Annals of Internal Medicine Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain A Randomized Trial Gert Bronfort, DC, PhD; Roni Evans, DC, MS; Alfred V. Anderson, DC, MD; Kenneth H. Svendsen, MS; Yiscah Bracha, MS; and Richard H. Grimm, MD, MPH, PhD Background: Mechanical neck pain is a common condition that adverse events. Blinded evaluation
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Microsoft word - urine rm.docxWhat tells Routine Urine Examination
Animals producing large volume of urine have low specific gravity where as very small volume of urine has high
specific gravity (animal with oliguric acute intrarenal failure that has a low urine volume and low specific gravity).
Fluid therapy, diuretics, glucocorticoids and diet affect urine specific gravity. Sp. gr. is higher in morning samples
and was observed to decrease as the age of the animal increased.
Acidic urine: - ingestion of meat, respiratory and metabolic acidosis, severe vomition, severe diarrhea, starvation,
pyrexia, other protein catabolic states and administration of urinary acidifiers.
Alkaline urine:- recent meal, ingestion of alkali, UTI with urease-producing bacteria, renal tubular acidosis, diets
rich in vegetables and cereals, and metabolic and respiratory alkalosis, urine allowed to stand open to air at room
Trace or 1+ protein level is considered normal with a specific gravity greater than 1.035. Highly alkaline urine (>8)
can produce a false positive result. The most common cause of inflammatory proteinuria is urinary tract infection
(UTI). If hematuria and pyouria is ruled out, then another urinalysis should be performed to determine the persistent
proteinuria. Transient proteinuria is due to strenuous exercise, fever, seizures, and venous congestion of the kidneys
and it is insignificant. Persistent proteinuria is usually due to glomerulonephritis or amyloidosis. The urine protein:
creatinine ratio helps to determine the magnitude and significance of proteinuria.
False negative results come due to large quantity of ascorbic acid, contaminated with H2O2, Cl, hypochlorite,
formaldehyde or fluorides in urine. Cats with cystitis may give a false positive reaction. A positive reaction for
glucose in the urine demands test of blood glucose level ( marked hyperglycemia is usually due to diabetes mellitus,
in cats it may be transient, stress-induced or chronic diseases unrelated to the kidney and administration of glucose-
containing fluids). If the blood glucose level is normal, the glucose level in the urine should be re-evaluated. If
glucosuria is still present, proximal renal tubular dysfunction may be the cause.
Lipolysis, starvation, fasting diabetic ketoacidosis, persistent fever, persistent hypoglycaemia produces ketones.
Ketonuria and glucosuria together in same patient strongly indicates diabetes mellitus (blood glucose should be
measured). Ketonuria without glucosuria suggests excessive lipid catabolism and but normal patient, is not
Normal dogs (esp. males) may have small amounts of bilirubin in the urine if the sp. gr. is greater than or equal to
1.030. Normal cats do not have bilirubinuria. This test may give false negative results if urine exposed to air or light
for long periods of time or it has a dark colour (hemoglobinuria). The most common causes are hepatic diseases,
post hepatic bile duct obstruction, and haemolytic diseases, fever, prolong fasting or starvation. Mild bilirubinuria
can possibly result from anorexia, especially in the horse.
The test results are of little significance. A small amount (0.0002 g/L) is normal. Increased amount: --Usually
spurious, may be seen with haemolytic or hepatobiliary disease, Decreased amount:--Spurious, Diurnal variation,
bile duct obstruction. False Negative: Photodegradation of urobilinogen due to exposure of the urine sample to
light, Oxidized by acidic urine to urobilin (green), Drugs: Formaldehyde formed from methenamine (hexamine).
False Positive: Drugs: aminosalicylic acid, aminobenzoic acid, phenazopyridine and sulphonamides.
Excessive RBCs in urine is called hematuria. Causes of hematuria include cystitis/urethritis (UTI, Idiopathic cystitis,
urolithiasis, Cyclophosphmide, Parasites), Urinary tract neoplasia, Genital tract contamination (oestrus, Prostatic
disease, uterine disease, vaginal disease and Preputial disease), Renal problems (Nephritis, Nephrosis, Renal infarct,
Renal pelvic hematoma, Benign renal hematuria, Renal parasites), Systemic coagulopathy, Strenuous exercise,
Increased WBCs in the urine sediment is called pyouria and usually indicates urinary tract inflammation or
contamination from the genital tract. UTI is the most common cause of pyouria, with calculi and neoplasia being
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