CASE 1

1. No. The leukocyte test pad on the reagent stix has a sensitivity of >10WBC/uL. Therefore,
while there may have been some WBCs present, there was not a sufficient number to cause
a positive reaction on the reagent stix. A similiar type of thinking can be applied to the
nitrite pad to explain the negative nitrite result even though bacteria were seen. The nitrite
pad requires 100,000 organisms/mL for a positive result to be given. 20-30 bacteria/hpf are
not sufficient to give a positive result on the reagent stix.
2. No. Ordinarly, bacteria in the presence of WBCs would suggest a urinary tract infection.
However, the 0-3 WBC/hpf is within the reference range and therefore is of no clinical
significance. The relatively low levels of bacteria are also of no clinical significance. Their
presence may be due to contamination.
3. There are two possible ways that blood could get into the urine. First, if the glomerulus was
in some way damaged, its efficiency as a filter may be somewhat compromised. If this was
the case, RBCs, protein, and other larger particles could get into the urine. However, in this
case, the high blood result with only trace amounts of protein suggests that the problem did
not occur at the glomerulus. This leads to the other cause of blood in the urine: damage to
the urinary tract. If any part of the urinary tract is damaged, blood could get into the urine,
even if the glomerulus is working fine. Renal calculi, or kidney stones, could cause damage
to the renal tubules as they flow down the urinary tract. This damage would explain the
presence of blood (in the absence of large amounts of protein).

CASE 2

1. A positive leukocyte esterase indicates the presence of WBCs. These are present due to an
inflammation or infection of some kind.
2. WBCs would be present during a yeast infection. However, these bacteria do not contain
the enzyme nitrate reductase. As a result, nitrate could not be reduced to nitrite so a
negative reaction would be seen on the nitrite pad.
WBCs would be present during inflammation. Since bacteria are not required for an
inflammatory reaction, the enzyme nitrate reductase would not be present and so nitrate
would not be reduced to nitrite. As a result a negative reaction would be seen on the nitrite
pad.
3. If the glomerulus was in some way damaged, its efficiency as a filter may be somewhat
compromised. As a result, RBCs, protein, and other larger particles could get into the urine.
4. Acute Glomerulonephritis. The recent streptococcal infection is a cause of
glomerulonephritis. The physical examination of the patient also indicates an inflammatory
disease. This is further supported by the presence of WBCs in the urine without any
bacteria. The presence of blood along with protein in the urine suggests that the problem is
occurring at the glomerulus itself.

CASE 5
1. The diagnosis for this patient is prednisone induced diabetes. Prednisone, in this case used
to treat the symptoms of SLE, is known to cause type 2 Diabetes. The results from the
urinalysis result that support this diagnosis is the fruity odor of the urine, the low specific
gravity, and the elevated glucose and ketone levels. The elevated protein levels are
common in patients that have renal involvement associated with SLE.
2. The microscopic finding for white blood cells (0-5/hpf) is normal for any individual. The
blood result however is not normal (normal range 0-2/hpf), but is common to see in patients
that have renal involvement associated with SLE.
3. Yes, the results correlate because it takes about 10 intact WBC/hpf to get a trace reading for
leukocytes.
4. No, these results do not correlate because it takes about 5 intact RBC/hpf to get a trace
reading for blood, and there were 2-10/hpf. The most likely cause for this discrepancy is the
ascorbic acid that the patient is taking (daily multi-vitamin).