Urine pt 4 and ectoparasites .docx

Urine Part 4 Urine Sediment Objectives - Elements observed in a microscopic urine sediment - Methodology used to perform a microscopic examination of urine - Importance of standardization - Descriptions of the various elements of urine sediment - Clinically important component to th...

Urine Part 4 Urine Sediment Objectives - Elements observed in a microscopic urine sediment - Methodology used to perform a microscopic examination of urine - Importance of standardization - Descriptions of the various elements of urine sediment - Clinically important component to the routine urinalysis - Comparable to the blood smear in the interpretation of the hemogram - Abnormal physical and chemical findings mandate careful evaluation of the urine sediment - Enhances the dip strip findings - moderate proteinuria in the absence of significant numbers of RBCs and WBCs indicates proteinuria of glomerular origin vs proteinuria due to pyuria and hematuria which can indicate an inflammatory response somewhere along the urinary tract - There is no dip strip methods for urine sediment Examination of Urine Sediment - Especially important in detecting and evaluating: - Crystals - Casts - WBC - RBC - Bacteria - Epithelial cells - Parasites - Again, like so many other laboratory test the urine sediment must be interpreted in conjunction with other clinical data and the physical and chemistry properties of urine  Methodology - minimize variations in sediment examination from sample to sample it is recommended that all personnel be trained to follow a standard sequence of steps - Sample collection - Collect uncontaminated samples in appropriate container - Fresh sample yields the most accurate results - Room temperature for more than 30 minutes can cause a change in pH, proliferation of bacteria, lysis of RBCs, casts, & WBCs - urinalysis cannot be performed within 30 minutes following collection place in refrigerator Centrifugation - Standard volume - 15ml - 5ml - Conical tip centrifuge tube - Sample should be capped - Centrifuged at a low rate of speed for approximately 5 minutes  - Decant the supernatant  (do not disturb sediment) - Leave a standardized amount of supernatant in tube (≈0.3-0.5) - Resuspend sediment by flicking or tapping tube - Add stain using manufacturer's directions-if needed - Use a standardized amount of sediment (placed on a clean slide with a cover slip)  Interpretations - Evaluation of urine can be difficult for a number of reasons: - Ability to recognize the cellular elements, casts, crystals, parasites and other objects - Cellular elements can originate from different areas of the urogenital tract - Subjected to different pH than their normal environment - Exposed to enzymes or toxic concentrations excreted in urine or produced by bacteria - RBC - Evaluated under high power - Generally, appear as pale yellow, smooth, anuclear disks that are 6-7 microns and of uniform, round shape - Smaller than WBC, contain no internal structures, and may appear biconcave - they have been in urine a long period of time, they may appear colorless - Concentrated urine-smaller, crenated, distorted - Dilute urine---large, swollen, and globular RBC  RBC Module 8.4: Common Structures Observed on the Sediment Exam -- Clinical Veterinary Diagnostic Laboratory RBC  RBC  RBC  WBC - The appearance of WBC can be variable, dependent on type and the influence of specific gravity, pH, toxin producing bacteria - Usually 1½ - 2 times bigger than RBCs - Expand in dilute urine and shrink in concentrated urine - Can appear as clumps or singular - Can be difficult to differentiate between renal tubular epithelial cells and WBC How we report white blood cells count in urinalysis \| Medical Laboratories WBC  WBC WBC red and white blood cells, and yeast in urine sediment \| Medical Laboratories - Epithelium - Renal tubular cells - microns, round and have a large central spherical nucleus - riginate in the renal tubules - Slightly larger than WBC - Squamous cells - Largest (50microns) - Thin, plate- like with distinct or irregular outline and small dense nucleus - Single or sheets - distal urethra, vagina, vulva, or prepuce - Transitional cells - Vary in size, depending on their depth of origin - May be 2-4 times larger than WBC - May appear as pear, spindle, caudate or polygonal - bladder, ureters, renal pelvis, and proximal urethra - Neoplastic cells - Transitional cell carcinoma, other forms - Catheterization are more likely to yield more neoplastic cells than cystocentesis - Difficult to differentiate hyperplastic verses neoplastic cells A picture containing table Description automatically generatedA picture containing water, people, beach, standing Description automatically generated Transitional Epithelium cat6 - Casts - Formed in the lumen of the distal and collecting tubules of the kidney - Tamm--Horsfall mucoprotein - Renal tubules, protein precipitates in acidic conditions and forms casts shaped like the tubules in which they are formed - Cylindric, with parallel sides - Cells in the area can be incorporated into casts - Cast dissolve in alkaline urine so identification is best done in fresh urine - few hyaline or granular casts may be seen in normal urine (0-1/hpf) Formation of Casts  - Hyaline - Clear - Colorless - Highly refractile - Dim light - Increased numbers indicate the mildest form or renal irritation HyalineHyaline Casts in Urine : Morphology And Clinical Significance Granular - Most common type seen in animals - Hyaline casts containing granules - Seen in large numbers with acute nephritis  WBC Cast Granular Cast  Cast compilation Severe Tubular Damage Presence of numerous granular cast  Cast - Small fat droplets that appear as refractile bodies Fatty Waxy - Resemble hyaline but are wider with square ends vs round ends - Dull homogeneous appearance Waxy Crystals - Crystalluria - May or may not be of clinical significance - Crystal formation may lead to the formation of urinary calculi - Type of crystals depend: - Urine pH - Concentration - Temperature - Solubility of the elements - a urine sample is allowed to cool the number of crystals increase - Struvite/ triple phosphate crystals - Alkaline to slightly acidic urine - Coffin lids may assume other shapes - Amorphous phosphate - Alkaline - Granular precipitate - Amorphous urates - Acidic - Granular - Ammonium biurates (thorny apple) - Brown Triple Phosphates  Ammonium burates  - Calcium oxalate - Calcium oxalate dihydrate - Squares with an X resembling the back of an envelope - Calcium oxalate monohydrate - "Picket Fence" or Dumbbell shaped - Increase numbers ethylene glycol poisoning - Calcium Carbonates (horses & rabbits) - Cystine - Six sided, flat - Leucine, tyrosine Calcium oxalate  Calcium oxalate (calcium monohydrate)-ethylene glycol poisoning Calcium Oxalate Monohydrate Ca Oxalate Monohydrate A picture containing white, looking, side, glasses Description automatically generated Calcium Carbonate-Normal in Horses and rabbits  Cystine Cystine Crystals cat9 Bacteria - Variety of organisms - Requires High magnification - Refractile - Movement - Yeast - Fungi Yeast  Misc - Mucus threads - Spermatozoa - Fat Droplets - Parasites - Artifacts  Parasites of the Urinary System Pearsonema  plica/Capillaria plica Dioctophyma renale Urolithiasis - Calculi - Uroliths of dogs and cats are usually struvite - Cystine and oxalate uroliths may also be observed - Urate uroliths are seen mostly in Dalmatians Review - Outline procedure used for microscopic examination of urine - Importance and method of standardization - Elements observed - Description of elements