DISKUSI PRAKTIKUM PATOLOGI KLINIK - URINALYSIS CASES

BLOK GINJAL 2021/2022

1. CASE No.1

A recently sexually active 28 year old white female is admitted to the emergency department with
left flank pain and blood in the urine. She explains to the doctor that she has been seen multiple
times in the last 6 months by her family doctor as well as the local emergency department and
medical aid unit for recurrent left flank pain, associated with a lower urinary tract infection. She was
recently diagnosed two months ago with a non obstructive kidneys stone in her right ureter.

Urinalysis result:

Patient Indicator

Characteristic Result
Color Red
Appearance Turbid
Leukocyte Esterase 3+
Nitrite Pos
pH 8
Protein 2+
Blood Neg
Specific Gravity 1.015
Ketones Neg
Glucose Neg
Bilirubin Neg

Microscopic Urinalysis result:

Characteristic Result
WBC/hpf 20-30/hpf
RBC/hpf 10-14/hpf
Casts WBC cast
Bacteria Full/hpf
Other Transitional epitelial cells

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Questions
1. What is the diagnosis for this patient? What results are you basing your decision on?
2. What is the significance of the protein result? Would running an SSA contribute to the
diagnosis of this patient?
3. What is the most likely cause of the positive bilirubin result for this patient?
4. Why does this patient still have an infection after previously receiving a round of antibiotics to
treat her UTI?
5. Are the kidney stones contributing to the blood result for this patient? Why or why not?
6. What is the most likely cause of this patients recent onset of recurrent UTI's?
7. What is accounting for the discrepancy between the stix reading and microscopic result for
blood?
8. Does the white blood cell result on the stix correlate with the microscopic reading?

2. CASE No. 2

A 23-year-old woman has noted an increase in her appetite and thirst over the past six
months, although she has lost 2 kg (5 pounds). The patient also has had considerable
frequency of urine output, without associated dysuria. On physical examination her vital
signs include T 37 C, P 77/min, RR 16/min, and BP 120/70 mm Hg. A midstream clean catch
urine sample is obtained.

Urinalysis result:

Patient Indicator

Characteristic Result Microscopic Urinalysis result:

Color Yellow
Appearance Clear
Leukocyte Esterase Neg Characteristic Result
Nitrite Neg WBC/hpf None
pH 5.5 RBC/hpf 1-2/hpf
Protein Neg Casts None
Blood Neg Other None
Specific Gravity 1.025
Ketones 4+
Glucose 4+
Bilirubin Neg

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Questions:
1. What disease is suggested by these findings?
2. Will all sugars be detected by the reagent test strip for glucose? Why?
3. What is the significance of the positive test for ketones? What would you suspect if the
ketones were positive and everything else was normal?
4. What other laboratory tests should be done in this patient?
5. What are some complications of her disease that can affect the urinary tract?

3. CASE No. 3
A 5-year-old boy usually drove his mother crazy by running around the house, but he has been
lethargic for the past 2 weeks. On physical examination he is afebrile, but there is puffiness around
his eyes

Urinalysis result:

Patient Indicator

Characteristic Result Microscopic Urinalysis result:

Color Yellow Characteristic Result
Appearance Hazy WBC/hpf 1-2/hpf
Leukocyte Esterase Neg RBC/hpf None
Nitrite Neg Casts None
pH 6.0 Other Oval fat bodies
Protein 4+
Blood Neg
Specific Gravity 1.020
Ketones Neg
Glucose Neg
Bilirubin Neg

Questions:
1. What abnormal finding is present? Just what does the dipstick measure here, and what other
test could be done on the urine?
2. What is suggested by the child's physical findings?
3. What other laboratory test(s) would be useful?
4. What is the diagnosis?