TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 

DIAGNOSIS: URINALYSIS (URINE TESTS)

 

ON THIS PAGE:


What is Urinalysis?


Obtaining the Urine Sample


The Various Tests:


Urine Specific Gravity (USG)


Osmolality


Blood in Urine (Haematuria)


Proteinuria


Urine Protein:Creatinine Ratio


Urine pH


Glucose


Urinary Tract Infections & Pyelonephritis (Kidney Infections)


 

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Home > Diagnosis > Urinalysis

 


Overview


  • There are a number of tests which can be run on a urine sample. Collectively these tests are known as urinalysis.

  • The USG test can help with the diagnosis of CKD, and may be useful for detecting early CKD before it begins to show in blood tests.

  • The UP:C (urine protein to creatinine ratio) test can give some idea of the severity of the CKD.

  • Urine tests are also very important for helping to diagnose kidney and urinary tract infections.


What is Urinalysis?


 

Urinalysis is the term used to refer to a series of tests run on a urine sample. These tests can help to confirm the CKD diagnosis, or may give an early warning of CKD. They are also used to check for imbalances and infections.

 

Pet Education gives an overview of urinalysis.

Pet Place discusses urinalysis.

VCA Hospitals has a good overview of urinalysis.

Pet MD explains the benefits of urinalysis.

Interpretation of canine and feline urinalysis (2004) Chew DJ & DiBartola SP Nestlé Purina Clinical Handbook Series has detailed information.

Diagnostic caveats for difficult bacterial urinary tract infections (2005) Osborne CA DVM News Magazine discusses UTIs and includes a table (Table 7) which shows what the levels of bacteria found in a urine sample obtained by various methods probably indicate.

Urinalysis (2016) Whitbread TJ The Merck Veterinary Manual has information about urinalysis.

Cornell University Colege of Veterinary Medicine explains more about urinalysis.

Urinalysis and Urine Sediment (2004) is a presentation by Dr MM Christopher to the World Small Animal Veterinary Association World Congress.

 


Obtaining Urine Samples


 

Urine samples may be obtained in a number of ways. Some methods (free catch and non-absorbent litter) can be used at home and you then take the sample to your vet for testing. Samples obtained in this way are sufficient to run most of the tests discussed here, but are not sterile, so are not suitable for running a culture and sensitivity test (see below) to check for infection. In this situation, ideally you need to take your cat to your vet for cystocentesis.

 

If you do obtain a sample at home, ideally you want to take it to the vet within four hours. If you are assessing the urine for the presence of crystals, you need to take it in sooner: Effects of storage time and temperature on pH, specific gravity, and crystal formation in urine samples from dogs and cats (2003) Albasan H, Lulich JP, Osborne CA, Lekcharoensuk C, Ulrich LK & Carpenter KA Journal of the American Veterinary Medical Association 222(2) pp176-179 found that "Storage time and temperature did not have a significant effect on pH or specific gravity" but "Urine samples should be analyzed within 60 minutes of collection to minimize temperature- and time-dependent effects on in vitro crystal formation."

Urine collection in dogs and cats (2013) Hüttig A & The IRIS Board International Renal Interest Society has information on the various urine collection methods.

 

Urinalysis: performing an accurate urine sediment analysis (2009) Lulich JP Delaware Valley Academy of Veterinary Medicine discusses how to obtain urine samples in more detail.

 

Free Catch


Free catch means that you stick a container under your cat as s/he urinates and catch some urine in it. I can't imagine my cats tolerating this but some people's cats don't mind, in which case it is probably the quickest and easiest way.

 

Some people use a ladle, which means you don't need to get too close to your cat. You can also buy sterile, individually wrapped cups for this purpose from your vet or online. As with humans, you should aim for a mid stream sample, i.e. let your cat urinate for a few seconds before putting the cup in place. To maintain sterility, try not to let the cup touch anything, such as your cat or the litter tray.

 

Rocket Medical sell a sterile urine catcher called the Urikone which costs £69.60 for 50.

 

Non-absorbent Litter


Non-absorbent litter is made of non-absorbent granules. You put it in the litter tray in place of normal litter, and since it does not absorb liquids, you can scoop up some urine to take to the vet.

 

Nosorb is one brand which can be washed and re-used.

 

Kit 4 Cat is another type of non-absorbent litter that is apparently very similar to real (sandlike) litter.

 

Katkor is a non-absorbent litter available in a variety of European countries.

 

My vet sells the Smart Cat Urine Test Kit for £2 a packet. My cats like a lot of litter, so I use two bags, but some people do only use one bag. This is a one use only kit.

 

Detection Litter


These are litters that change colour when they detect certain things in a cat's urine, such as blood. Veterinary Practice News (2008) explains more about how these products work.

 

Although these tests can give you some basic information, e.g. the presence of blood or bacteria, you should take a urine sample to your vet for proper analysis. The white blood cell reading in the urine test itself is often inaccurate.

The Pet Check Up is a test that checks for blood in urine, and which may also be used to check for other issues, such as diabetes.

 

Pretty Litter is a similar product.

 

Crystal Clear Pet Products sell Nullodor Health Indicator litter in the UK.

 

Cystocentesis


This is the best way to obtain a sterile sample, which is required in order to run a culture and sensitivity test to check for infections (see below).

 

Cystocentesis means the removal of urine from the bladder via a fine needle. It sounds far worse than it is, I've seen this done on my cats and they do not even flinch. It is safe as long as you have a competent vet, who should use ultrasound to guide the needle. It is only suitable for a cat who has urine in the bladder, and it is usually not appropriate for a cat who struggles at the vet's.

 

Occasionally cystocentesis can cause blood in the urine. Diagnostic cystocentesis: technique and considerations (2006) Brown C Lab Animal 35(4) pp21-23 explains more about this.

 

Urinary tract infection: how to diagnose and treat correctly (2003) is a presentation by Claudio Brovida to the World Small Animal Veterinary Association World Congress 2003, which explains why cystocentesis is the ideal method of urine collection, but not always possible.

 

Pet Place describes how cystocentesis is performed.

 


The Various Urine Tests


 

The urine sample will be used to run a number of different tests, which will provide your vet with a variety of information about various aspects of your cat's health. The tests include:

 


Urine Specific Gravity (USG)


 

The urine specific gravity (USG) test checks whether the cat is concentrating urine appropriately. Because of their desert heritage, in normal circumstances healthy cats have concentrated urine, but CKD cats usually have dilute urine.

 

A cat's USG level may change quite a lot over the course of even a day. Before diagnosing CKD, therefore, the test should be run more than once and other causes ruled out.

 

Once a cat is receiving regular fluid therapy, this test can be rather unreliable. 

 

Urine specific gravity (2015) Watson ADJ, Lefebvre HP & Elliott J International Renal Interest Society has information on the significance of USG in cats.

Cornell University College of Veterinary Medicine has more information about USG. 

Azotaemia and urine specific gravity (2008) is a presentation by Dr JE Maddison to the World Small Animal Veterinary Association World Congress.

 

Urine Specific Gravity (USG): How to Check


This test should be run by refractometer - using the dipstick method is rather unreliable.

 

Advanced interpretation of the urine dipstick (2010) Pressler B CVC in Washington DC Proceedings states ""Refractometers are the best balance between cost and accuracy for measuring urine specific gravity. The best refractometers have different scales for dogs and cats; however, if these are not available, the differences are rarely clinically significant. Urine dipsticks are too inaccurate to be clinically reliable for measurement of specific gravity."

 

Urine Specific Gravity (USG): Ranges


This is not actually as simple as it first appears because "normal" depends upon a number of factors, such as how much a cat is drinking, the weather etc. USG therefore needs to be considered in conjunction with blood test results and the cat's overall status.

  • The typical range for hydrated cats is around 1.035 to 1.060.

  • A cat with a USG below 1.040 is generally considered to have a problem of some kind.

  • In a cat with normal bloodwork, it may be an early warning sign that CKD is developing.

  • Most CKD cats have a much lower USG of between 1.008 and 1.012.

Although these numbers have a decimal place after the 1, vets often say the numbers verbally in a different way, so for example, a USG of 1.012 would be referred to as "ten twelve" rather than "one point oh one two."

 

Urine Specific Gravity Levels in CKD Cats


A USG level below 1.040 is considered low in cats. Most CKD cats have a much lower USG of between 1.008 and 1.012, which is known as isothenuria. Prolonging life and kidney function (2007) a paper presented to the 32nd World Small Animal Veterinary Association Congress by Dr D Chew, explains more about this.

 

Of course, CKD is never simple, so occasionally a cat will have what appears to be a normal USG yet have CKD. Urine specific gravity (2015) Watson ADJ, Lefebvre HP & Elliott J International Renal Interest Society states: 'However, USG values in some cats with chronic kidney disease (CKD) and azotaemia may be as high as 1.040 or 1.045, so kidney disease could still be suspected in a cat if these values are accompanied by persistent azotaemia.'

 

Urine Specific Gravity: Other Causes When Low


A low USG may also be seen in cats with the following conditions:

A USG below 1.008 is uncommon but may occasionally be seen in cats with pyelonephritis, hypokalaemia (low potassium levels) and hypercalcaemia (high calcium levels).


Osmolality


 

This is a measure of particles dissolved in solution, and measures the concentration of the urine. It is usually used in conjunction with USG. The approximate normal range for urine osmolality is 270-320.

 

Serum (blood) measurement of osmolality gives some indication of hydration levels - a dehydrated cat will often have high osmolality, while an over-hydrated cat will usually have low levels. High levels may also indicate azotaemia.

 

Cornell University College of Veterinary Medicine has more information about osmolality. 

Rn Ceus is a human nursing site with some information on osmolality.

 


Proteinuria (Protein in the Urine)


 

Proteinuria (excess protein in the urine) is important because it may make CKD progress faster. It is also used to determine the stage of CKD.

 

Please visit the Proteinuria page for more information.

 


Blood in Urine (Haematuria)


 

This is usually a sign of a urinary tract infection, or bladder or kidney stones.

 

Obtaining a urine sample via cystocentesis (a needle into the bladder) may sometimes cause blood in the urine.

 

Other possible causes include high blood pressure. or, occasionally, cancer. Ollie had this symptom towards the end, and I think it might have been because of cancer (he had been treated for cancer a couple of years previously).

 

Persistent haematuria and proteinuria due to glomerular disease in related Abyssinian cats (2008) White JD, Norris JM, Bosward KL, Fleay R, Lauer C & Malik R Journal of Feline Medicine & Surgery 10(3) pp219-29 discusses how in Abyssinian cats with haematuria, the cause may be glomerular disease.

 

Sometimes it is not possible to ascertain the cause. "Benign renal haematuria" is a condition in which there is bleeding from the kidneys but the cause cannot be found. However, this is rare in cats.

 

Severe or ongoing haematuria may cause or worsen anaemia, so you should always take your cat to the vet if you see this symptom.

 

The diagnostic approach to hematuria (2008) Bowles M Veterinary Medicine discusses haematuria.

Pet Place has some information about haematuria in cats.

 

Pet MD explains more about blood in urine.

 


Urine pH


 

This is a measure of the acidity/alkalinity of urine. A normal pH level is in the range of 6.0 - 6.5.

 

A cat with a urine pH higher than this (i.e. more alkaline urine) can be at risk of developing struvite crystals

 

A cat with urine pH lower than this (i.e. more acidic urine) can be at risk of developing calcium oxalate stones.

 

A more alkaline urine may be a possible sign of infection.

 

Controlling urine pH (2016) Dowling PM Merck Veterinary Manual discusses urine pH.

 

Pet Education mentions that normal pH for cats is 6 - 6.5.

 

Cornell University College of Veterinary Medicine has some information about urine pH.

 


Glucose


 

Your vet may wish to test for glucose (sugar) in the urine, particularly if your cat has high blood glucose levels, in order to rule out diabetes.

 

Normally cats do not have glucose in their urine. However, this value may increase suddenly in cats because of stress, for example in cats who get stressed or frightened at the vet’s.

 

Glucose may also be elevated in cats with acute kidney injury.

 

Overview of feline bloodwork (2008) Jensen A 2008 Zimmer Feline Foundation states "One way to differentiate between a glucose spike due to acute stress and high blood glucose due to diabetes is through urinalysis.  If there is no glucose in the urine in the face of high blood glucose, it may be due to the fact that the blood glucose has not been high long enough to overflow into the urine, suggesting an acute spike.  This is not definitive, however.  Presence of glucose in the urine is, however, highly suggestive of diabetes."

 

Cornell University College of Veterinary Medicine has some information on glucose.

 


Infections: Kidney Infections (Pyelonephritis) and Urinary Tract Infections


 

Please see the new Pyelonephritis and Urinary Tract Infections page.

 

 

 

 

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This page last updated: 03 May 2017

Links on this page last checked: 03 May 2017

 

   

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TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

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