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AtlasofCanineandFelineUrinalysis Atlas of Canine and Feline Urinalysis TheresaE.Rizzi OklahomaStateUniversity,Stillwater,OK AmyValenciano IDEXX,FlowerMound,TX,USA MaryBowles OklahomaStateUniversity,Stillwater,OK,USA RickCowell IDEXX,HillsideStreet,OK,USA RonaldTyler Harlingen,TX,USA DennisB.DeNicola ChiefVeterinaryEducatorIDEXXLaboratoriesOneIDEXXDriveWestbrook,ME,USA Thiseditionfirstpublished2017. ©2017JohnWiley&Sons,Inc. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inany formorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,exceptaspermittedbylaw. Adviceonhowtoobtainpermissiontoreusematerialfromthistitleisavailableat http://www.wiley.com/go/permissions. TherightofTheresaE.Rizzi,AmyValenciano,MaryBowles,RickCowell,RonaldTyler,andDennisB.DeNicolatobe identifiedastheauthorsofthisworkhasbeenassertedinaccordancewithlaw. RegisteredOffices JohnWiley&Sons,Inc.,111RiverStreet,Hoboken,NJ07030,USA EditorialOffice 111RiverStreet,Hoboken,NJ07030,USA Fordetailsofourglobaleditorialoffices,customerservices,andmoreinformationaboutWileyproductsvisitusat www.wiley.com. Wileyalsopublishesitsbooksinavarietyofelectronicformatsandbyprint-on-demand.Somecontentthatappears instandardprintversionsofthisbookmaynotbeavailableinotherformats. LimitofLiability/DisclaimerofWarranty Thecontentsofthisworkareintendedtofurthergeneralscientificresearch,understanding,anddiscussiononlyand arenotintendedandshouldnotberelieduponasrecommendingorpromotingscientificmethod,diagnosis,or treatmentbyphysiciansforanyparticularpatient.Inviewofongoingresearch,equipmentmodifications,changesin governmentalregulations,andtheconstantflowofinformationrelatingtotheuseofmedicines,equipment,and devices,thereaderisurgedtoreviewandevaluatetheinformationprovidedinthepackageinsertorinstructionsfor eachmedicine,equipment,ordevicefor,amongotherthings,anychangesintheinstructionsorindicationofusage andforaddedwarningsandprecautions.Whilethepublisherandauthorshaveusedtheirbesteffortsinpreparing thiswork,theymakenorepresentationsorwarrantieswithrespecttotheaccuracyorcompletenessofthecontentsof thisworkandspecificallydisclaimallwarranties,includingwithoutlimitationanyimpliedwarrantiesof merchantabilityorfitnessforaparticularpurpose.Nowarrantymaybecreatedorextendedbysalesrepresentatives, writtensalesmaterialsorpromotionalstatementsforthiswork.Thefactthatanorganization,website,orproductis referredtointhisworkasacitationand/orpotentialsourceoffurtherinformationdoesnotmeanthatthepublisher andauthorsendorsetheinformationorservicestheorganization,website,orproductmayprovideor recommendationsitmaymake.Thisworkissoldwiththeunderstandingthatthepublisherisnotengagedin renderingprofessionalservices.Theadviceandstrategiescontainedhereinmaynotbesuitableforyoursituation.You shouldconsultwithaspecialistwhereappropriate.Further,readersshouldbeawarethatwebsiteslistedinthiswork mayhavechangedordisappearedbetweenwhenthisworkwaswrittenandwhenitisread.Neitherthepublishernor authorsshallbeliableforanylossofprofitoranyothercommercialdamages,includingbutnotlimitedtospecial, incidental,consequential,orotherdamages. LibraryofCongressCataloging-in-PublicationData Names:Rizzi,TheresaE.,author.|Valenciano,Amy,author.|Cowell,Rick,author.|Tyler,Ronald,author.|Bowles, Mary,1950–author.|DeNicola,D.B.,author. Title:Atlasofcanineandfelineurinalysis/Dr.TheresaE.Rizzi,Dr.AmyValenciano,Dr.RickCowell,Dr.Ronald Tyler,Dr.MaryBowles,Dr.DennisB.DeNicola. Description:Hoboken,NJ:JohnWiley&SonsInc.,2017.|Includesindex. Identifiers:LCCN2017006139(print)|LCCN2017014316(ebook)|ISBN9781119110354(pbk.)| ISBN9781119110392(AdobePDF)|ISBN9781119110415(ePub) Subjects:LCSH:Dogs–Diseases–Diagnosis.|Cats–Diseases–Diagnosis.|Urine–Analysis.|MESH:Dog Diseases–urine|Urinalysis–veterinary|CatDiseases–urine|Atlases Classification:LCCSF991.R592017(ebook)|LCCSF991(print)|NLMSF991|DDC636.7089/607566–dc23 LCrecordavailableathttps://lccn.loc.gov/2017014316 CoverDesign:Wiley CoverImages:CourtesyofTheresaRizzi Setin10/12ptWarnockProbyAptaraInc.,NewDelhi,India 10 9 8 7 6 5 4 3 2 1 v Dedication TheauthorswouldliketodedicatethisAtlastoourfamilieswhosupportedusnotonlyinour effortstowritethetextbutalsointhemanyyearsspentinacquiringtheknowledgetodevelop itscontent.WealsodedicatethisAtlastotheveterinarypractitioners,technicians,diagnostic laboratory personnel, and students who strive to enhance the care of the dogs and cats that enrichpeople’slives. PersonalDedications MyeffortsarededicatedtoJesusChrist,LordandSavior,andtomyhusband,Daniel,daughter, Avery,andson,Ty. AmyValenciano Tomymotherwhogavememycoretenantsoffaith,honestyandrespect;myamazingwife, Reba,forherpatienceandsupport;mychildren–Reba,Ron,Britt,andBlake–whohavemade my life truly wonderful, exciting, and worthwhile; and the many exceptional colleagues who havetaught,inspiredandguidedme–especiallyRogerPancieraforhismentorshipandRick Cowellforhismanycontributionstomydevelopmentasapersonandpathologistand,mostof all,forhisfriendshipthroughtheyears. RonTyler To my parentswho taught me the value of honestyand instilled in me a work ethic that has servedmewellthroughtheyears.Tomywife(Annette)anddaughter(Anne)whohavecontin- uallygivensupport,meaning,andinspirationtomylife.Tomydaughter(Rebecca)whoshowed methefaceoftruecourageandtaughtmehowtolaughandloveevenintheworstoftimes. Whileshelostherbattlewithcancerattheageof11,hermemoriesandlifelessonswillforever beremembered. TothemanyoutstandingveterinaryclinicalpathologistsIhavehadtheopportunitytolearn from, especially Drs. Ronald D. Tyler, James Meinkoth, and Dennis DeNicola. To the many veterinarypractitioners,residents,andstudentswhotaughtmemuchmorethanIcouldhave everhopedtoteachthemandhavebecomecolleaguesandfriends.ToIDEXXlaboratoriesfor theircontinuedsupportofveterinaryeducation. RickCowell vi Dedication Tothemanypeoplewhoencouragedandassistedmeduringmycareerasaveterinaryclinician andeducator. Myparentswhomademanysacrificestohelpmeattainmygoalofbecomingaveterinarian. Myhusband,John,andmychildren,WillandLisa,whogavemeunconditionalsupportwhile experiencingmanywork-relatedinterruptionsinourfamilylife. Dr.JoeDorner,theveterinaryclinicalpathologistandinstructor,whofirstsparkedmyinterest inclinicalpathologyandmademerealizeitsimportanceinpatientmanagement. Dr. Ralph Buckner, who was a wonderful mentor and role model for my development as a clinician,teacher,andhumanbeing. ThenumerouscontributorstotheveterinaryurologyliteraturesuchasDrs.CarlOsborne, JodyLulich,StephenDibartola,DennisChew,GregGrauer,ShellyVaden,andJoeBartges,who helpedexpandmyknowledgeandabilitytoteachthesubjectofurology. Thestudents,colleagues,clients,andpatientsIhavebeenprivilegedtoknowwhoconstantly stimulatedmetoenhancemyknowledgeandskillsasaclinicianandateacher. MaryBowles Thisbookisdedicatedtomywife,Debbie,andsonAiden,whoeverydayinspiremetobethe persontheybelieveIam.Tomyparentsthatinstilledinmeastrongworkethicandthevalue ofintegrityinallIdoandtomysiblingswhohelpedmedevelopmysenseofhumoranddeep senseofunconditionallove.Tomymentors,Drs.RickCowellandJamesMeinkoth,whogave meanopportunitymanyyearsagoandcontributedtomydevelopmentasaclinicalpathologist; Iamforevergrateful.Lastly,thisbookisdedicatedtocolleagues,residents,students,andstaff atOklahomaStateUniversitywhomakewhatIdosoenjoyable. TheresaE.Rizzi vii Contents Acknowledgments ix Introduction 1  SampleCollectionandHandling 3 CollectionofUrineSamples 3 Free-CatchUrineCollection 3 TransurethralCatheterization 15 Cystocentesis 37 UrineSampleHandling 44 Culture 44  InitialAssessment:PhysicalCharacteristics 47 Volume 47 Color 47 Clarity/Turbidity 48 Odor 48 UrineSpecificGravity 49  UrineChemistry 53 UrinepH 53 Protein 54 Glucose 60 Ketones 61 Blood(OccultBlood,Heme) 63 Bilirubin 64  UrineSediment 67 PreparationforMicroscopicExamination 67 Casts 67 HyalineCasts 68 CellularCasts 71 GranularCasts 73 WaxyCasts 78 FattyCasts(LipidCasts) 79 HemoglobinCasts 81 viii Contents MixedCasts 82 PseudoCasts 85 Crystals 86 CrystalsAssociatedwithUrolithFormation 86 CrystalsNotTypicallyAssociatedwithCanineandFelineUrolithFormation 120 Drug-InducedCrystals 130 Cells 131 TransitionalEpithelialCells 131 SquamousEpithelialCells 136 RenalTubular(Cuboidal)EpithelialCells 140 Leukocytes 141 Erythrocytes 145 Atypical(Neoplastic)Cells 148 Organisms 157 Bacteria 157 FungalHyphae 161 Yeast 163 DioctophymarenaleOva 165 Capillariaplica(nowPearsonemaplica)andCapillariafeliscati Ova 166 Microfilaria 168 MiscellaneousFindingsandArtifacts 169 Pollen 169 FungalSpores 170 Mucus 172 LipidDroplets 173 Sperm 174 AirBubbles 176 StarchGranules(GlovePowder) 177 Fiber 178 Reference 181 Index 183 ix Acknowledgments We thank our families for their love and Health Sciences; to John W. Bowles for support. Acknowledgement and thanks are photographic contributions to the many of extended to the dedicated doctors, tech- the figures included in this Atlas; and to nicians, students, and staff of Oklahoma Wiley-Blackwell’s extraordinary editors and State University’s Center for Veterinary staff.  Introduction Urinalysis(UA)isarelativelyrapiddiagnos- characteristics, the measurement of specific tic test that provides information about the gravity, assessment of chemical properties, urinary system as well as other body sys- and the microscopic examination of urine tems, and is often performed as part of the sediment. The UA, when performed in- minimum database of diagnostic tests that house,shouldbeevaluatedsoonaftercollec- includesacompletebloodcount(CBC) and tiontoeliminateartifactsthatoccurduetoa clinical biochemistry profile. Indications for timedelay,thusemphasizingtheimportance performingaUAincludeclinicalsignsassoci- ofanaccurateevaluationofthecompleteUA. atedwiththeurinarytract,butalsoaspartof The purpose of the Atlas of Canine and ageneralhealthscreen,inpatientswithsys- Feline Urinalysis is to aid veterinary prac- temicillness,whenmonitoringaresponseto titioners, veterinary technicians, veterinary treatment,andinscreeningforbreed-related students, and veterinary diagnostic labora- urinarytractdisease. tory personnel in the accurate collection, There are four components to a complete handling,andevaluationofcanineandfeline UA:evaluationoftheurinesample’sphysical urinesamples. AtlasofCanineandFelineUrinalysis,FirstEdition.TheresaE.Rizzi,AmyValenciano,MaryBowles,RickCowell, RonaldTyler,andDennisB.DeNicola. ©2017JohnWiley&Sons,Inc.Published2017byJohnWiley&Sons,Inc.   SampleCollectionandHandling Themethodofurinecollectionandthesub- sample contamination, urinary bladder sequenthandlingofthesamplecaninfluence trauma,andrefluxofinfectedurineintothe the interpretation of results. The following ureters, kidney, and prostate. Furthermore, discussionisareviewofurinecollectionand this technique cannot be used following a handlingtechniques. cystotomyoperationandmaybeunpleasant inotherpostoperativelaparotomypatients. Collecting a midstream urine sample is CollectionofUrineSamples preferredtominimizesamplecontamination; however, some contamination with cells, The three techniques for urine collec- bacteria, and debris from the distal urethra, tion are: free-catch, catheterization, and genitaltract,andexternalskinandhaircoat cystocentesis. Each of these methods of is unavoidable. Obtaining an optimal free- collection and their associated advantages catchsamplecanbefacilitatedbyusingone anddisadvantageswillbediscussed.General container to collect the beginning of the considerations related to urine sample col- urinestreamandthenchangingtoasecond lection,handling,andsubmission,regardless collectingcontainerastheurinestreamcon- of collection method, are listed in Box 1.1 tinues. The urine in the second container (Figures1.1–1.4). should be more representative of a true midstream sample. In some cases, a free- Free-CatchUrineCollection catch sample containing white cells, bacte- ria, and/or protein may be an indication to The free-catch method of urine collec- collectasubsequentpatienturinesamplevia tion (Box 1.2 and Figures 1.5–1.9) is often cystocentesis or catheterization in order to easy to perform but is dependent upon helpestablishthesourceoftheabnormalities the cooperation of the patient and may identifiedinthevoidedsample. be difficult to accomplish in patients with Sometimes a satisfactory free-catch sam- conditions producing urge incontinence. plecannotbeobtainedeitherduringnormal Samplesareusuallycollectedduringnormal voiding or via manual expression, most voiding or by manual external compression commonly due to the pet’s behavior or urge of the urinary bladder. Normal voiding incontinence. Manual expression can be free-catch urine sampling can often be especiallyproblematicinmalecatsasaresult performedbytheownersanddoesnotpose of resistance to handling and difficulty in a risk to the pet. The manual compression initiating voiding due to the small diameter of a distended urinary bladder (Box 1.3 and of the male feline urethra. Collecting urine Figures1.10–1.14)maybeattheconvenience bycatheterizationorcystocentesisarealter- ofthecollector;however,drawbacksinclude native options but not readily accomplished AtlasofCanineandFelineUrinalysis,FirstEdition.TheresaE.Rizzi,AmyValenciano,MaryBowles,RickCowell, RonaldTyler,andDennisB.DeNicola. ©2017JohnWiley&Sons,Inc.Published2017byJohnWiley&Sons,Inc.

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