CASE STUDY DISCUSSION (A)

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 Negative Urobilinogen Normal
Appearance Clear Protein Trace Blood Large
Specific Gravity 1.025 Ketones 150mg/dL Nitrite Negative
pH 5.0 Bilirubin Negative Leukocyte Negative
Microscopic Analysis
>100 RBC/hpf
0-3 WBC/hpf
20-30 Bacteria/hpf
0-5 Squamous Epithelial Cells/hpf
Unidentified Crystals

Questions
1. Is there a discrepancy between the leukocyte and nitrite counts on the reagent stix compared
to the results reported in the microscopic analysis?
2. Is the presence of WBCs with bacteria clinically significant?
3. Suggest an explanation for blood in the urine.

Case 2.

A 10 year old boy, who recently recovered from a streptococcal infection, was taken to the
doctor with symptoms including fever, nausea, and malaise. Physical examination reveals
edema around the eyes and the knees. Blood tests reveal a decrease in serum complement. A
routine urinalysis reveals the following results.

Chemical/Physical Analysis

Color Yellow Blood Moderate

Clarity Hazy pH 6.5
Glucose Negative Protein 300mg/dL
Bilirubin Negative Urobilinogen Normal
Ketones Negative Leukocyte Esterase Small
Specific Gravity 1.015 Nitrite Negative
Microscopic Analysis
20-50 RBC/hpf
10-20 WBC/hpf
2-5 RBC casts/lpf
2-5 Granular casts/lpf

Questions

1. What is the significance of a positive leukocyte esterase?

2. How could there be a positive leukocyte esterase and a negative nitrite?
3. What is the significance of the presence of blood along with protein in the urine?
4. What disease are the results indicative of?

Case 3.

A 10-year old girl had a routine urine exam at the time of her school physical. Results follow:

Questions

1. Identify the abnormal test results highlighted

2. What is the most probable diagnosis for this patient? Support your answer (include in
your discussion the physical, chemical and microscopic findings).
3. Based on your diagnosis, what follow up testing should be done on this urine?
4. What single microscopic finding is most helpful in differentiating an upper UTI from a
lower UTI?