Question

Urinalysis Case #1

A college student, Bobo, 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

	Bobo	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 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 Bobo's prognosis?

Answer 1

A) The probable diagnosis would be acute renal failure. Because the signs and symptoms like edema on lower limbs , high BP are the indication.

B) BUN and creatinine report is abnormal. This report is very important to reach the diagnosis.

C ) To reach the diagnosis another test called USG KUB is highly recommended.

D) measuring the GFR rate is another test to know the kidney function. It is done via blood test.checking of albumin level in the urine also helps to know the kidney function.

If it is not treated in the initial stage the creatinine and BUN level would be elevated. The prognosis is good if get treated at the initial stage itself.