Question

Urinalysis Case #1

A college student, Jane Austin, has a throat infection, fever, and possibly pneumonia. Her physician had her on a number of antibiotics. Jane noticed edema of her lower limbs (swollen feet) and went back to her doctor. The doctor also noted an elevated blood pressure. See Table 1 below.

Table 1: Urinalysis and additional tests

	Jane Austin	Reference Range
Macroscopic
Color	Red	Colorless to amber
Appearance	Cloudy	Clear
Specific gravity	1.028	1.001-1.035
pH	6.0	5.0-7.0
Protein	2 + (100 mg/dL) (SSA: 2+)	Neg
Glucose	Neg	Neg
Ketones	Neg	Neg
Bilirubin	Neg	Neg
Blood	2 + (~50 RBCs/μL)	Neg
Urobilinogen	Normal	Normal
Nitrite	Neg	Neg
Leukocyte esterase	Neg	Neg
Microscopic
WBCs	0-3/HPF	0-5/HPF
RBCs	30-60/HPF (dysmorphic forms present)	0-2/HPF
Epithelial cells	Few squamous/HPF Rare transitional/HPF	Few to moderate
Casts	1-3 hyaline/LPF 0-3 RBC/LPF 0-1 hemoglobin/LPF 1-3 granular/LPF	Few hyaline
Bacteria	Neg	None
Additional Urinalysis Tests
24-h urine volume	400 h	1200-1500 mL/24 h
24-h total protein	1 g/24 h	50-80 mg/24 h
Chemistry
BUN	28 mg/dL	7-24 mg/dL
Creatinine	1.6 mg/dL	0.5-1.2 mg/dL
Serology
ASO titer	500 TU	< 160 TU
Anti-DNase	Positive	Neg

Questions

1. List or highlight the abnormal or discrepant urinalysis result(s).
2. What is the probable diagnosis?

3. Which urinalysis result(s) is/are pathogenic (characteristic) of this condition?

4. Explain the significance of the dysmorphic red cells in the sediment.

5. What is the difference in sensitivity and specificity of the reagent strip protein and the SSA protein?
6. Are the 24-hour urine volume and protein consistent with the diagnosis?

7. What is the probable causative agent (organism) in this case? Briefly describe the pathogenesis (the process).

8. List 3 other possible causes for this disease.

9. Are the increased BUN and creatinine consistent with the diagnosis? Why or why not?
10. Is the BUN/creatinine ratio consistent with the probable diagnosis?

12. What other renal function test could be performed on the 24-hour urine that might help in the diagnosis? Would you expect the results to be decreased, normal, or elevated?

13. Discuss the results of the ASO titer, and anti-DNase. Are they consistent with the probable diagnosis?

14. What is Jane’s prognosis?

Answer 1

1.Abnormal Urinalysis are 1.color red 2.cloudy appearance and 3.presence of protein and RBCs.

2.probable diagnosis is Glomerulonephritis.

3.red colour and protein in the urine are pathogenic characters.

4.Dysmorphism suggests renal rather than glomerular bleeding.

5.yes , 24 hrs urine collection gives total urine volume in 24 hrs and normal is 1200 to 1500 ml in 24 hrs and less than this indicate abnormalities.

6.causative agent mostly is bacterial that is beta hemolytic streptococcus.

7.other possible illness like lupus, goodpasture syndrome, Wenger's disease and polyarteritis nodosa.

8. BUN and creatinine consistently increase because of kidney damage and not functioning properly.

9.ASO titer increases and anti DNase positive.

10. Prognosis of this disease is poor.