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छोटी सी बात

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Dr. Vinod Soni PETVET CLINIC

Terminology

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1. Ploydipsia: Excessive drinking of water. 2. Azotemia: Presence of high level of nitrogenous waste( like creatinine urea) 3. ADH: Anti diuretic hormone 4. PTH: Para thyroid Hormone 5. Calcitriol: Hormone regulate calcium absorption and blood calcium level

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Routine Urine Analysis

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Glucose

Bilirubin

Ketones

Specific Gravity

Blood

pH

Protein

Urobilinogen

Nitrite

Leukocyte Esterase

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First year of B.V.Sc. : Subject Physiology

Mechanism of Urine formation

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Auto regulatory mechanism

1.Specific Gravity of Urine

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1.005

1.012

1.008

1.015 1.020

1.050

1.035

URINE ANALYSIS

Isosthenuric

Adequate

Inadequate

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Cat 1.020–1.040

Cow 1.030–1.045

Dog 1.015–1.060

Goat 1.015–1.045

Horse 1.025–1.060

Sheep 1.015–1.045

Specific Gravity of Urine in different species

Normal USG range 1.015 and 1.040

• High: less water and or more concentrates

• Low: More water and or less concentrates

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High Urine Specific Gravity

Dehydration Excessive protein leak in the Urine. Diabetes

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If USG is persistently high: chances of uroliths

Low Urine Specific Gravity

Almost equal concentration of plasma

2. Polydipsia

1. Blood Calcium level is high

1.008 -1.012

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Blood Calcium

Ionized Calcium

(Free Calcium)

Bound calcium

(Albumin)

Complex

( un available)

complex calcium

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8.9 - 11.4mg/dl

Note: Blood calcium range in domestic animals is almost same with some marginal difference

Ionized Portion Blood Calcium Low While Its Total Blood Calcium Level Remained Normal :

Free or Ionized Portion Blood Calcium High :

Total Blood Calcium Level High: Ionized Calcium Level Normal :

Ionized Portion Calcium Normal Total Blood Calcium Level Remains High :

High Ionized Portion Blood Calcium Level Total blood Calcium High :

The Ionized Portion Blood Calcium Level Low Total Calcium Levels Might Be Low :

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Normal Total Calcium

Normal Ionized Calcium

Normal Total Calcium

Low Ionized Calcium

Normal Total Calcium

High Ionized Calcium

High Total Calcium

Normal Ionized Calcium

High Total Calcium

High Ionized Calcium

Low Total Calcium

Low Ionized Calcium

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A

E

B

D

C

Normal Total Calcium

Normal Ionized Calcium

Normal Total Calcium

Low Ionized Calcium

1. Chronic Kidney Failure Why?

Hint Calcitriol, and feedback mech. PTH

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Pathological Normal A

Normal Total Calcium

Normal Ionized Calcium

Normal Total Calcium

HIGH Ionized Calcium

1. Some forms of Cancer 2. Hyper parathyroidism 3. Overdose of Vit D 4. Rodent poison exposure 5. Rarely some granulomatous infection

Pathological Normal

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B

In Horse with chronic renal disease frequently have high total calcium with a normal albumin, so presumably ionized calcium is also high

Normal Total Calcium

Normal Ionized Calcium

2. Treatment loswith Phosphate binders 3. Vitamin D3 Deficiency 4. Low blood Albumin

Pathological Normal

Low Total Calcium

Low Ionized Calcium

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C

1. Alkalosis

Normal Total Calcium

Normal Ionized Calcium

High Total Calcium

Normal Ionized Calcium

Pathological Normal

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Also in CKD , may be due to complex Calcium level No need to treat with Vit. D3

D

Normal Total Calcium

Low Ionized Calcium

Pathological A

Normal Total Calcium

Normal Ionized Calcium

1.Acidosis 2.Thyroxin Supplement 3.Faulty blood collection

Pathological Normal

High Total Calcium

High Ionized Calcium

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E

Polydipsia

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4.Cushing Disease: Hyperadrenocorticism

3.Hepatic Insufficiency

2.Pyometra

5.Adison’s Disease: Hypoadrenocorticism

1.Initial sign of Kidney disease

6.Diabetes insipidus

High Specific Gravity

• 1 Dehydration

• 2 Proteinurea

• 3 Diabetes

Risk Factors:

Kidney and or

Bladder stone

formation

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Low Specific Gravity

1.Some forms of Cancer in older dogs 2. Hyper parathyrodism 3. Overdose of Vit D 4. Rodent poison exposure 5. granulomatous infection

12. Acidosis

13.Thyroxin Supplement

9. Cushing Disease: Hyperadrenocorticism

8. Hepatic Insufficiency 7 .Pyometra

10. Adison’s disease: Hypoadrenocorticism

11. Diabetes insipidus

6. Initial sign of Kidney disease

Low Urine Specific Gravity

1. Some forms of Cancer in older dogs 2. Hyperparathyrodism 3. Overdose of Vit D 4. Rodent poison exposure 5. Rarely some granulomatous infection 6. Initial Sign of Kidney disease 7. CKD 8.Pyometra 9. Cushing Disease: Hyperadrenocorticism 10. Addison's disease: Hypoadrenocorticism 11. Diabetes insipidus 12. Hepatic Insufficiency

More investigation required

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All must be seen in the light of clinical findings

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Even though specific gravity is in range of 1.015-1.035 it can be Pathological

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PROTEINURIA

Pre renal cause

Post renal cause

1. CHF 2. Cancer 3. Infection 4. Inflammation

1. Glomerulonephritis 2. Amyloidosis

1.Infection in U.Bladder 2.Leptospirosis 3.UTI

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PROTEINURIA

1. Proteinuria in diluted urine (USG1.008)is more significant than USG 1.035

Acidic urine can cause false negative results while alkaline urine can cause false positive results in U. Protein

2. Urine Protein /Creatinine (UPC ratio)

It is normal up to 2 where BUN is normal . In elevated BUN this ratio > 0.5 is significant

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PROTEINURIA

Urine Protein (mg/dl) Urine Creatinine ( mg/dl)

UPC =

UPC Significance/ Interpretations

Less than 0.5 Normal

0.5 to 1. 0 Doubtful/ Check other parameters

More than 2.0 Considerable proteinuria

More than 5 Glomerular disease like Glomerulonephritis

More than 8 Amyloidosis

Note : Presence of blood and heavy leukocyte count give wrongly elevated Urine Protein

1. Protein loss can reduce antithrombin leading clot formation

2. Ascites 3. Damage to Tubules

causing KI and hyper tension

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Pre renal RENAL Post renal

1. Cardiac Disease Glomerulo nephritis Acute Tubular Necrosis

Hydronephrosis, obstruction, injury to urethra, leptospirosis Rupture of bladder

Sign: Hypovolemia, Dehydration

Sign: Vomiting, diarhea, etc

Sign : Vomiting, dia. Anorexia,edema

Lab: USG>1.035 Lab: USG <1.05 or isosthenuric Urine Presence of non regenerative anemia

BUN:S. cr. >20:1 (However not a marker)

BUN:S. cr. <10:1 Ca+, variable, PO4 increases In cattle PO4 may not increased

BUN:S. cr. =<11 to20:1

Differentiation has clinical importance

Blood Urea Nitrogen 6 – 25 mg/dl

Serum Creatinine 0.6-1.3 mg/dl

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Pre renal RENAL Post renal

1. Cardiac Disease Glomerulo nephritis Acute Tubular Necrosis

Hydronephrosis, obstruction, injury to urethra, leptospirosis Rupture of bladder

Sign: Hypovolemia, Dehydration

Sign: Vomiting, diarhea, etc

Sign : Vomiting, dia. Anorexia,edema

Lab: USG>1.035 Lab: USG <1.05 or isosthenuric Urine Presence of non regenerative anemia

BUN:S. cr. >20:1 (However not a marker)

BUN:S. cr. <10:1 Ca+, variable, PO4 increases In cattle PO4 may not increased

BUN:S. cr. =<11 to20:1

Differentiation has clinical importance

Blood Urea Nitrogen 6 – 25 mg/dl

Serum Creatinine 0.6-1.3 mg/dl

Urine pH

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Dog6.0 to 6.9

6.5 6.0 5.5 5.0 8.5 8.0 7.5 7.0

Food Dog pH< 6.0 (Acidic) 1. CKI 2. Uncontrolled diabetes 3. Chronic diarrhea Dog pH > 7.0 (Alkaline) 1. UTI 2. Possibility of Stone formation

Urine pH

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Horse 6.5- 7.5

Cattle 7.0 9.

6.5 6.0 5.5 5.0 8.5 8.0 7.5 7.0

In Cattle Low pH seen in ketosis

Horse pH > 8.0 (Alkaline) 1.Over reactive and frightened 2. Head flicking Horse pH > 6.0 (Acidic) 1. Dull and lethargic 2. Reluctant to move

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Some times we do perfect treatment and get excellent result,

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without knowing what disease we treated.

Some times we make proper diagnosis, even get failure.

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Some times we make proper diagnosis, even get failure.

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pH 5.50

Specific Gravity 1.009

Protein Trace (Rechecked)

Three daily reports are consistent

of 14 yrs F. Mongerel GINGER

Date Total WBcs /cmm

Hb( g/dl) S.Creatinine

10/8/2015 44500 10.4 2.64

17/8/2015 25100 9.9 1.67

Case no 1

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Date Total WBcs

thousand/cmm Hb G/dl S.creatinine

mg/dl Normal Value

10.00 Normal Value

15.00 Normal Value

1.2

06-10-13 28.9 16.9 9.0

10-10-13 22.5 17.4 6.5

17-10-13 13.3 17.5 3.2

25-10-13 16.3 17.5 2.3

01-11-13 16.9 17.3 2.3

10-07-14 13.2 16.5 2.65

16-08-15 18.7 17 1.5

Case no 2: Mongrel F 11 yrs

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Case no 2 : Mongrel F 11 yrs

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5

10

15

20

25

30

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Total WBcs thousand/cmm

Hb G/dl

S.creatinine mg/dl

Normal S.Cr Value is1.2

Petvet Clinic

Survived

Some times we do perfect treatment and get excellent result,

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without knowing what disease we treated.

Case Paper no 3 Buddy, Rottweiler Male

Date WBC Serum creatn.

BUN Total Calcium mg/dl

Free calcium mmoL/L

SPG pH

Urine Protein

U. pro/u. cr (ratio)

5/08/15 40000 (P 90, L8)

0.8mg/dl

9.3 1.24 1.020 pH 6.0

+++

7/08/15 1.030 pH 6.5

+

8/ 08/15 to 14/08/15

1.030 to 1.045 pH 6.0

+

17/08/15 1.28

26/08/15 38000

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Story of misdiagnosis Female Labrador 9 yrs age

Uterine bleeding with bad smell, anorexia and occasional vomiting

TC very high, Swelling on abdomen

Thought either Pyometra or ovarian cyst

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Actual Case was : Enlarged ureter and cystitis

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First June 2015 1. Leucocytosis 2. S.creatinine

1.3mg/dl

Beginning of September 2015 1. WBC Count : within

Normal range 2. S.Creatinine

1.6mg/dl Sonography report Right kidney grossly dialated renal pelvis and ureter up to its opening into Urinary bladder

Imaginary

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Specific Gravity<1.08 Rule out systemic infection

Azotemic Non Azotemic

Check Blood Calcium

Free Calcium low

CKD

Normal Check U. Protein

Significant UP

Check U. Protein: Creatinine ratio

Algorithm

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Further reading

1. Other routine urine analysis parameters like casts and crystals ,WBC, RBC, Bilirubin, Urobilinogen Glucose and Ketone.

2. Limitations of Dip stick methods and alternative tests.

3. False positive and false negative results

4. Some hormone functions : ADH, Aldosterone hormone, ACTH.

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Specially to listeners

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Special thanks to my 10 years old HP Desktop And to my pen drive too.

And thanks to Dr. Dhara and Dr. Varun Dr. Alekhya, Dr. Rohit, Dr.Dave and Dr. Vacchani

Suvarna, my wife: and my daughter Taral

Shreeji lab., Toparani lab and Sonal lab

Thanks to Mr. and Ms. Google

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Never last but always first My Patients.

Don’t

hesitate to

ask any

question.

Question – Answer Session