oxalate urinary tract infection, and, if the organism produces
• Phosphate urease, urine pH increases leading to struvite crystal
• Magnesium formation.
• Ammonium
• Uric acid Struvite uroliths
• Cystine. Struvite uroliths (Figure 10.19) may form in sterile urine
that contains high concentrations of magnesium, phos-
Uroliths can also be analysed using X-ray phorus and ammonium ions and is of neutral to alkaline
crystallography, polarized light microscopy and infra- pH. In dogs, they are formed more frequently, and
red (IR) spectroscopy. These methods are preferable more rapidly, when there is also a co-existing infection,
to chemical semiquantitative mineral ion analysis. particularly with urease-producing bacteria (Staphylo-
Identification of crystal types and/or mineral content coccus and Proteus). This enzyme can split urea
is essential for successful therapy in animals with (abundant in urine) to produce ammonium ions and
related urolithiasis. CO2, which forms bicarbonate and increases urine pH.
Uroliths are believed to form more readily in super- The ammonium ions become part of the struvite crys-
saturated urine. However, other factors play a part: tals. Increased concentrations of these ions are also
reported to affect the mucins glycosaminoglycans pro-
• The presence of a nucleation centre or nidus duced by the bladder mucosal lining cells, reducing
(e.g. bacteria, mucin plug) their protective ability. Struvite calculi are most com-
• Urine pH mon in young female dogs and in the following breeds:
• Duration of urine supersaturation mixed breeds, Miniature Schnauzers, Shih Tzu and
• Absence of crystallization inhibitors normally Bichon Frise.
produced by bladder mucosal cells
• Possibly genetic factors.
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Chapter 10 Urine analysis
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Chapter 10 Urine analysis
WDT is dangerous or contraindicated in these patients. the monitoring methods of choice are measuring urine
This test is also contraindicated in polyuric animals that SG and recording bodyweight. When performing the
are dehydrated and/or azotaemic. Polyuria and poly- test the same balance/scales must be used for each
dipsia (PU/PD) are frequently reported in dogs and weighing and the same refractometer must be used for
cats, but CDI, NDI and PP are relatively rare and it is measuring urine SG throughout.
essential to attempt to rule out all other causes of It is important to rule out hyperadrenocorticism
polyuria and polydipsia before performing a WDT. The (Cushing’s disease) as a cause of PU/PD before per-
test is designed to determine whether ADH is released forming a WDT. Although some animals with this
in response to dehydration (increased plasma osmo- condition can concentrate urine normally following
lality), and whether the kidney can respond to ADH. water deprivation, many are able to concentrate urine
When the test is performed correctly CDI, NDI, and PP to SG >1.008, but not to >1.025, because of ADH
can be differentiated from each other in the majority of antagonism. When desmopressin (DDAVP, a syn-
cases (Figure 10.20). Serum and urine osmolality can thetic ADH analogue) is administered, concentrating
be measured to monitor the response to water depriva- ability returns, thus mimicking CDI.
tion but freeze point depression osmometers are not If the animal is markedly polyuric, water deprivation
widely available to veterinary practitioners. Therefore should be done with extreme caution because such
animals may become rapidly dehydrated, as a result
of pre-existing medullary washout. In these animals it
Protocol is better to restrict water intake partially for 5 days
Partial water restriction for 2–3 days prior to the test is recommended, beforehand (120 ml/kg per day on days –5, –4 and –3,
to correct medullary washout. About 100 ml/kg is allowed on the first 90 ml/kg on day –2 and 60 ml/kg on the day before the
day, reducing by 10–15% per day for 2 further days. On the fourth day test). Salt can be added to the food from day –5 to help
complete water deprivation is commenced as follows: correct medullary washout.
1. Empty bladder (catheter) measure urine S.G.
2. Weigh animal
3. Deprive the animal of food and water Tests used in conjunction with water
At 1–2 hourly intervals: deprivation testing
1. Empty the bladder and measure urine S.G. Endogenous plasma ADH levels are used to distin-
2. Weigh the animal guish between CDI, NDI and PP in humans as part
3. Measure serum/plasma urea and creatinine (optional) of the WDT. ADH measurement is available on a
Discontinue the test when:
limited basis for veterinary patients in human hospi-
• The urine S.G. is >1.025
• Or there has been >5% loss of body weight tal laboratories but it is expensive and has a long
• Or the animal becomes azotaemic or depressed turnaround time, and, therefore, is impractical in most
clinic cases.
Interpretation
The Hickey–Hare test is sometimes used if the
PP can be identified at this stage because the SG will become >1.025 WDT is non-diagnostic. This test measures renal
CDI and NDI will fail to concentrate above 1.010 even when there is tubular and pituitary responses to hyperosmolality
>5% loss of body weight (intravenous hypertonic saline administration) by as-
Values between 1.010 and 1.020 are equivocal and indicate
submaximal concentration suggesting partial central DI. sessing the output, SG and, if possible, osmolality of
To distinguish between CDI and NDI the desmopressin response urine. In normal animals and animals with PP, the
test is performed (preferably immediately after the WDT): urine output progressively decreases and urine SG
1. Empty the bladder and measure urine SG and osmolality increase following hypertonic saline
2. Inject desmopressin intravenously or intramuscularly (2.0 µg administration, whilst there is no response in animals
for small dogs <15 kg, 4.0 µg for dogs >15kg)
with CDI and NDI. However there is a significant risk
3. Measure urine SG every 2 hours for 6–10 hours, then at 12
and 24 hours of inducing marked hypertonicity (hyperosmolality),
4. Provide small amounts of water (3 ml/kg/hour) during and especially in severely polyuric animals. The test re-
following the test to prevent cerebral oedema quires close monitoring and is probably best per-
Intrepretation of desmopressin response test formed in referral hospitals.
• Urine SG values >1.015 indicative CDI A closely monitored trial of the ADH analogue
• Failure to concentrate above 1.010 is indicative of NDI
• Urine SG values between 1.010 and 1.015 are equivocal and
desmopressin (DDAVP) administration over 5–7 days
could reflect medullary washout is often a safer alternative when WDT is non-diagnos-
tic. Desmopressin administration should cause a >50%
decrease in water intake in CDI, but will have no effect
10.20 Water deprivation test and its interpretation.
in NDI.
Case examples
Case 1
Signalment diagnosed and treated but the PD/PU persisted. The dog was drinking
2-year-old entire female Boxer 180–280 ml of water/kg/day, but was otherwise bright and well. There
were no abnormalities detected on clinical examination.
History
2-month history of PD/PU with a sudden onset. Cystitis had been Case 1 continues
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Chapter 10 Urine analysis
Biochemistry Result Reference interval Time Body weight Urine Urine Plasma
Sodium (mmol/l) 149.6 136–155 (% reduction) SG osmolality osmolality
Potassium (mmol/l) 4.07 3.5–5.8 T=0h 23.8 kg 1.002 100 mmol/kg 282 mmol/kg
Chloride (mmol/l) 116 107–120 T+4h 23.6 kg (0.8%) 1.004 132 mmol/kg 312 mmol/kg
Glucose (mmol/l) 5.6 3.4–5.3 T + 10 h 23.2 kg (2.5%) 1.005 165 mmol/kg 326 mmol/kg
Calcium (mmol/l) 2.73 2.2–2.9 T = 13.1 h Water was offered in 100 ml aliquots every 45 min for
following 4 h then in 200 ml aliquots for 2 h then unrestricted
Inorganic phosphate 1.46 0.8–2.0
(mmol/l) T + 16 h 4µg DDAVP injected i.m.
Sediment examination 1–2 WBC per hpf; no casts or (Case 1 courtesy of E Villiers.)
crystals seen
Case 2
Signalment dysuria and nocturia. Multiple courses of antibiotics. Possible discomfort
13-year-old female Bearded Collie. on sitting down. Very tense on abdominal palpation. No other significant
clinical findings.
History and clinical findings
5-month history of haematuria. Increased frequency of urination; Case 2 continues
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Chapter 10 Urine analysis
Case 2 continued
Urine analysis
SG (refractometer) 1.024
Dipstick results pH 6.5; protein + to ++; blood +++;
negative for glucose, ketones,
urobilinogen, bilirubin,
haemoglobin
Sediment examination See Figure 10.21
➚
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.
How would you interpret these results and
what are the likely differential diagnoses?
The cytological findings confirm that the dog has bacterial cysititis. The 10.22 Pneumocystogram.
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.
➚
What further tests would you recommend?
• Culture and sensitivity testing
• Imaging to identify any mass lesion, and suction biopsy via catheter
if indicated, or cystoscopy and biopsy.
Results of further tests
A pneumocystogram and double-contrast cystogram (Figures 10.22 and
10.23) showed an ill-defined mass extending from the apex of the bladder
along the dorsal wall almost to the trigone. The outline is irregular, with
a ‘moth-eaten’ appearance suggesting mucosal disruption. The bladder 10.23 Double contrast cystogram.
wall appears thickened craniodorsally: on the pneumocystogram, this
may be a result of insufficient inflation, but on the double-contrast study
this is a genuine finding. This extensive ill-defined irregular mass, which dysplasia, caused by the severe inflammation present; and further
has caused mucosal disruption, is most likely neoplastic, and most likely diagnostic investigations should always be performed when neoplasia is
a transitional cell carcinoma. This should be confirmed by suction biopsy suspected cytologically.
(declined by the owner on grounds of cost).
These findings are consistent with a bladder tumour with secondary
Case outcome
The dog was treated palliatively with piroxicam, and survived for a further
urinary tract infection. Great care should be taken in diagnosing neopla-
6 months.
sia on urine cytology, especially if there is concurrent inflammation, as in
this case. The atypical cellular features could have been due to tissue (Case 2 courtesy of L Blackwood.)
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Chapter 10 Urine analysis
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Houston DM, Moore AE, Favrin MG and Hof B (2004) Canine (2003) Urine albumin concentration is increased in dogs with
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Canadian Veterinary Urolith Centre from February 1998 to April Medicine 17, 404 (abstract)
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plugs and bladder uroliths: a review of 5,484 submissions 1998– Journal of Veterinary Internal Medicine 17, 406 (abstract)
2003. Canadian Veterinary Journal 44, 974–977 Raskin RE, Murray KA and Levy JK (2002) Comparison of home
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of microalbuminuria in dogs. Journal of Veterinary Internal Clinical Pathology 31, 51–55
Medicine 15, 300 (abstract) Vaden SL, Jensen WA and Simpson D (2001) Prevalence of
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Duncan and Prasse’s Veterinary Laboratory Medicine Clinical Journal of Veterinary Internal Medicine 15, 300 (abstract)
Pathology, 4th edn, ed. CR Gregory, pp. 231–259. Iowa State Vaden S L, Barrak M P, Lappin M R and Jensen W A (2004) Effects
Press, Iowa of urinary tract inflammation and sample blood contamination on
Ling GV, Thurmond MC, Choi YK, Franti CE, Ruby AL, Johnson DL urine albumin and total protein concentrations in canine urine
(2003) Changes in proportion of canine urinary calculi composed samples. Veterinary Clinical Pathology 33, 14–19
of calcium oxalate or struvite in specimens analyzed from 1981 Wisnewski N, Clarke KB, Powell TD and Sellins KS (2004) Prevalence
through 2001. Journal of Veterinary Internal Medicine 17, 817–823 of microalbuminuria in cats. www.heska.com/erd/erd_datacat.asp
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