Adventist University of the Philippines

Medical Laboratory Science Department

Medical Technology Assessment Program with
Clinical Correlations 1

Eddrei Paullynne D. Desoasido 3/23023

CASE STUDY ANALYSIS WITH CLINICAL CORRELATION

ANALYSIS OF URINE AND BODY FLUIDS

A 45-year-old woman is recovering from injuries received in an automobile accident that

resulted in her being taken to the emergency department with severe hypotension. She develops
massive edema. Significant laboratory results include a BUN of 30 mg/dL (normal 8 to 23
mg/dL), cholesterol of 400 mg/dL (normal 150 to 240 mg/dL), triglycerides of 840 mg/dL
(normal 10 to 190 mg/dL), serum protein of 4.5 mg/dL (normal 6.0 to 7.8 mg/dL), albumin of
2.0 mg/dL (normal 3.2 to 4.5 mg/dL), and a total urine protein of 3.8 g/d (normal 100 mg/d).
Urinalysis results are as follows:
Color: Yellow Ketones: Negative
Clarity: Cloudy Blood: Moderate
Sp. gravity: 1.015 Bilirubin: Negative
pH: 6.0 Urobilinogen: Normal
Protein: 4+ Nitrite: Negative
Glucose: Negative Leukocyte: Negative
Microscopic:
15–20 RBCs/hpf Moderate free fat droplets
0–2 granular casts/lpf Moderate cholesterol crystals
0–5 WBCs/hpf
0–2 fatty casts/lpf
0–2 oval fat bodies/hpf

Questions:
1. What renal disorder do these results suggests?
The results suggest that the patient has nephrotic syndrome.
2. How does the patient’s history relate to this disorder?
The patient may have had renal ischemia due to a history of severe hypotension
brought on by a car accident. This condition can harm the glomeruli and result in nephrotic
syndrome.
3. What physiologic mechanism accounts for the massive proteinuria?
Massive proteinuria, which is a characteristic of nephrotic syndrome and is brought
on by increased glomerular filtration barrier permeability, is present. Large amounts of
protein are able to flow into the urine due to this enhanced permeability.
4. What is the relationship of the proteinuria to the edema?
When plasma oncotic pressure drops as a result of proteinuria in nephrotic syndrome,
fluid leaks from blood arteries into tissues, resulting in edema.
5. What mechanism produce the oval fat bodies?
As fat droplets are absorbed by renal tubular cells and become protein-coated, oval-
shaped structures called oval fat bodies are formed. Lipid nephrosis, also known as this
process, is frequently seen in nephrotic syndrome patients. Oval fat bodies are a clear
indicator of lipiduria, which is a characteristic of nephrotic syndrome, and they can be found
in the urine.