Case Study 1.

Blood tests show that the patient has azotemia, is anemic, and has a GFR of 18 ml/min.

The patients urinalysis results are as following:

Multistix:

Color:  yellow	Glucose:  100 mg/dL	Protein:  300 mg/dL
Appearance:  slightly hazy	Bilirubin:  negative	Urobilinogen:  0.2 mg/dL
Specific gravity:  1.010	Ketone:  80 mg/dL	Nitrite:  negative
pH:  6.5	Blood:  negative	Leukocyte:  negative

Microscopic:

15-20 granular casts/hpf.	10-20 WBCs/lpf
0-2 WBC casts/hpf	2-5 squamous epithelial cells.
2-5 hyaline casts/hpf	0-2 transitional epithelial cells.
1+ amorphous

Link to questions:

 Question 1
 Question 2
Question 3
 Question 4
 Question 5
 Question 6
 Question 7
 Question 8

Here is a characteristic microscopic view of the urine specimen at 200x magnification:
 

Click on the image to view the cellular cast magnified.

Question 1.  To what condition do these lab results point:
    a.  Acute renal failure.
    b.  Chronic renal failure.
    c.  Nephrotic syndrome.
    d.  Hepatitis.

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Question 2.  What one stix result is the most helpful in making this diagnosis:
    a.  Glucose.
    b.  Ketone.
    c.  Protein.
    d. Leukocyte.

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Question 3.  What microscopic results help you to make this diagnosis:
    a.  WBCs.
    b.  Squamous epithelial cells.
    c.  Hyaline, cellular and granular casts.
    d.  Amorphous.

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Question 4.  What is a technical discrepancy in this patient's urinalysis results.:
    a.  Blood on Multistix and microscopic.
    b.  Glucose and specific gravity.
    c.  Leukocytes on Multistix and microscopic.
    d. Urobilinogen on Multistix and microscopic.

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Question 5.  The patient's specific gravity for her first morning specimen was 1.010.
    What would you expect her afternoon urine specimen specific gravity to be with the given diagnosis:
    a.  1.035.
    b.  1.025.
    c.  1.010.
    d.  1.003.

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Question 6.  What other symptoms would you expect in a patient with proteinuria:
    a.  Jaundice.
    b.  Edema.
    c.  Rash.
    d.  Oliguria.

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Question 7.  What Multistix results point to uncontrolled diabetes mellitus:
    a.  Glucose.
    b.  Leukocytes.
    c.  Protein.
    d.  Ketone.

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Question 8.  Which of the following conditions does the patient have:
    a.  Isosthenuria.
    b.  Myoglobinuria.
    c.  Diabetic Nephropathy.
    d.  Pyuria.
    e.  Hematuria
    f.   Porphyrinuria.

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