Directions
Students should complete one (1) case (your choice) from Part 1, complete all of Part 2, complete one (1) case (your choice) from Part 3 and complete Part 4. Note: All case studies are provided as a learning tool for students who wish to have them.
Part 1: Pick one of the three (3) cases
Review the urinary infectious cases and determine the most likely cause, including pathogen and mode of transmission. Discuss data that supports your decision and treatment strategies.
Case 1
A 50-year-old woman presented complaining of burning sensation when urinating and feeling like she has to go every hour for the last day. She denies fever and suprapubic or back pain.
Past medical history: dyslipidemia and hypertension.
Medications: atorvastatin.
Allergies: sulfa.
Physical examination: temperature 98.5°F; pulse 80 beats per minute; respirations 18 per minute; blood pressure 110/66 mmHg; examination unremarkable; no suprapubic or costovertebral angle tenderness; urine dipstick reveals moderate leukocytes and positive nitrites, with all other values within normal limits.
What is the most likely diagnosis and pathogen causing this disorder and mode of transmission? Discuss data that support your decision.
What diagnostic test, if any, should be done?
What are diagnostic test findings would support your diagnosis?
Develop a treatment plan for this patient.
Case 2
A 65-year-old woman with no urinary system complaints had a routine urinalysis with the following results:
What is the most likely diagnosis and pathogen causing this disorder and mode of transmission? Discuss data that support your decision.
What diagnostic test, if any, should be done? Develop a treatment plan for this patient.
Case 3
A 45-year-old woman is complaining of urgency and dysuria for the past 2 days. Yesterday, she started getting chills, feels she is getting a fever, and her back hurts.
Past medical history: UTI 1 year ago.
Medications: none.
Allergies: no known drug allergy (NKDA).
Physical examination: temperature 100°F, pulse 86 beats per minute; respirations 18 per minute; blood pressure 110/70 mmHg; positive costovertebral angle and suprapubic tenderness, otherwise unremarkable; urine dipstick reveals positive leukocytes but negative for nitrites and blood.
What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
Discuss data that support your decision.
What diagnostic test, if any, should be done? What diagnostic test findings would support your diagnosis?
Develop a treatment plan for this patient.
Part 2: Complete all
Review the following case and urinalysis report.
A 46-year-old woman is asymptomatic and has a routine urinalysis as part of her annual physical. The urinalysis with microscopy report is as follows:
Describe the urinalysis findings and determine possible reasons for the findings and follow-up, if necessary.
Part 3: Pick one of the three (3) cases
Hematuria is common and can be due to benign conditions (e.g., strenuous exercise) or serious disorders (e.g., renal cell carcinoma). Review these cases and determine the most likely cause of the hematuria. Discuss data that supports your decision as well as diagnostic and treatment strategies.
Case 1
A 50-year-old White man is complaining of left-sided flank pain that started about 3 hours ago. He describes the pain as sharp and intermittent. He notes that his urine is a bit darker, but he denies seeing blood. The pain started after he finished mowing a client’s lawn (he is a gardener). He denies dysuria, urgency, or fever.
Past medical history: gout.
Medications: allopurinol 100 mg orally every day.
Allergies: no known drug allergies (NKDA).
Social history: denies smoking, alcohol use, or drug misuse.
Physical examination: temperature 98.5°F; pulse 96 beats per minute; respirations 20 per minute; blood pressure 138/88 mmHg.
General: anxious, holding left side, and moving around; otherwise, examination is unremarkable.
Urinalysis: positive for blood with 15 RBCs per HPF; remainder unremarkable.
Discuss most likely cause of the hematuria. Discuss data that supports your decision as well as diagnostic and treatment strategies.
Case 2
An 8-year-old Black girl is complaining of burning when urinating for the past day. She reports wetting herself at school because she was unable to hold it until she was able to get to the bathroom. When she toileted, she voided only small amounts. She denies fever, back, or suprapubic pain. The child is accompanied by her mother.
No past medical history or medications.
Allergies: penicillin (hives).
Vaccines: up to date.
Physical examination: vital signs and examination are within normal limits.
Urine dipstick: positive for leukocytes, nitrites, and blood.
Discuss most likely cause of the hematuria. Discuss data that supports your decision as well as diagnostic and treatment strategies.
Case 3
A 68-year-old White man is concerned because he thinks he is peeing blood. He noticed it about 1 month ago, and he thought it was related to sex as he noticed it right after intercourse. However, he has had two other episodes within the past two weeks not related to sexual intercourse. He denies fever, dysuria, frequency, abdominal, back, or pelvic pain. He states he used to have a weak stream and have to urinate at night, but these symptoms have improved since starting finasteride (5α-reductase inhibitor).
Past medical history: BPH.
Medications: finasteride.
Allergies: no known drug allergy (NKDA).
Social history: has smoked 1 pack of cigarettes per day for the past 40 years; drinks two to three beers on the weekends.
Physical examination: body mass index 32; vital signs and examination are within normal limits.
Urinalysis with microscopic evaluation: positive for blood with 40 RBCs/HPF; no casts or dysmorphic cells noted.
Discuss most likely cause of the hematuria. Discuss data that supports your decision as well as diagnostic and treatment strategies.
Part 4: Complete
A 13-year-old boy presented to the clinic complaining of a sore throat that persisted for 2 days. After those 2 days, he developed fever, nausea, and malaise. A throat culture revealed the presence of group A beta-hemolytic streptococci, and the child was started on antibiotic therapy. The child’s symptoms gradually improved, but approximately 2 weeks later, he returned to the clinic because the fever, nausea, and malaise returned. He became tachypneic and short of breath. The mother noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy.
On examination, the child’s blood pressure was 148/100 mmHg; his pulse 122 beats per minute; and his respirations were 35 per minute. Orbital and ankle edema were present. Crackles were auscultated bilaterally. No heart murmurs were found. Slight tenderness to percussion over the flank areas was noted.
A chest X-ray showed evidence of congestion and edema in the lungs. The patient’s hematocrit was 37%, and his WBC count was 11,200/mm3. Blood urea nitrogen was 48 mg/dL (normal is less than 20 mg/dL). Urinalysis results showed that the patient’s protein was 2+ (24-hour excretion was 0.8 g), specific gravity was 1.012, and there were moderate amounts of RBCs and WBCs in the urine. Serum albumin was 4.1 g/dL (normal is 3.5–4.5).
Which evidence supports the conclusion that this patient has a kidney disease?
Which clinical pattern of kidney disease does this patient have? Explain the symptoms.
Which morphologic changes would you expect in the kidney?
What is the prognosis?
What are the possible short- and long-term complications of this disease?
Is it necessary to hospitalize the patient?