Post-Infection Complications

A 7-year-old boy was brought in to see a doctor after complaining of swelling in the face and knees, joint stiffness, fever, and a decrease in urine output. He was just recently treated for a case of strep throat. The doctor ordered a urinalysis, and the results were as follows:
Color: amber   (varies) Protein: 2+   (negative) Blood: moderate   (negative)
Appearance: hazy   (varies) Glucose: negative   (negative) Urobilinogen: 0.2 EU   (0.1-1.0 mg/dL)
Specific Gravity: 1.025   (random: 1.010-1.025) Ketones: negative   (negative) Nitrite: negative   (negative)
pH: 5.5   (5.0-8.0) Bilirubin: negative   (negative) Leukocyte: 2+   (negative)
 (**Reference Ranges**)       
                         
                                         Microscopic
                                         1-2 RBC casts/lpf     (none)
                                         1-2 granular casts/lpf     (none)
                                         5-10 renal epithelial cells/hpf     (0-5/hpf)
                                         1-2 squamous epithelial cells/hpf     (05/hpf)
                                         20-50 RBC/hpf     (0-2/hpf)   
                                         20-30 WBC/hpf     (0-5/hpf)


1) What condition do these results suggest? Which results led you to this conclusion?  ANSWER

2) Why would there be a positive leukocyte result when there is a negative nitrite and no bacteria or yeast present?   ANSWER

3) Identify this formed element (400x) present in the patient sample. Is this a normal find in urine samples?  ANSWER
                                 Image 1
  

4) What additional test would need to be run to confirm the presence of protein in the sample?   ANSWER

5) Identify this formed element (200x). Why would it be associated with this condition?   ANSWER

                                           Image 2
                                         
6) Should the doctor be concerned about the results/diagnosis?   ANSWER
***Go to case study #2***

    For more urinalysis case studies, visit: http://www.udel.edu/medtech/mclane/UAcases.html      

References
Brunzel, Nancy A. Fundamentals of Urine and Body Fluid Analysis. Philadelphia: Saunders, 2004.

Schacht, Robert G. "Acute Poststreptococcal Glomerulonephritis." eMedicine. 7 Aug 2006. 20 Nov 2008 <http://www.emedicine.com/ped/TOPIC27.HTM>.