KASUS 1

A 39-year-old female suddenly notices her urine is a dark smoke color and she feels general
malaise. Her urine output is decreased and she has edema with puffy eyelids. Her blood
pressure has become elevated. She has a history of systemic lupus erythematosis, but her
urinary symptoms, edema, and hypertension are new; so she goes to see her physician. The
physician orders a BUN, creatinine, creatinine clearance test, and a urinalysis. Her results are
below:
BLOOD TEST RESULTS
↑BUN, ↑creatinine Also, her creatinine clearance shows a greatly decreased GFR
URINALYSIS RESULTS
Dipsticka: 4+ protein, 4+ blood, 1+ leukocyte esterase Other dipstick tests are negative or
normal Microscopic examination: RBCs 25–50/HPF, many dysmorphic, RBC casts 5–10/LPF,
hyaline cast 0–1/LPF
1. Is this condition acute or chronic?
2. What do you suspect is her condition?
3. What are other conditions in this group?
4. What further tests could you do to confirm this?

KASUS 2
A 65-year-old female has a long history of microscopic hematuria and has had oliguria for a few
years. She has been feeling fatigued and run down this past year and feels like she has been
getting worse for a few years. She visits her physician and he orders a BUN, creatinine,
creatinine clearance test, serum phosphorus, serum IgA, and a urinalysis. Her results are below:
↑BUN, ↑creatinine, ↑serum phosphorus, ↑serum IgA Also, her creatinine clearance shows a
markedly decreased GFR
Dipstick: SG 1.010, 3+ protein, 4+ blood, 1+ leukocyte esterase, glucose trace. Other dipstick
tests are negative or normal
Microscopic examination: RBCs >100/HPF, WBCs 5–10/ HPF, mixed casts—granular casts 5–
10/LPF, hyaline cast 0–1/LPF, waxy casts 5–10/LPF, mixed cell casts 0–1/LPF, broad waxy
casts 0–1/LPF
1. Is this condition acute or chronic?
2. What do you suspect is her condition?
3. What are the other conditions in this group?
4. Is the specific gravity significant in this case?
5. What additional problems does this urinalysis suggest?
6. What is the significance of broad and waxy casts?
7. Why might this patient have glucose in her urinalysis findings?