Question

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 /

1. What disorder/disease process is most likely manifesting these symptoms in this patient? What are your presumptive and alternative diagnoses?
2. Which lab tests above [and corresponding results] could be used to confirm or eliminate your diagnoses? Be sure to note all that apply.
3. Which parameter would be most significant in differentiating a lower versus upper urinary tract disorder? Why?
4. Describe the likely physiological cause of this condition and how this may develop.

Answer 1