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Clin Path- Urinary 2

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drraythe's version from 2015-12-05 18:15

Part 1: serum [UN] & [Crt] with urine specific gravity CONTINUED

Question Answer
*Interpret USGref results--> 1.030, other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationnormal, ok, ok, inc ADH release, ok, ok, ok.
*Interpret USGref results--> 1.060, other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationDEHYDRATED. dec blood vol, ok, inc inc ADH release, ok, inc inc water conserv.
*Interpret USGref results--> 1.003(hyposthenuric), other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservation(possible causes are Too many IV fluids; drinks too much H2O) overhydrated, ok, NO ADH release, n/a tubule resp., conc gradient ok, dec dec water conservation
*Interpret USGref results--> 1.010(isosthenuric), other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservation(possible causes are IV fluids; drinks H2O) well hydrated, inc blood vol, ok, a little ADH release, n/a tubule resp., conc gradient ok, dec water conservation\
*Interpret USGref results--> 1.010(isosthenuric) CHRONIC RENAL FAILURE(prolly see an azotemia and anemia), other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationdehydrated, dec dec blood vol, plasma osm ok, inc inc ADH release, tubule resorp poor, conc gradient poor, water conserv dec dec
*Interpret USGref results--> 1.025, 4+glucosuria OSMOTIC DIURESIS AND DEHYDRATION. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationdehydrated, dec dec blood vol, inc plasma osm, inc inc ADH release, inc tubular resp, dec conc gradient, inc water conservation
*Interpret USGref results--> 1.002(hyposthenuric) Renal diabetes insipidus(TUBULES CAN'T RESPOND TO ADH), other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationdehydrated, dec dec blood vol, plasma osm ok, AHD release inc inc, NO tubule resp, conc gradient ok, water conserv dec
*Interpret USGref results--> 1.002(hyposthenuric) central diabetes insipidus, other findings neg. Describe: hydration stat, blood vol, plasma osm., ADH release, tubule response, conc gradient, and water conservationdehydrated, blood vol dec dec, plasma osm ok, NO ADH release, tubular response ok, conc gradient ok, water conservation dec
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Part 2: Semiquantitative urine chemistry

Question Answer
look at the dipstick picture and chart. understand what's going onwee
when using the dipstick to get semiquantitative concentrations, what must you always consider?Must consider volume of urine being excreted per hr or day. Usually inversely proportional to urine specific gravity
explain why you need to be careful with the dipstick for protein and stuff, explain how volume of urine plays a central role in knowing the accuracy of the reading(example)in two different situations, a dipstick can say that a dog produces 300mg of protein a day. However, in one case, the dog is producing 300mg/100mL, and only produces 300mL, to it's 300mg protein. The other case, the dog is only producing 30mg/100mL, but produces 1000mL of urine, which mean he too was read as having 300mg protein excreted a day (So, 3+ protein @ 1.045 -->same as -->1+ protein @ 1.005) (the +1 is more significant in more dilute urine)
for dipstick results, Need to consider volume of urine produced per day OR need to consider USGref. how does urine volume relate to USGref?urine volume is inversely proportional to USGref. So, lower SG, indicates more dilute, so animal is producing more volume
explain carnivore vs herbivore urinecarni=acidic and herbi=basic
explain aciduria. whats going on, what is the value?Kidneys excreting H+from blood, Urine pH is less than or equal to 7
explain alkalinuria. whats going on, what is the value?Kidneys returning H+to blood. Urine pH is greater than or equal to 7.5
If you see protein in the urine, should you be worrying?depends, most animals have very little protein in their urine, but dogs can have some in health.
what are the pros and cons of detecting protein with the Reagent strip method?BEST detection of albumin, and can detect globulins, but there can be false positives in ALKALINE urine.
how does the SSA (sulfosalicylic acid) turbidity test for protein hold up compared to the reagent strip method? pros/cons?detects albumin better than it does globulins (but reagent strips are still best at detecting albumin) and it has false NEGATIVES in ALKALINE urine
what should you know about prerenal proteinuria?< 60,000 Mr sized molecules, bc have to be small enough to filter, so usually myoglobin, hemoglobin dimers, and light chains of immunoglobulins are what you see in this
what should you know about glomerular proteinuria?Only proteinuria that causes hypoalbuminemia because of porous glom which can let proteins >60,000 Mr in (so, will have albumin and all but the largest globulins)
what should you know about tubular proteinuria?there is a dec in absorption of small proteins ( <60,000 Mr), so you will see lots of small globulins in the urine
what should you know about Hemorrhagic or inflam. proteinuria (postrenal)?post-renal urinary tract is injured and inflamed, so Plasma proteins added to urine (albumin & globulins).
which type of proteinuria might lead to hypoproteinemia & hypoalbuminemia?Glomerular
what are the names of the three types of PRE-renal proteinuria, and what are the causes of them?(1) Hemoglobinuria (intravascular hemolysis)
(2) Myoglobinuria(acute muscle necrosis)
(3) Bence Jones proteinuria (lymphoid neoplasms)
what are the two conditions which lead to glomerular proteinuria?(typically a result of chronic renal dz) (1) Glomerulonephritis (2) Glomerular amyloidosis (*these may lead to hypoproteinemia & hypoalbuminemia)
what are the two conditions which lead to tubular proteinuria?(1) Acute tubular toxicity
(2) Congenital disorders (e.g., Fanconi’s syndrome)
what are the two conditions which result in post-renal proteinuria, what is the situation which caused these to happen? what else will you see aside from protein?(1) Hematuria: urinary tract hemorrhage (with plasma) (2) Pyuria: urinary tract inflammation(exudation of plasma proteins)
what is the norm for glucose in the urine? how do you test for glucose in the urine?glucose passes through the glom, but ALL should be resorbed- a negative result is expected. To test if there is glucosuria, do the Reagent strip method. (tests for Reagent strip methodglucose oxidase-->high analytical specificity)
what are the two ways glucose can get into the urine?(1) Hyperglycemic glucosuria--> this is when there is too much glucose in the plasma, more than the glucose transporters can handle, so it exceeds the hreshold and gets through. (2) Renal glucosuria (glycosuria)--> the TUBULES ARE DAMAGED (blood is normoglycemia)
what are the thresholds for renal absorption of glucose for dog? cat? horse? cow?Dog= apprx 180mg/dL. Cat= >200mg/dL. Horse=apprx 180ml/dL. Cow= apprx 100mg/dL
what are some causes of the damaged tubules in Renal glucosuria(glycosuria)?Two causes- acquired and congenital. Acquired= toxins, ischemia. Congenital= Fanconi syndrome (basenjis)
explain osmotic diuresisthe glucose in the tubular fluid reduces the H2O (keeps water in the tubule, so urine is dilute, because the osmotic gradient is decreased (less diff between tubule and interstitium) so less H2O resorbed, so inc urine volume)
where do ketone bodies come from? what are the types? which do we detect with our reagent strip?ketones are made in the liver, and can be acetoacetate, β-hydroxybutyrate, or acetone. the reagent strip Detects primarily acetoacetate (because acetone degrades quickly, and β-hydroxybutyrate isnt actually a true ketone, only the other two are)
how does acetoacetate get into urine?Excess ketogenesis-->ketonemia-->ketonuria. The main reasons for excess ketogensis is Excess catabolism of fatty acids by hepatocytes, which is encouraged by dec insulin and inc glucagon activity, which is common in diabetes mellitus and bovine ketosis
how do ketones and ions relate?ketones are non-resorable(exteremly low renal resorption threshold) anions (neg charge). This means that the urine is full of neg charges, so the body dumps positive charges in to balance it out, which means you lose Na+ and K+, so Contributes to hyponatremia& hypokalemia
what are the two tests to detect heme (aka blood, occult blood)? what exactly are they detecting?can use a reagent strip, or hematest tablets. Both detect peroxidaseactivity of heme
explain Hematuria, vs Hemoglobinuria, vs Myoglobinuria, and how each of these happens to end up in urine(1) Hematuria= RBCs in urine, which is usually caused by a bleed in the urinary tract below the kidney, or in the renal tubule. (2) Hemoglobinuria= hemoglobin in the urine. usually due to either RBCs which were in the urine and then were lysed, OR the RBCs were lysed in the blood(hemoglobinemia) and the kidney filtered out the hemoglobin dimers.
(3) Myoglobinuria is myoglobin in the urine, and this happens where there is muscle damage, which results in myoglobin in the blood (myoglobinemia) which is then filtered into the urine by the kidney. ALL THREE result in pink-red urine which test positive for heme.
Bilirubinuria--> How does bilirubin get into the urine? (2 ways- explain a little about them)(1) Hemolytic icterus. RBCs lysed, their contents are turned into bilirubin, and if the amount formed is more than the amount the bile is able to excrete, the bilirubin stays in the blood and is filtered by the kidney into the urine
(2) Hepatobiliary disease (cholestaticicterus). This is when there is impaired bilirubin excretion (either from the liver or post-hepatic) so it regurgitates into the plasma--> hyperbilirubinemia--> bilirubinuria
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