Case Study Urin

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



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



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


)!'hpf (&%'hpf

R)!'hpf &*$%'hpf

!asts 4any )!

=ther =ccasional transitional cells



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



$acroscopic Urinalysis% $icroscopic Urinalysis%


!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


)!'hpf $*2'hpf

R)!'hpf one

!asts one

=ther =ccasional oval fat bodies

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Case Study Urin