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8/20/2019 Case Study Urin
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CASE STUDY DISCUSSION
Case 1.
A 28 year old man visits his physician complaining of an intense, sharp pain in his back and
side. In a conversation with his physician, the patient confesses to eating a diet high in animal proteins such as meat, cheese, and fish. Results of a complete urinalysis are shown below.
Chemical/Physical Analysis
Color Yellow Glucose egative Urobilinogen ormal
Appearance !lear Protein "race Blood #arge
Specific Gravity $.%2& Ketones $&%mg'd# Nitrite egative
pH &.% Bilirubin egative Leukocyte egative
Microscopic Analysis
($%% R)!'hpf
%*+ )!'hpf
2%*+% )acteria'hpf%*& -uamous /pithelial !ells'hpf
0nidentified !rystals
Questions
$. Is there a discrepancy between the leukocyte and nitrite counts on the reagent sti1 compared
to the results reported in the microscopic analysis2. Is the presence of )!s with bacteria clinically significant
+. -uggest an e1planation for blood in the urine.
Case 2.
A $% year old boy, who recently recovered from a streptococcal infection, was taken to the doctor with symptoms including fever, nausea, and malaise. 3hysical e1amination reveals edema
around the eyes and the knees. )lood tests reveal a decrease in serum complement. A routine
urinalysis reveals the following results.
Chemical/Physical Analysis
Color Yellow Blood 4oderate
Clarity 5a6y pH 7.&
Glucose egative Protein +%%mg'd#
Bilirubin egative Urobilinogen ormal
Ketones egative Leukocyte sterase -mall
Specific Gravity $.%$& Nitrite egative
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Microscopic Analysis
2%*&% R)!'hpf
$%*2% )!'hpf
2*& R)! casts'lpf2*& ranular casts'lpf
Questions
$. hat is the significance of a positive leukocyte esterase
2. 5ow could there be a positive leukocyte esterase and a negative nitrite
+. hat is the significance of the presence of blood along with protein in the urine9. hat disease are the results indicative of
Case !"
A $%*year old girl had a routine urine e1am at the time of her school physical. Results follow:
Questions
$. Identify the abnormal test results highlighted
2. hat is the most probable diagnosis for this patient -upport your answer ;include in
your discussion the physical, chemical and microscopic findings<.+. )ased on your diagnosis, what follow up testing should be done on this urine
9. hat single microscopic finding is most helpful in differentiating an upper 0"I from a
lower 0"I
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Case #"
A $9*year*old boy is brought to the pediatrician by his mother because he has had a feverwith shaking chills for the past day. =n physical e1amination, he has a temperature of
+>.7 ! and has mild right costovertebral angle tenderness.
$acroscopic Urinalysis% $icroscopic Urinalysis%
C&aracteristic 'esult
!olor Yellow
Appearance "urbid
#eukocyte /sterase +?
itrite 3os
p5 7.&
3rotein eg
)lood eg
-pecific ravity $.%$&
@etones $?
lucose eg
)ilirubin eg
(uestions%
$. 5ow do you e1plain the appearance of the urine 5ow do you relate this to other
findings
2. hat is the significance of the finding on physical e1amination
+. Is there a relation between the color of the urine and the diagnosis
9. hat findings on microscopic urinalysis are of help in this case
&. hat is the suspected diagnosis
7. hat else should you do
C&aracteristic 'esult
)!'hpf (&%'hpf
R)!'hpf &*$%'hpf
!asts 4any )!
=ther =ccasional transitional cells
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Case )
A +9 year old @orean woman is admitted to the emergency room with the maor complaint of
Bnot feeling herself.B Cor the past week, she has been suffering from e1treme fatigue andheadaches, but did not feel the need to have it checked out until she has noticed that her vision is
Ba little fu66yB. hen asked if she is taking any medications, she responds a low dosage birth
control, a womenDs daily multivitamin and prednisone for her systemic lupus erythematosus;-#/<.
An urinalysis is ordered. "he nurse notices that the urine has a BsweetB odor to it as sheconducts the point of care testing. "he urinalysis results are:
$acroscopic Urinalysis%
$icroscopic Urinalysis%
R)! 2*$%'hpf )! %*&'hpf
(uestions
$. hat is the diagnosis of this patient hat results from the urinalysis ;both sti1 and
microscopic< support your answer2. Is it normal for a patient with -#/ to have red and white blood cells in the urine hy or why
not
+. Eoes the sti1 result for leukocytes correlate with the microscopic findings hy or why not9. Eoes the sti1 result for blood correlate with the microscopic findings hy or why not
Case *
A &*year*old boy usually drove his mother cra6y by running around the house all day long, but
he has been lethargic for the past 2 weeks. =n physical e1amination he is afebrile, but there is
puffiness around his eyes.
!olor Yellow
Appearance !lear
-pecific ravity $.%$%
p5 F.%
3rotein "race
lucose &%% mg'd#
@etones -mall
)ilirubin egative
)lood egative
0robilinogen %.2 mg'd#
itrite egative
#eukocyte
egative
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$acroscopic Urinalysis% $icroscopic Urinalysis%
C&aracteristic 'esult
!olor Yellow
Appearance 5a6y
#eukocyte /sterase eg
itrite eg
p5 7.%
3rotein 9?
)lood eg
-pecific ravity $.%2%
@etones eg
lucose eg
)ilirubin eg
(uestions%
$. hat key abnormal finding is present Gust what does the dipstick measure here, and
what other test could be done on the urine
2. hat is suggested by the childDs physical findings
+. hat other laboratory test;s< would be useful
9. hat is the diagnosis
C&aracteristic 'esult
)!'hpf $*2'hpf
R)!'hpf one
!asts one
=ther =ccasional oval fat bodies
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