LOWER URINARY TRACT

INFECTION
Clinical Microscopy Case Study – Group 4A

Prepared by:
Cantago, Mitzi G.
Flores, Carla L.
Hepiga, Adah Mae L.
Obut, Karenn A.
OBJECTIVES:
 To identify the patients diagnosis based on the laboratory results given
 To correlate physical and chemical urinalysis results with microscopic
observations and recognize abnormal findings
 To describe and give significance about urinary tract infection
 To integrate critical thinking skills and to promote good relationship among
the members of the group

CASE:

An 8-year-old girl complains of feeling like she needs to urinate all the time. Her urine
burns when she does void and it is cloudy. She is seen by her pediatrician’s office, where urine
is collected for routine urinalysis and culture. The following urinalysis results were obtained:

Color pale
Transparency cloudy
pH 7.5
Specific gravity 1.010
Protein (reagent strip) trace
Protein (SSA) trace
Blood negative
Nitrite positive
Leukocyte esterase positive
Glucose negative
Ketones negative
Bilirubin negative
Urobilinogen normal
RBC 0-2 per hpf
WBC 50-100 per hpf, clumps of white cells seen
Casts none
Crystals moderate amorphous phosphates
Bacteria many rods
QUESTIONS:
1. List the abnormal findings.
 Transparency - cloudy
 Nitrite - positive
 Leukocyte esterase - positive
 White blood cells - 50-100/hpf; clumps of white cells seen
 Bacteria - many rods

2. What is the cause of the positive reagent strip for nitrite in the patient?
Answer: The cause of the positive reagent strip for nitrite in the patient is an infection
with gram-negative bacteria. The reagent strip test for nitrite provides a rapid screening
test for the presence of urinary tract infection wherein the chemical basis of the nitrite
test is the ability of the of certain bacteria to reduce nitrate, a normal constituent of urine,
to nitrite, which does not normally appear in the urine. Therefore, the positive reaction
for nitrite indicates the existence of gram negative bacteria.

3. What cause the positive reagent strip test for leukocyte esterase in this patient?
Answer: The cause of positive reagent strip test for leukocyte esterase is the presence of
white blood cells. Chemical test for leukocyte esterase have been included as another
means of detecting UTI. The leukocyte esterase test is based on the measurement of
esterase in the granulocytic white blood cells and monocytes. In practice, positive
reaction occur with increased neutrophils. Neutrophils are the leukocytes most frequently
associated with bacterial infections. The detection of leukocytes esterase as an indicator
of infection is useful because neutrophils are generally increased in response to bacterial
infection. When bacteria infect the urinary tract, at any point from the urethra to the
kidney, the presence of increased numbers of WBC, particularly neutrophils, is typical.
Therefore, the presence of WBC indicate bacterial infection.

4. What is the cause of the patient’s alkaline pH?

Answer: The cause of the patient’s alkaline pH is the presence of bacteria and moderate
number of amorphous phosphate. The presence of urease-producing bacteria breaks
 down urea to ammonia and also the increased number of amorphous phosphate which is
an alkaline crystal results to a pH of 7.5 .

5. What is the cause of the patient’s proteinuria?

Answer: The patient exhibit trace of protein indicating only minimal protein detected.
Healthy kidneys only filter tiny (trace) amounts in the urine as most protein molecules
are too large for the glomeruli. Thus, the trace amounts of protein are due to the small
molecules of protein that find its way to the glomerular filtration resulting to a trace or
minimal amount of protein.

6. What is the condition exhibited by this patient?

Answer: The patient exhibit lower urinary tract infection. Urinalysis test finding include
positive chemical test for nitrite and leukocyte esterase accompanied with the presence
of abnormal number WBC and bacteria in microscopic analysis and an increased pH.
The patient also complain the need to pass urine much more frequently than usual and a
burning sensation when passing the urine wherein it manifest in a patient experiencing
urinary tract infection. These findings lead to the diagnosis of urinary tract infection. But
there are two types of urinary tract infection the upper and lower. The patient urinalysis
result signifies a lower urinary tract infection because of the absence of formation of cast
in the urine indicating that the infection is not in the kidney but either in the urinary
bladder or urethra.

REVIEW OF RELATED LITERATURE

A urinary tract infection (UTI) is an infection in any part of the urinary system —kidneys,
ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the
urethra. UTIs are among the most common bacterial infection that lead patients to seek medical
care. Approximately 10% of humans will have UTI at some time during their lives. Of note, UTIs
are also the most common hospital-acquired infection. Escherichia coli is far by the most frequent
cause of community-acquired UTI. Thus, women are at greater risk of developing a UTI than are
men. Infection limited to the bladder can be painful with onset of urinary frequency and burning
sensation when urinating. However, serious consequences can occur if a UTI spreads to the
kidneys.
CLINICAL SIGNIFICANCE
This study will help us identify the etiology of lower urinary tract infection and the
susceptibility. It helps us know the prevalence of UTI which markedly varies among sex and age.
Thus, considering that it will affect our daily routine which will give us pain when urinating,
frequent urination, and feeling the need to urinate despite of having an empty bladder. And if UTI
is left untreated, it can travel to the kidneys and cause further infection. Therefore, it is important
to know how to prevent from contracting to certain bacteria that causes UTI from invading and
spreading in the body which will probably lead to more serious case of diseases.

LEARNING OUTCOMES
After the case study, the group members were able to:
 Identify the diagnosis of the patient
 Apply the knowledge and correlate the laboratory results in determining the
diagnosis of the patient
 Obtain sufficient information about urinary tract infection
 Demonstrate good relationship while working the activity

REFERENCES
• Strasinger, S.K., Di Lorenzo, M.S. (6th Edition) Urinalysis and Body Fluids
• Tille, P.M. (13th Edition) Bailey and Scott’s Diagnostic Microbiology
• McPherson, R.A., Pincus, M.R (22nd Edition), Henry’s Clinical Diagnosis and
Management by Laboratory Methods
• Tortora, G.J., Derrickson, B.( 1st Asia Pacific Edition) Principles of Anatomy and
Physiology