An obese 58-year-old woman is seen by her physician. Her chief complaint is peri

Question

An obese 58-year-old woman is seen by her physician. Her chief complaint is perineal itching and soreness. When giving her health history, she also complains of being thirsty “all the time: and to be urinating more frequently. On pelvic examination, a white discharge is noted. A urine specimen is collected for a routine urinalysis.

Urine Physical Examination

   Color:       Yellow

   Clarity:   Cloudy

   Odor:        None

Urine Chemical Examination

   Specific gravity:       1.015

   pH:               6.0

   Blood:               Moderate

   Protein:           Trace

   Leukocyte:           Positive

   Nitrite:               Negative

   Glucose:           500 mg/dl

   Ketones:           Trace

   Bilirubin:           Negative

   Urobilinogen:           Normal

   Ascorbic Acid:       None Detected

Microscopic Examination

   RBC/hpf:           0-2

   WBC/hpf:            10-25 clumps

   Casts/lpf:            0-2 hyaline

   Epithelials:           Many squamous epithelial cells/lpf

   Bacteria:           Negative

   Yeasts/hpf:           Moderate

   Crystals/hpf:           Few urates

Identify any abnormal or discrepant urinalysis findings.

What is the most likely cause of this patient’s vaginitis?

What is the most likely origin or source of the white blood cells in this urine?

Which two microscopic findings suggest that this urine is not a midstream clean catch specimen?

Explanation / Answer

1). The following are the abnormal urine findings of the given case:

Urine Physical Examination

   Color:       Yellow (Normal)

   Clarity:   Cloudy (abnormal, a fresh urine must be clear)

   Odor:        None (normal)

Urine Chemical Examination

   Specific gravity:       1.015 (normal)

   pH:               6.0 (normal)

   Blood:               Moderate (abnormal, normal value is, 3 RBCs)

   Protein:           Trace (normal)

   Leukocyte:           Positive (abormal, normal values are 2-5 WBCs/hpf)

   Nitrite:               Negative (normal)

   Glucose:           500 mg/dl (abnormal, normal value is 130 mg/d)

   Ketones:           Trace (abnormal, the normal urine does not contain ketone bodies)

   Bilirubin:           Negative (normal)

   Urobilinogen:           Normal (normal value is, 0.5-1 mg/dL)

   Ascorbic Acid:       None Detected (abnormal, indicates vitamin C deficiency)

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