Question

Case Study 4 A 14-day-old baby girl is admitted to the hospital with lethargy, diarrhea, vomiting, and difficulty in feeding. Physical examination reveals jaundice, an enlarged liver, and neurologic abnormalities (e.g., increased muscular tonus). No blood group incompatibility is found. She has lost 1.8 lb since birth. The infant is fitted with a collection bag to obtain a urine specimen. The collection takes place over several hours, and the baby's urine is sent to the laboratory for routine urinalysis Urinalysis findings; Color- Amber SG-1.025 RBC/hpf 0-2 Clarity- cloudy pH-8.0 WBC/hpf 0-2 Odor-Yellow foam noted Blood- Negative Csts/lpf- 0-2 hyaline 0-2 granular Protein- Trace Epithelials- few SE cells/lpf SSA 1+ Crystals/hpf- moderate triple phosphate WBC- negative Bacteria/hpf-few Nitrite negative Glucose-negative Clinitest 1000 mg/dl ketones- negative Bilirubin positive ictotest- positive urobilinogen-normal Case Questions: 1. List any abnormal or discrepant urinalysis findings. 2. Which results may have been modified by the specimen collection conditions? 3. What substance is most likely causing the yellow coloration of the foam? 4. What is the most likely explanation for the discrepancy in the glucose screening results? 5. What is a possible diagnosis for this patient? How could this diagnosis be confirmed? 6. Does this patient have a urinary tract infection? Why or why not?

Answer 1

1. Foamy urine

Granular protein- trace

SSA 1+ (protein)

Crystals/hpf - moderate

Clinitest 1000 md/dL

Bilirubin positive

Ictotest - positive (bilirubin)

2. Bacterial count

3. The yellow colour is caused by the pigment urobilin (or urochrome). The foaming could be explained by the presence of protein in urine, or less likely because of urine concentration due to dehydration.

4. Clinitest is a test for the detection of non-specific reducing substances in urine. A negative glucose assay and positive Clinitest could suggest the presence of other reducing substances like galactose, lactose, fructose or certain drugs.

5. Galactosemia.

Quantitative erythrocyte galactose-1-phosphate uridyltransferase (GALT) analysis is done to confirm diagnosis.

Brain MRI might show edema.

6. No.

Child has no fever or urinary symptoms. WBC/hpf is minimal and Bacteria/hpf is few, ruling out UTI.