Question

Case Study #1 udent health service. A A 20-year-old female college student with a sore throat is seen in the st throat swab is cultured with an intramuscular injection of pen and reported positive for group A β-hemolytic streptococci. She is treated icillin. Two weeks later, she wakes up in the morming and finds that she has decreased urine volume, and her urine is dark red. She also has a fever swelling in her feet. She retuns to the student health service, where urine is collect urinalysis. The following urinalysis results were obtained. ed for Physical Appearance Color: Red Transparency: Cloudy Chemical Screening pH: 6.0 Specific gravity: 1.025 Protein (reagent strip): 100 mg/dL. Blood: Large Nitrite: Negative Leukocyte esterase: Negative Glucose: Negative Ketones: Trace Bilirubin: Negative Urobilinogen: Normal Microscopic Examination (hpf, high-power field; Ipf, low-power field): Red blood cells: 10-25/hpf, dysmorphic forms present White blood cells: 0-2/hpf Casts: 2-5 red blood cell casts/lpf Crystals: Moderate amorphous urates Critical Thinking Questions 1. Based on the laboratory data, what is a likely diagnosis for this patient?

Qn based on the laboratory data what is a likely diagnosis for this patient?

Question 2 How does this patient ‘s condition differ from the conditions of other patients who might have similar laboratory findings?

Answer 1

Case 1:

1. Glomerulonephritis

(Reasons: As the urine is cloudy

Protein urea

Presence of HPF cast and RBC in urine.

Patient has fever and swelling of feet. )

2. The patient may have post-streptococcal glomerulonephritis (PSGN).

The infection may have occurred due to the strep throat irrespective of the penicillin treatment. The lab values of the patient along with the recent history of strep-throat suggest the PSGN.

Case 2:

1. Urinary tract infection

As the child’s urine test reveals:

WBC : 50-100 /hpf

Many rods of Bacteria

pH of 7.5

Cloudy appearance of urine

Leukocyte esterase and nitrite positive in urine

2. Girls are susceptible for UTI due to the shorter urethra

The child was experiencing clinical features of UTI like frequency, urgency and burning micturition

Case 3:

1. The diagnosis could be Urinary Tract Infection (UTI)

As the lab values are:

Cloudy and yellow urine

pH is 6.5

protein : 100 mg/dl

Leukoterase esterase: positive

WBC : 10-25/hpf

Casts: 5-10 WBC casts/lpf

Moderate rod bacterium

2. A patient is at high risk for developing UTI due to the presence of an indwelling catheter, immobility/paralysis/ and frequent UTI

Case 4:

1. Nephrotic syndrome could be the diagnosis

Lab values supporting it:

Urine protein : 4+ >2000 mg/dl

Casts: 10-15 fatty casts/lpf, 2-5 hyalin casts/ lpf

Epithelial cells: few renal epithelial cells and many oval fat bodies present

(not an infectious condition as the WBC, RBC are within normal range, no leukoterase esterase)

2. A child has generalized oedema

History of frequent infections predispose to nephrotic syndrome

Cloudy and foamy urine

Lethargic