What's your diagnosis? A urinalysis challenge

How would you interpret the results in these seven case presentations?

The following questions are designed to facilitate self-assessment of your interpretation of urinalyses of several patients admitted to the Veterinary Teaching Hospital at the University of Minnesota. When choosing your answer, remember to distinguish between observations and interpretations and to consider the most appropriate answer in terms of probabilities rather than possibilities. (Note: hpf means high-power microscopic field, or 450X; lpf means low-power microscopic field, or 100X).

Question 1

Urinalysis results of a voided sample from a 2-year-old neutered male English bulldog (sample refrigerated immediately after collection):

• Color = yellow

• Turbidity = clear

• Specific gravity = 1.031

• pH = 6.0

• Glucose = negative

• Acetone = negative

• Bilirubin = negative

• Occult blood = negative

• Protein = trace

• RBC = 1-2/hpf

• WBC = 0-1/hpf

• Casts = none

• Epithelial cells = occasional

• Bacteria = none
• Crystals = few ammonium urate

Which is the most appropriate interpretation of these results?

a. Hepatic disease

b. Inflammatory disease syndrome along the urinary tract

c. Normal

d. Acute renal failure

e. Urate uroliths

Question 2

Urinalysis results of a voided sample from a 9-year-old spayed female boxer:

• Color = light yellow

• Turbidity = clear

• Specific gravity = 1.003

• pH = 6.5

• Glucose = negative

• Acetone = negative

• Occult blood = negative

• Protein = negative

• RBC = negative

• WBC = negative

• Casts = none

• Epithelial cells = none

• Bacteria = none

Which is the most appropriate interpretation of these results?

a. There is an insufficient population of viable nephrons to concentrate glomerular filtrate.

b. There is a sufficient population of viable nephrons to dilute glomerular filtrate.

c. There is a sufficient population of nephrons to concentrate or dilute glomerular filtrate.

d. All of the nephrons of both kidneys are functional.

e. More than two-thirds of the nephrons of both kidneys are nonfunctional.

Question 3

Urinalysis results of a sample collected by cystocentesis from a 10-year-old spayed female basset hound:

• Color = yellow
• Turbidity = cloudy
• Specific gravity = 1.029
• pH = 8.5
• Glucose = negative
• Acetone = negative
• Occult blood = 4+
• Protein =2+
• RBC = 200/hpf
• WBC = 200/hpf
• Casts = none
• Epithelial cells = occasional
• Bacteria = numerous rods
• Crystals = many struvite

Which is the most likely diagnosis?

a. Struvite urocystoliths caused by bacterial infection

b. Primary bacterial infection of the urinary bladder

c. Secondary bacterial infection of the urinary bladder

d. Inflammatory disease of the urinary tract caused or complicated by bacterial infection

e. Iatrogenic hematuria caused by cystocentesis

Question 4

Urinalysis results of a sample collected by cystocentesis from a 2-year-old spayed female domestic shorthaired cat:

• Color = light yellow

• Turbidity = slightly cloudy

• Specific gravity = 1.014

• pH = 6.0

• Glucose = negative

• Acetone = negative

• Bilirubin = negative

• Occult blood = 2+

• Protein = 2+

• RBC = 20-30/hpf

• WBC = 20-30/hpf

• Casts = occasional WBC/lpf

• Epithelial cells = moderate

• Bacteria = many cocci

• Crystals = none

This patient has an infectious inflammatory disease most likely involving which of the following (pick the best answer)?

a. Urinary tract

b. Urinary bladder

c. Renal tubules

d. Glomeruli

e. Renal vessels

Question 5

Urinalysis results of a sample collected by catheterization from a 4-year-old neutered male Alaskan malamute:

• Color = pink
• Turbidity = slightly turbid
• Specific gravity = 1.035
• pH = 7.0
• Glucose = negative
• Acetone = negative
• Occult blood = 3+
• Protein = 3+
• RBC = > 100/hpf
• WBC = 0 to 1/hpf
• Casts = none
• Epithelial cells = occasional
• Bacteria = none
• Crystals = occasional struvite

Which is the most likely diagnosis?

a. Iatrogenic hematuria induced by rough catheterization

b. Inflammatory disease of the urinary tract

c. Hematuria induced by struvite uroliths

d. Pyelonephritis

e. Hemorrhage of the urinary tract excluding the urethra

Question 6

Urinalysis results of a voided sample collected from a 2-year-old neutered male Norwegian elkhound:

• Color = yellow
• Turbidity = slightly cloudy
• Specific gravity = 1.016
• pH = 6.5
• Glucose = 2+
• Acetone = negative
• Bilirubin = negative
• Occult blood = negative
• Protein = negative
• RBC = 0-1/hpf
• WBC = none
• Casts = none
• Epithelial cells = moderate
• Bacteria = negative
• Crystals = negative

Which is the most likely cause of these findings?

a. Diabetes mellitus

b. Glucosuria

c. Primary renal glucosuria

d. Fanconi syndrome

e. Generalized tubular disease

Question 7

Urinalysis results of a voided sample collected from a 15-year-old female cat:

• Color = light yellow
• Turbidity = clear
• Specific gravity = 1.022
• pH = 5.5
• Glucose = negative
• Acetone = negative
• Bilirubin = negative
• Protein = negative
• RBC = none
• WBC = occasional
• Casts = negative
• Epithelial cells = occasional
• Bacteria = negative
• Crystals = none

Which is the most appropriate interpretation of these results?

a. The patient's kidneys have impaired ability to concentrate and dilute urine.

b. The patient's kidneys have impaired ability to concentrate urine.

c. The patient's kidneys have impaired ability to dilute urine.

d. The patient has a fixed urine specific gravity, probably as a result of primary renal failure.

e. The patient's kidneys can concentrate urine to some degree.