Question

A 67-year-old female has a history of kidney and circulatory problems and now has oliguria and marked edema. She visits her physician and he orders a BUN, creatinine, creatinine clearance test, blood lipid and albumin levels, a urinalysis, and a urine culture and sensitivity. Her results are below:


RESULTS:

BLOOD TEST

BUN: Increased
Creatinine: Increased
Serum lipids: Increased
Serum albumin: Decreased


URINALYSIS
Dipstick:
SG: 1.010
Protein: 4+
Blood: 2+
Leukocyte esterase: 1+
Glucose: Trace

Microscopic Examination:
RBCs: 20-25/HPF
WBCs: 0-5/HPF
Oval fat bodies
Cholesterol Crystals

Mixed casts:
Granular casts: 0-5/LPF
Hyaline casts: 0-1/LPF
Waxy casts 0-1/LPF
Mixed WBC/RTE casts: 0-1/LPF
Fatty casts: 0-5/LPF

Urine Culture: No Growth


QUESTIONS:
1. What do you suspect in her condition?
2. What additional problems does this urinalysis suggests?
3. Are Renal tubular epithelial cells seen in this condition? Why?
4. Why might this patient have glucose in the urinalysis findings?

Answer 1

1. From the above values we can suspect the disease called Nephrotic Syndrome. It is a kidney disorder with a group of other signs & Symptoms. It is characterized by edema, loss of protein, and decreased albumin levels.

2. Urine analysis suggests the following problems:

1. Proteinuria
2. Inflammation
3. Urinary tract infection
4. Kidney stone
5. Renal tubular disease

3. Normally cells are found in the urine, but a raise in the cell is a matter of concern. Nephrotic syndrome is also associated with other signs and symptoms of the kidney. It is found in the condition where there are inflammation and renal tubular disease( present in nephrotic syndrome). Increase in the cholesterol crystal and protein cause damage to renal tubes causing degradation leading to an increase in the number of epithelial cells.

4. Because of Nephrotic syndrome due to diabetic nephropathy there is increased glucose level.