Transcript Case Review

Review Topic:
Renal Disease
Ricki Otten MT(ASCP)SC
[email protected]
Case #1
A 3-year-old left unattended in the garage
for 5 minutes is suspected of ingesting
antifreeze (ethylene glycol). His parents
brought him to the ER. STAT urinalysis
results follow:
2.Based on the patient’s history and
urinalysis results, select the most probable
diagnosis:
a. Acute glomerulonephritis
b. Acute tubular necrosis
c. Urinary tract infection
3.What type of crystals would you except to
be present in this patient?
4. What are the two forms of crystal
typically seen in this type of poisoning?
5. The amorphous material present will be
classified as:
a.
Amorphous phosphates
b.
Amorphous urates
Case #2
A urine specimen was sent to the
laboratory from a patient being evaluated
for kidney stones. Six hours earlier the
patient was given radiographic contrast
media by I.V.
2. Identify the discrepant test results
3.
What is the most likely identity of this
crystal?
a. Uric acid, rare form
b. Cystine
c. Triple phosphate
d. X-ray contrast media
4. State two results that support the crystal
selection made in question #3
5.Which specific gravity result is the better
indicator of this patient’s renal
concentrating ability:
a. Refractometer
b. Reagent strip
Case #3
A 24-year-old female is seen in the
outpatient clinic complaining of a painful
burning sensation (dysuria) when urinating
and feeling a constant urgency, like she
‘has to go’ all the time. A midstream clean
catch urine specimen is collected for a
routine urinalysis and culture.
2.Based on the patient’s symptoms and
urinalysis results, select the most probable
diagnosis:
a. Acute glomerulonephritis
b. Cystitis (bladder infection)
c. Pyelonephritis
d. Nephrotic syndrome
3.Suggest a cause for the increased number
of transitional epithelial cells seen in this
patient’s urine:
4. State three reasons why the nitrite test
can be negative despite bacteriuria
5. Provide one reason why this patient’s
diagnosis is not pyelonephritis:
Case #4
A 43-year-old man with a history of
diabetes mellitus is seen in t he diabetes
clinic complaining of decreased frequency
of urination, having a constant ‘bloated’
feeling, and mild weight gain. Physical
exam revealed mild edema of the ankles,
abdomen and eyes. Urinalysis results
follow:
2. Based on the patient’s symptoms and urinalysis
results, select the most probable diagnosis:
a. Acute glomerulonephritis
b. Pyelonephritis
c. Nephrotic syndrome
d. Cystitis
3. The proteinuria in this patient should be
classified as:
a. Glomerular proteinuria
b. Tubular proteinuria
4.What substance is responsible for the
large amount of white foam:
5.What type of protein is predominantly
present in the urine?
6. Explain why the glucose result is
positive, yet the ketone result is negative
7. Decreased frequency of urination is
called:
Case #5
A 43-year-old man is seen in the ER
because his urine is red, he is having
headaches and lacks an appetite. Careful
questioning revealed he had a sore throat
about 3 weeks ago that lasted 4-5 days,
but went away without having to take
medicine. Also, his daughter had strep
throat about a month ago that was
successfully treated with antibiotics.
Urinalysis results follow:
2.The proteinuria in this patient would be
classified as
a. Glomerular proteinuria
b. Tubular proteinuria
c. Overflow proteinuria
d. Transient proteinuria
3. What is the likely process by which the
red blood cells are entering the urine:
4. Of the microscopic findings, which
sediment entity specifically indicates
adverse glomerular changes and the
presence of a renal disorder
5. Based on the patient’s history and
urinalysis test results, select the most
probable diagnosis:
a. Nephrotic syndrome
b. Acute glomerulonephritis: post
streptococcal infection
c. Toxic tubular necrosis
6. Provide one reason why this patient’s
diagnosis is not nephrotic syndrome:
7. Does this patient have isosthenuria?
Explain your answer
Case #6
A 53-year-old woman is seen by her
physician complaining of vaginal itching,
soreness and a white discharge. She also
noted that she has been ‘thirsty all the
time’ and seemed to be urinating more
frequently. Urinalysis results follow:
2. What is the most likely cause of this
patient’s vaginitis?
Does this patient have a urinary tract
infection?
3.What is the most likely origin or source of
the white blood cells in this patient’s urine?
4.List two microscopic findings that suggest
this urine is not a midstream clean catch:
5.Explain why the glucose and ketone
results are positive:
6. Frequent urination at night is called:
7. Explain why the nitrite test is negative in
this patient:
Case #7
A 50-year-old male had an emergency
appendectomy and received a unit of
packed red blood cells following surgery.
Two hours later he developed fever, chills
and nausea. Two days following surgery,
urine was submitted for urinalysis:
2. Explain the apparent discrepancy seen
between the reagent strip blood result
and the microscopic findings:
3. The positive blood reagent strip reaction
would be classified as:
a.
Hematuria
b.
Hemoglobinuria
c.
Myoglobinuria
4. Explain why the urobilinogen is elevated
in this patient:
5.Because of the intravascular hemolytic
episode, her serum bilirubin is significantly
increased.
Explain why her urine bilirubin is negative.
6.Provide a possible explanation as to why
the ictotest was performed despite a
negative bilirubin reagent strip test:
Case #8
A 19-year-old female college basketball
player is seen in student health clinic for a
sports physical. She states she feels
healthy and is taking no medications. A
midstream clean catch urine is collected
for urinalysis:
2.Identify any discrepant test results
3.The technologist checks the pH of the urinary
sediment and rechecks that of the urine in the
original specimen cup obtaining the following
test results:
Urine sediment:
pH 5.0
Urine in specimen cup: pH 7.5
Suggest a cause for the discrepancies noted
Case #9
An 82-year-old woman was admitted to
the hospital complaining of back and left
rib pain. X-ray shows lytic lesions of the
spine and ribs. A bone marrow evaluation
showed >30% plasma cells in sheets. A
diagnosis of multiple myeloma is made.
Urinalysis results follow:
2.Identify the discrepant test results
3.Explain the most probable cause for the
discrepancy between the protein results
4.Which protein(s) is most likely responsible
for the proteinuria in this patient?
a. Albumin
b. Hemoglobin
c. Uromodulin
d. Globulins (immunoglobulins)
5.The proteinuria seen in this patient would
be classified as
a. Glomerular proteinuria
b. Tubular proteinuria
c. Overflow proteinuria
d. Transient proteinuria
Case #10
A 25-year-old male is seen in the
outpatient clinic complaining of extreme
tiredness and nausea for the past 2
weeks. Physical examination revealed a
tender liver and yellowish discoloration in
the sclera of his eyes. Urinalysis results
follow:
2.What substance most likely accounts for
the urine color and foam color
observations:
3.Explain why the reagent strip test for
bilirubin is negative, yet the Ictotest is
positive
4.Should the bilirubin result on this urine be
reported as negative or positive?
5.Explain the physiologic process that
accounts for the bilirubin result in this urine
6.Which form of bilirubin is present in this
patient’s urine:
a. Conjugated bilirubin
b. Unconjugated bilirubin
Explain why only this form of bilirubin is
found in urine:
Case #11
A 43-year-old female is seen by her
physician complaining of sudden weight
loss and frequent urination, especially
during the night. Urinalysis results follow:
2.Identify any discrepant test results
3.Explain why the glucose and ketone
results are positive
4.The most likely diagnosis of this patient is:
a. Diabetes mellitus
b. Diabetes insipidus
5.What reagent strip test when positive, is
an early sign of renal disease:
6.Is this patient showing signs of early renal
disease:
7. Explain why the specific gravity results
are different
8. Which specific gravity result most
accurately reflects the concentrating
ability of the kidneys?
9. Excessive night time excretion of urine is
called:
Case #12
A 9-day-old infant is seen by the
pediatrician. His mother states that the
baby cries all the time, cannot keep his
formula down, has diarrhea and pulls his
legs up as if he has gas. A catheterized
urine specimen was obtained. Urinalysis
results follow:
2. Identify any discrepant test results
3. What makes the reagent strip test
specific for glucose?
4.The copper sulfate test reacts with what
type of substance?
5.Explain the glucose reagent strip and
Clinitest results:
6.Based on the clinical presentation of this
patient and the urinalysis results, select
the most likely diagnosis:
a. Diabetes mellitus
b. Diabetes insipidus
c. Inborn error of metabolism such as
galactosemia
d. Renal glycosuria
7.Should the physician be concerned to see
transitional epithelial cells? Explain