Recurrent Urinary Tract Infections


     A 35 year old female presented with a fever that has lasted for three days, nausea, and pain in her back.  She complains of a frequency of urination, especially at night, and a painful, burning sensation while urinating.  She has a history of recurrent urinary tract infections and of kidney stones as a result of previously diagnosed vesicoureteral reflux.  Her blood pressure was found to be elevated at 142/90 mm Hg.

Her routine urinalysis results were as follows:
Color:  yellow                 
 Protein:  100 mg/dL                              
 Blood: small
Appearance: +3  
Glucose: negative
Urobilinogen: 0.2 mg/dL   
Sp. Gravity:  1.010
Ketones: negative
 Nitrite: positive
pH:    8.0  
 Bilirubin: negative
 Leukocyte: moderate  

Microscopic:
5-10 RBC/hpf
20-50 WBC/hpf
5-10/hpf renal tubular epithelial cells
Moderate bacteria
0-2/lpf WBC casts
2-5/lpf granular casts
amorphous

Questions:

1)  From what condition is this patient most likely suffering and what results support this diagnosis?
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2)

  image1

What is the formed element to which the arrow is pointing?

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3)

image2

What is the formed element to which the arrow is pointing?  Does the presence of this formed element correlate with the data? Why or why not?

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4)

image3

What is the formed element to which the arrow points?  Does the presence of this formed element correlate with the data?  Why or why not?

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5)

image4

What is the formed element to which the arrow is pointing?  Is this formed element clinically significant?

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6) What is the major discrepancy between the stix results and the microscopic results?  Why is it a discrepancy?

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