छोटी सी बात - vvets.orgvvets.org/wp-content/uploads/2015/11/Chhotisi-Baat.pdfNo...
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छोटी सी बात
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Dr. Vinod Soni PETVET CLINIC
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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
Slide with this symbol shows that it is taken from internet
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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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Mechanism of Urine formation
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Auto regulatory mechanism
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
0
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
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Some times we do perfect treatment and get excellent result,
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without knowing what disease we treated.
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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
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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.
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Don’t
hesitate to
ask any
question.
Question – Answer Session