CASE DESCRIPTION: Laura Rambaux was 11 years old when her parents first brought her into
the clinic where you work. Laura had been eating and drinking a lot more
than usual for several weeks but her parents believed it was just a growth
spurt before puberty. However, she began to seem very tired and irritable
all the time, and was actually noticeably losing weight. The doctor
ordered a CBC, blood chemistry and urinalysis.
Part 1: Urinalysis
The blood samples needed to be sent to an off-site lab for analysis but you
were able to perform the basic urinalysis at the clinic. Refer to the
urinalysis report below to answer the following questions:
Urinalysis
Normal Value Range
Yellow (light/pale to dark/deep amber)
Clear or cloudy
4.5-8
1.005-1.025
Analyte
Color
Clarity/Turbidity
PH
Specific gravity
Glucose
Ketones
Nitrites
Leukocyte esterase
Bilirubin
Urobilirubin
Patient Values
Pale yellow
Coudy
5.2
1.028
135 mg/d
0.8 mmol/L
Negative
Negative
Negative
0.6 mg/dL
0
58 mg/d
0
0
5 sec/hpf
0
Negative
Negative
Negative
s130 mg/d
<0.6 mmol/L
Negative
Negative
Negative
0.5-1 mg/dL
3RBCS
s150 mg/d
RBCs/hpf
2-5
WBCs/hpf
s15-20 squamous epithelial cells/hpf
0-5 hyaline casts/ipf
Occasionally
None
None
Blood
Protein
ROS
WBOS
Squamous epithelial cells
Casts
Crystals
Bacteria
Yeast
1. Compare Laura's results to the normal values. Are there any abnormal
results present? Identify any abnormal results. (2 pts)
2. The normal pH range of urine is very broad. Consider the urinary
anatomy and physiology you have learned and EXPLAIN how urinary pH
is regulated including specific anatomical structures and cells, as well as
required hormones, enzymes or chemical reactions. (12 pts)
3. Why would the presence of proteins or cells in the urine be extremely
concerning? Your explanation should include a description of the relevant
anatomical structures in the kidney and how normal filtration and
reabsorption works. (12 pts)