Practical urinalysis in the cat: 2: Urine microscopic examination 'tips and traps'

Early detection of feline chronic kidney disease via 3-hydroxykynurenine and machine learning

Feline chronic kidney disease (CKD) is one of the most frequently encountered diseases in veterinary practice, and the leading cause of mortality in cats over five years of age. While diagnosing advanced CKD is straightforward, current routine tests fail to diagnose early CKD. Therefore, this study aimed to identify early metabolic biomarkers. First, cats were retrospectively divided into two populations to conduct a case-control study, comparing the urinary and serum metabolome of healthy (n = 61) and CKD IRIS stage 2 cats (CKD2, n = 63). Subsequently, longitudinal validation was conducted in an independent population comprising healthy cats that remained healthy (n = 26) and cats that developed CKD2 (n = 22) within one year. Univariate, multivariate, and machine learning-based (ML) approaches were compared. The serum-to-urine ratio of 3-hydroxykynurenine was identified as a single biomarker candidate, yielding a high AUC (0.844) and accuracy (0.804), while linear support vector machine-based modelling employing metabolites and clinical parameters enhanced AUC (0.929) and accuracy (0.862) six months before traditional diagnosis. Furthermore, analysis of variable importance indicated consistent key serum metabolites, namely creatinine, SDMA, 2-hydroxyethanesulfonate, and aconitic acid. By enabling accurate diagnosis at least six months earlier, the highlighted metabolites may pave the way for improved diagnostics, ultimately contributing to timely disease management.

2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats

PRACTICAL RELEVANCE

Lower urinary tract signs (LUTS) such as dysuria, haematuria, periuria, pollakiuria and stranguria can occur as the result of a variety of underlying conditions and diagnostic investigation is required to uncover the underlying cause and select appropriate treatment.

AIM

The '2025 iCatCare consensus guidelines on the diagnosis and management of lower urinary tract diseases in cats' provide an overview of the common presenting signs caused by underlying feline lower urinary tract (LUT) diseases in cats, which often are indistinguishable between different underlying causes. The Guidelines set out a diagnostic approach to affected cats before focusing on the most common causes of LUTS: feline idiopathic cystitis (FIC), urolithiasis, urinary tract infection and urethral obstruction. The aim is to provide practitioners with practical information on these problematic conditions.

CLINICAL CHALLENGES

The fact that LUTS are similar despite different underlying causes creates a diagnostic challenge. The most common cause of LUTS, FIC, is challenging to manage due to a complex pathogenesis involving organs outside the LUT. Urethral obstruction is a life-threatening complication of various underlying LUT diseases and recurrent LUTS can lead to relinquishment or euthanasia of affected cats.

EVIDENCE BASE

These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society (formerly the International Society of Feline Medicine [ISFM]). Information is based on the available literature, expert opinion and the panel members' experience.

[Urinalysis in dogs and cats, part 2: Urine sediment analysis]

Examination of the urine sediment is part of a routine urinalysis and is undertaken in order to identify insoluble particles in the urine. This procedure is mainly used in the context of diagnostic evaluation of urinary tract diseases, but may also be useful for the diagnosis of systemic diseases and intoxications. Analysis of fresh urine is recommended as changes in cell morphology, cell lysis and in vitro crystal formation may occur in the course of its storage. Manual urine sediment analysis is still performed in many veterinary practices. Native wet-mount preparations are suitable for the identification and quantification of urine sediment particles. The examination of stained wet-mount preparations or air-dried smears may be necessary to further differentiate cells and to identify bacteria. For several years, automatic urine sediment analyzers have been available in veterinary medicine. These save considerable time and staff resources, however verification of the automatically generated results by an experienced observer remains necessary. Urine sediment particles that are frequently identified and clinically relevant include red blood cells, white blood cells, different types of epithelial cells, crystals, and casts as well as bacteria. Furthermore, parasite eggs, fungal hyphae, lipid droplets, spermatozoa, fibres, hair, mucus, plant parts or environmental contaminations may be found in the urine sediment and result in a complication of the result interpretation.

Comparison of six microscopic methods and two operators for estimation of white and red blood cells in canine urine sediment

BACKGROUND

Little information is currently available about the analytical variability of urinalysis.

OBJECTIVE

We aimed to compare results obtained by two operators using six microscopic methods in the quantification of urinary leukocytes (WBC) and erythrocytes (RBC).

METHODS

Forty urine samples (10 mL) were centrifuged (450g, 5 minutes) and resuspended in 0.5 mL of supernatant. Two operators with different expertise in urinalysis interpreted sediment results using the six methods, obtained by combining the use of microscope slides (Slide) or counting chambers (Chamber) with three different techniques: bright-field (BF) microscopy, phase-contrast (PC) microscopy, and stained sediment (SS) evaluations. The mean WBC and RBC counts from 10 fields (Slide) or squares (Chamber) observed at 400× were used to calculate the difference and agreement between operators and methods. We also estimated the concordance between methods in classifying microhematuric or pyuric samples.

RESULTS

Operator 2 counted significantly lower WBC counts using Slide+BF (P = 0.009) and Slide+PC (P = 0.001) than Operator 1, whereas no inter-operator differences were recorded for RBC counts. The concordance between the operators ranged from "good" to "very good." No differences or biases were found for WBC counts among the methods, and concordances were "good" to "very good"; proportional biases were found for RBC counts between Slide+BF vs Slide+SS and Slide+PC vs Slide+SS. Concordance measurements for RBC counts ranged from "good" to "very good."

CONCLUSIONS

All methods yielded good reproducibility among operators, although stained SS evaluations allowed better identification of WBC by the inexperienced operator. However, we suspected that the SS preparations affected RBC counts. All other methods yielded reproducible WBC and RBC counts.

Urinalysis in dog and cat: A review

Urinalysis is the examination of normal and abnormal constituents of urine. It is an easy, cheap, and vital initial diagnostic test for veterinarians. Complete urinalysis includes the examination of color, odor, turbidity, volume, pH, specific gravity, protein, glucose, ketones, blood, erythrocytes, leukocytes, epithelial cells, casts, crystal, and organisms. Semi-quantitative urine analysis with urine dipsticks, as well as an automatic analyzer, provides multiple biochemical data. Contamination is almost entirely avoided if the protocols for ensuring a proper sample have been followed, as mentioned still consideration must be given to the likelihood of contamination, even if the sample is correctly obtained. Interpretation of urinalysis will be doubtful if the knowledge of the interference is limited. Well-standardized urinalysis, when correlated in the context of history, clinical findings, and other diagnostic test results, can identify both renal and non-renal disease. This paper reviews significance of different components of urinalysis of dog and cat, such as collection, storage, examination, interpretation, and common causes of error in the result.