DISKUSI KASUS KELAS B

1. A 14-year-old boy is brought to the pediatrician by his mother because he has had a fever
with shaking chills for the past day. On physical examination, he has a temperature of
39.6 C and has mild right costovertebral angle tenderness.

Macroscopic Urinalysis: Microscopic Urinalysis:

Characteristic Result Characteristic Result

Color Yellow WBC/hpf >50/hpf
Appearance Turbid RBC/hpf 5-10/hpf
Leukocyte Esterase 3+ Casts Many WBC
Nitrite Pos Other Occasional transitional cells
pH 6.5

Protein Neg

Blood Neg

Specific Gravity 1.015

Ketones 1+

Glucose Neg

Bilirubin Neg

Questions:

1. How do you explain the appearance of the urine? How do you relate this to other
findings?
2. What is the significance of the finding on physical examination?
3. Is there a relation between the color of the urine and the diagnosis?
4. What findings on microscopic urinalysis are of help in this case?
5. What is the suspected diagnosis?
6. What else should you do?

2. A 34 year old Korean woman is admitted to the emergency room with the major complaint of
"not feeling herself." For the past week, she has been suffering from extreme fatigue and
 headaches, but did not feel the need to have it checked out until she has noticed that her vision
is "a little fuzzy". When asked if she is taking any medications, she responds a low dosage
birth control, a women's daily multivitamin and prednisone for her systemic lupus
erythematosus (SLE).

An urinalysis is ordered. The nurse notices that the urine has a "sweet" odor to it as she
conducts the point of care testing. The urinalysis results are:

Macroscopic Urinalysis:

Microscopic Urinalysis:
Color Yellow
RBC 2-10/hpf
Appearance Clear
WBC 0-5/hpf
Specific Gravity 1.010
pH 7.0
Protein Trace

Glucose 500 mg/dL

Ketones Small

Bilirubin Negative

Blood Negative

Urobilinogen 0.2 mg/dL

Nitrite Negative

Leukocyte Negative

Questions

1. What is the diagnosis of this patient? What results from the urinalysis (both stix and
microscopic) support your answer?
2. Is it normal for a patient with SLE to have red and white blood cells in the urine? Why or why
not?
3. Does the stix result for leukocytes correlate with the microscopic findings? Why or why not?
4. Does the stix result for blood correlate with the microscopic findings? Why or why not?

3. A 5-year-old boy usually drove his mother crazy by running around the house all day long,
but he has been lethargic for the past 2 weeks. On physical examination he is afebrile, but
there is puffiness around his eyes.

Macroscopic Urinalysis: Microscopic Urinalysis:

 Characteristic Result Characteristic Result
Color Yellow WBC/hpf 1-2/hpf
Appearance Hazy RBC/hpf None
Leukocyte Esterase Neg Casts None
Nitrite Neg Other Occasional oval fat bodies
pH 6.0

Protein 4+

Blood Neg

Specific Gravity 1.020

Ketones Neg

Glucose Neg

Bilirubin Neg

Questions:

1. What key abnormal finding is present? Just what does the dipstick measure here, and
what other test could be done on the urine?
2. What is suggested by the child's physical findings?
3. What other laboratory test(s) would be useful?
4. What is the diagnosis?

4. 14-year-old boy who has recently recovered from a sore throat develops edema and
hematuria. Significant laboratory results include a BUN of 30 mg/dL (normal 8 to 23
mg/dL) and a positive group A streptococcal antibody test. Results of a urinalysis are as
follows:
Color: Red
Clarity: Cloudy
Sp. gravity: 1.020
pH: 5.0
Protein: 3+
Glucose: Negative Ketones: Negative
Blood: Large
Bilirubin: Negative
Urobilinogen: Normal
 Nitrite: Negative
Leukocyte: Trace

Microscopic:
100 RBCs/hpf—many dysmorphic forms
5–8 WBCs/hpf
0–2 granular casts/lpf
0–1 RBC casts/lpf

a. What disorder do these results and history indicate?

b. What specific characteristic was present in the organism causing the sore throat?
c. What is the significance of the dysmorphic RBCs?
d. Are the WBCs significant? Why or why not?
e. What is the expected prognosis of this patient?
f. If the above urinalysis results were seen in a 5-year-old boy who has developed a red,
patchy rash following recovery from a respiratory infection, what disorder would you
suspect?

5. A 25-year-old pregnant woman comes to the outpatient clinic with symptoms of lower
back pain, urinary frequency, and a burning sensation when voiding. Her pregnancy has
been normal up to this time. She is given a sterile container and asked to collect a
midstream clean-catch urine specimen. Routine urinalysis results are as follows:
Color: Pale yellow
Clarity: Hazy
Sp. gravity: 1.005
pH: 8.0
Protein: Trace
Glucose: Negative
Ketones: Negative
Blood: Small
Bilirubin: Negative
Urobilinogen: Normal
Nitrite: Positive
Leukocyte: 2+

Microscopic:
6–10 RBCs/hpf
40–50 WBCs/hpf
Heavy bacteria
Moderate squamous epithelial cells

a. What is the most probable diagnosis for this patient?

b. What is the correlation between the color and the specific gravity?
c. What is the significance of the blood and protein tests?
 d. Is this specimen suitable for the appearance of glitter cells? Explain your answer.
e. What other population is at a high risk for developing this condition?
f. What disorder might develop if this disorder is not treated?

6. An 85-year-old woman with diabetes and a broken hip has been confined to bed for the past 3
months. Results of an ancillary blood glucose test are 250 mg/dL, and her physician orders
additional blood tests and a routine urinalysis. The urinalysis report is as follows:
COLOR: Pale yellow
CLARITY: Hazy
SP. GRAVITY: 1.020
pH: 5.5
PROTEIN: Trace
GLUCOSE: 100 mg/dL KETONES: Negative
BLOOD: Moderate
BILIRUBIN: Negative
UROBILINOGEN: Normal
NITRITE: Negative
LEUKOCYTES: 2+

Microscopic:
20 to 25 WBCs/hpf
Many yeast cells and hyphae

a. Why are yeast infections common in patients with diabetes mellitus?

b. With a blood glucose level of 250 mg/dL, should glucose be present in the urine? Why or why
not?
c. Is there a discrepancy between the negative nitrite and the positive leukocyte esterase results?
Explain your answer.
d. What is the major discrepancy between the chemical and microscopic results?
e. Considering the patient’s history, what is the most probable cause for the discrepancy?