Urinalysis and UTI

RE: Urinalysis and UTI

Michael Woodhouse — Tue, 07 Nov 2017 00:44:44 GMT

[quote user="Avril mcginn"]hibi bid for the vulva[/quote]

If I had a vulva and it was sore the last thing in the world I'd want on it was Hibiscrub!

RE: Urinalysis and UTI

Anthony Todd — Tue, 07 Nov 2017 00:13:27 GMT

Wot, no virulent microbes?

RE: Urinalysis and UTI

Beats — Mon, 06 Nov 2017 23:51:29 GMT

A light anecdote:

When one of my toddlers got up one Friday morning complaining of a sore penis (which looked normal on exam) and squealing when he tried to urinate, producing only a tiny squirt, a visit to the GP seemed inevitable.

As a small squirt was available in a moderately clean potty and the GP did not open for another couple of hours, I checked it out under the microscope the same way I would a dog and there was no sign of any rbcs/wbcs/bacteria. Knowing the GP (whom I highly rate) doesn't have access to such high-tech equipment as a microscope, I wrote down the SG, dipstick and sediment findings and sent them with my wife. The GP was grateful, acknowledged that a culture from potty urine a few hours old that would not be plated up for a few days and would not generate any results for a week was a fairly pointless activity, but did so anyway.

The toddler proceeded to urinate normally for the remainder of the day.

RE: Urinalysis and UTI

Anthony Todd — Mon, 06 Nov 2017 23:20:00 GMT

Avril mcginn "since posting the original question I came across a paper (Olin and Bartges, 2015) "

Urinary tract infection (UTI) occurs when there is compromise of host defense mechanisms and a virulent microbe adheres, multiplies, and persists in a portion of the urinary tract. Most commonly, UTI is caused by bacteria, but fungi and viruses are possible. Urine culture and sensitivity are the gold standards for diagnosis of bacterial UTI. Identifying the location of infection (eg, bladder, kidney, prostate) as well as comorbidities (eg, diabetes mellitus, immunosuppression) is essential to guide the diagnostic and therapeutic plan. Antimicrobial agents are the mainstay of therapy for bacterial UTI and selected ideally based on culture and sensitivity.

I leave others to assess the summary above, but it reminds me of the views of Rich and Fabricant in the late 60s and the style too.

RE: Urinalysis and UTI

Beats — Mon, 06 Nov 2017 21:57:51 GMT

[quote user="Avril mcginn"]

On a side note......neutrophils in urine sample don't have clear segmented nucleus that you see in blood smears....my old boss used to call them 'fluffy neutrophils', does anyone know the proper term for this?

Thanks :)

[/quote]

I think I would call these "toxic" neutrophils, but fluffy neutrophils sounds a better term to me.

RE: Urinalysis and UTI

Avril Mc Ginn — Mon, 06 Nov 2017 21:01:40 GMT

Thanks :)

RE: Urinalysis and UTI

Avril Mc Ginn — Mon, 06 Nov 2017 20:37:59 GMT

thank you everyone for all your advice, busy week and on call weekend so only getting to read it now!!

since posting the original question I came across a paper (Olin and Bartges, 2015) which suggests that for an uncomplicated bacterial UTI (so I'm thinking of female dogs first presentation here) if the appropriate antibiotic has been used 'clinical signs and results of a complete urine analysis should resolve within 48hours' and if possible to perform a urine culture 5-7days after stopping antibiotics (I guess I only do this is signs recur usually).

Olin S and Bartges J. 2015 Urinary Tract Infections Treatment/Comparative Therapeutics. Vet Clin Small Anim 45(721-746)

I happened to have a case present over the weekend, FN lab, 4/5year old, pollakuria/stranguria, with saliva staining over the vulva and vulval irritation, so I gave amox-clav, hibi bid for the vulva and plan repeat urinalysis in 3days, but continue ab for the week as the vulva as quite inflammed, then reassess, I guess irritated vulva could be the cause in this one, and if not then move onto u/s and culture.

RE: Urinalysis and UTI

Anthony Todd — Mon, 06 Nov 2017 17:46:00 GMT

[quote user="Martin Atkinson"]everyone else comprehensively disagreed with you and its not going to change![/quote]

Wish I was squashed by evidence, rather than unsubstantiated dogma, but there never is any.

I'll shut up if you stop the "corticosteroids are bad" every single time they're advised or used.

RE: Urinalysis and UTI

Martin Atkinson — Mon, 06 Nov 2017 16:49:49 GMT

[quote user="Avril mcginn"]this is for a simple uncomplicated UTI[/quote]In an uncomplicated case I would just give a short course of antibiotics and only start repeating urinalysis if the symptoms don't resolve/recur quickly/frequently.

[quote user="Anthony Todd"]

My whole one-starred point!

"uncomplicated UTi's" in the cat are always crystal-based.

The "infection" is just because bacteria are found in the sample and, now, crystals are normal ,therefore ignored.

[/quote]For the love of God Anthony don't let's start this argument again. We've had it all before, everyone else comprehensively disagreed with you and its not going to change!

RE: Urinalysis and UTI

Anthony Todd — Mon, 06 Nov 2017 13:02:54 GMT

[quote user="Lucy Fleming"]Arguably not - I'm not saying you are wrong, just that the OP was about uncomplicated UTIs, so we are already in danger of wandering severely off topic by starting to talk about crystalluria.[/quote]

My whole one-starred point!

"uncomplicated UTi's" in the cat are always crystal-based.

The "infection" is just because bacteria are found in the sample and, now, crystals are normal ,therefore ignored.

RE: Urinalysis and UTI

Lucy Fleming — Mon, 06 Nov 2017 12:34:50 GMT

[quote user="Anthony Todd"]Do they exist in the cat, which is my sole point?[/quote] Arguably not - I'm not saying you are wrong, just that the OP was about uncomplicated UTIs, so we are already in danger of wandering severely off topic by starting to talk about crystalluria.

Regarding the AGs, I don't think I've even seen anything reported, and I could be wildly off base with it but:

Signalment: usually female dog.

Presenting signs: pollakiuria, stranguria, sometimes haematuria also reported by owner. When questioned, usually licking of the perinuem also present. Often this predates the urinary signs.

My theory is this (and it is only my pet theory, not proven by any means!) - full glands cause discomfort, which the dog tries to alleviate by licking. As is often the case, they tend to lick the general area (same as when you get those bald spots due to chewing on the side of the rump) which often includes the vulva. Licking leads to ascending infection of the lower urinary tract (opportunistic).

Treatment: manually empty glands to stop the licking. Treat with short course broad spectrum abs (as infection already established) and usually nsaid for inflammation/ discomfort. Resolution might occur without abs but I'm not convinced...

RE: Urinalysis and UTI

Anthony Todd — Sun, 05 Nov 2017 17:29:47 GMT

[quote user="Lucy Fleming"]which was about uncomplicated bacterial UTIs[/quote]

Do they exist in the cat, which is my sole point?

And in the dog without uroliths??

RE: Urinalysis and UTI

Anthony Todd — Sun, 05 Nov 2017 11:29:15 GMT

[quote user="Lucy Fleming"]poorly targeted licking of the general area ---> ascending UTI[/quote]

I don't think i've ever heard of the A/Gs being incriminated before??

How do you treat this? Give full details of all measures please.

RE: Urinalysis and UTI

Anthony Todd — Sun, 05 Nov 2017 11:25:49 GMT

[quote user="robloxley"]Tell that to the dog I saw on Wednesday with a stone stuck in it's urethra, unable to pee![/quote]

I actually said "often don't" not "never". Similar to cats' crystals which often don't cause obstruction, Oh, sorry, they're now normal".

PS The original post did say "animal".

RE: Urinalysis and UTI

Lucy Fleming — Sun, 05 Nov 2017 10:55:20 GMT

I think talking too much about crystals and stones is in danger of tangent-ing the thread, which was about uncomplicated bacterial UTIs

[quote user="Beats"]My personal approach? When I see a case presenting with signs of cystitis, I stick the ultrasound on to quickly check bladder, take a cysto and examine it - bacteria seen then offer culture (19.99+VAT at Idexx I think) based on if antibacterials given don't work then will be useful in few days time, but chances are won't change treatment. I check the vulval confirmation. I don't auscultate the heart. Time taken = 10mins-15mins.[/quote]

I don't ultrasound the bladder generally (ours takes too long to boot up!) but I do usually check anal glands. Especially in a female dog I often find impacted glands ---> poorly targeted licking of the general area ---> ascending UTI

RE: Urinalysis and UTI

Rob Loxley — Sun, 05 Nov 2017 10:26:26 GMT

[quote user="Anthony Todd"]No, dogs are different in that crystals don't form obstructions, I suppose because the urethra in the dog is much wider, crystals are passed and stones obstruct or enlarge in the bladder, but often don't form total blockages.[/quote]

Tell that to the dog I saw on Wednesday with a stone stuck in it's urethra, unable to pee!

RE: Urinalysis and UTI

Beats — Sun, 05 Nov 2017 07:50:50 GMT

I was assuming this discussion was on dogs given I've never personally seen a simple uncomplicated UTI in a cat? (No doubt others have, but I can't remember one so must be pretty rare)

Assuming I'm correct, then might be better starting a separate thread for cats to avoid confusion.

[quote user="Anthony Todd"]The crystals form stones and concurrently you get a bacterial infection probably, I guess, because the pH of the urine is increased, with struvite [or triple phosphate].[/quote]

I would guess that the bacteria typically come first and then struvite uroliths in dogs. Urease-producing bacteria resulting in urea being split to ammonia, increasing the pH and ready supply of of one part of struvite. Has always seemed reasonable hypothesis to me and fits with my experience of clinical cases.

Healthy dogs make much less concentrated urine than healthy cats, so crystallisation much less likely in this more dilute solution unless conditions such as presence of urease-producing bacteriuria (symptomatic/asymptomatic) present, leading to increased pH and ammonia - thus shifting the equilibrium position in favour of struvite.

Culture can identify the bacterial species, irrespective of any sensitivity MIC data (which I still consider helpful), which is usually a pure culture and usually correlates well with sediment exam - the knowledge of the bacterial species alone can be of some use in selecting antibacterials for that case, as well as identifying if a further UTI is a re-infection or persistent infection, as well as identifying whether a possible urease-producer or not. It is perhaps most helpful for the cases where clinical signs do not clear with the initial empirical choice of antimicrobial, and having collected the culture at initial presentation lest the empirical choice not be effective has the advantages that one actually has results at the same time as note lack of efficacy to initial empirical choice (so can choose second-choice antibacterial based on culture results), and, I suspect, overall better culture rate rather than taking while on clinically-ineffective antimicrobial?

My personal approach? When I see a case presenting with signs of cystitis, I stick the ultrasound on to quickly check bladder, take a cysto and examine it - bacteria seen then offer culture (19.99+VAT at Idexx I think) based on if antibacterials given don't work then will be useful in few days time, but chances are won't change treatment. I check the vulval confirmation. I don't auscultate the heart. Time taken = 10mins-15mins. I fully appreciate could do in 5mins by just dispensing antibacterials based on signs alone, but I personally find it irritating when these cases come back and haven't simply resolved, so prefer to check them all at first presentation time-permitting. I personally find that a a fair proportion of such cases tend not to turn out to be "simple uncomplicated" UTI's, but perhaps that is a bias of my memory of those cases while I forget the simple ones.

RE: Urinalysis and UTI

Anthony Todd — Sun, 05 Nov 2017 01:11:15 GMT

[quote user="Lucy Fleming"]And dogs?[/quote]

No, dogs are different in that crystals don't form obstructions, I suppose because the urethra in the dog is much wider, crystals are passed and stones obstruct or enlarge in the bladder, but often don't form total blockages.

The crystals form stones and concurrently you get a bacterial infection probably, I guess, because the pH of the urine is increased, with struvite [or triple phosphate].

Cats present differently although they do form struvite and other stones sometimes but usually it is the crystals that obstruct.

I'm hope I'll be corrected, as I'm mainly interested in the cat, and recent research may prove me wrong.

RE: Urinalysis and UTI

Lucy Fleming — Sat, 04 Nov 2017 22:16:34 GMT

And dogs?

RE: Urinalysis and UTI

Anthony Todd — Sat, 04 Nov 2017 19:55:38 GMT

[quote user="Lucy Fleming"]Are you suggesting that bacterial infection never plays a role at all [/quote]

Yup, you may not have heard of Koch's postulates, but I've never seen that tested with UTis in cats.

But then crystals in cats' urine are "normal" these days..... it's all stress.

A turboposting may ensue.

RE: Urinalysis and UTI

Lucy Fleming — Sat, 04 Nov 2017 19:47:47 GMT

[quote user="Anthony Todd"]

[quote user="Lucy Fleming"]

I can think of a few we've had back where the bacteria involved have some innate resistance (sometimes to the antibiotic we've chosen) so it has had its uses. I don't use it often though (especially as a lot of our samples are free catch)

[/quote]

Or it was nothing to do with bacteria in the first place??

[/quote]

That's possible, of course. Signalment, history, clinical exam findings and comorbidities would play a role in decision making. Are you suggesting that bacterial infection never plays a role at all or have I misunderstood completely?

RE: Urinalysis and UTI

Anthony Todd — Sat, 04 Nov 2017 18:58:11 GMT

[quote user="Lucy Fleming"]

[/quote]

Or it was nothing to do with bacteria in the first place??

RE: Urinalysis and UTI

Lucy Fleming — Sat, 04 Nov 2017 18:23:56 GMT

RE: Urinalysis and UTI

Anthony Todd — Fri, 03 Nov 2017 13:35:51 GMT

[quote user="David Mills"]

How useful is urine culture? Depending on the antibiotic used, many are excreted in the urine and reach very high concentrations. I tend to think of it like ears. Pretty useless in vivo.

[/quote]

Me too, just because they're there doesn't mean they are pathogenic [we go here a lot....]

Take faeces as a similar situation.

RE: Urinalysis and UTI

Anthony Todd — Fri, 03 Nov 2017 12:56:10 GMT

Am I correct in thinking dysuria and/or frequency with low volumes is essential to make a diagnosis of cystitis as, often on here, it seems to be simple incontinence and large volumes, usually at night??