Question

URINALYSIS CASE STUDY

A 35 year-old women enters the ER with a 101.5°F temperature and pain in in her flanks. In the initial interview, the patient reveals she has been urinating more frequently but with only minor discomfort. A midstream clean catch urine is collected and the routine UA and culture performed:What are the abnormal findings in this urinalysis that may point to a disease?

Urinalysis Testing
Examination	Parameters	Result
Physical	Color	yellow
	Clarity	cloudy
Chemical	Specific gravity	1.010
	pH	6.5
	Protein	30 mg/dL
	RBC	trace
	Leukocyte esterase	positive
	Nitrite	positive
	Glucose	negative
	Ketones	negative
	Bilirubin	negative
	Urobilinogen	normal
Microscopic	RBC	1-3 /hpf
	WBC	20-40 /hpf (clumping seen)
	Casts	3-6 WBC casts /lpf 1-3 granular casts /lpf
	Epithelial cells	0-2 /hpf
	Crystals	none seen
	Bacteria	moderate /hpf

What disorder/disease process is most likely manifesting these symptoms in this patient?

What parameter above was most helpful in differentiating a lower versus upper urinary tract disorder?

Describe the likely physiological cause of this condition.

Answer 1

ANSWER

* Abnormal finding in urine analysis point out the disease.

                     * Positive results of leucocyte esterace and nitrate in the urine analysis.

                     * Presence of bacteria in the urine.

                     * Elevated number of WBS cells in the urine.

* Symptoms in this patient (fever,discomfort in urination,frequency of urination,pain in flank region)

   indicate she has upper UTI (urinary tract infection) or Pyelonephritis.

* In the case of upper urinary tract infection inflammation parenchymal cells of kidney result in

flank pain,fever along with symptoms of lower UTI .so this patient manifestations shows upper UTI.

* Physiological cause of upper urinary tract infection.

             * E coli is a type bacteria which present normally in the digestive system enter into the bladder from bowel

                into the bladder through urethra or infection may occur via lymph or blood.

              * After enter into the bladder this bacteria form a biofilm (microorganisms stick toghether in a self produced matrix)

                which resist immune response of the body and begin to produce problems.

              * Infective bacteria enter into the bladder move towards kidney during the progressive stages of infection

                leads to upper urinary tract infection.