Case Study: Female with Painful Urination 

A 26-year-old female makes an appointment with her physician because of painful urination and back pain that has lasted for a couple of days.  During the preliminary assessment, it is discovered that the patient has a fever of 102°F.  The physician asks the patient to provide a first morning urine specimen to be delivered the next morning.  The patient does as asked and brings in a sample when the physician's office opens (maintaining proper refrigeration and using proper clean catch techniques).  The results of the routine urinalysis are as follows:

Color: yellow                                                Protein (mg/dL): 100                                      Blood: Trace
Appearance: cloudy                                       Glucose: Negative                                          Urobilinogen (mg/dL): 0.2
Specific Gravity: 1.020                                  Ketones: Negative                                          Nitrite: Positive
pH: 7.5                                                         Bilirubin: Negative                                         Leukocytes: Large

Microscopic
Many bacteria
1-2 WBC casts/lpf
0-2 Granular casts/lpf
50-100 WBC/hpf
5-10 RBC/hpf

Reference Ranges

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1. What important formed element is missing from the microscopic that can help diagnose the patient?
Answer


2. Does the patient's age and gender play an important role in diagnosis?
Answer


3. What type of cast is circled below?  Is it common to find the cast shown below in a patient's urine with this disease?  If so, why does this disease cause these formed elements to form?
Answer

               
x400                                                                    x400


4. What is the level of the formed element circled below that signifies a disease rather than contamination?  For this patient, does the presence of the formed element signify contamination?
Answer

               
x400                                                                   x400


5. What is the probable diagnosis for this patient, which result helped to make that diagnosis, and what is the most common method of treatment?
Answer





Case Study 2

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