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Updated: Aug 23 2017


  • Snapshot
    • A 22-year-old woman presents with dysuria, pyuria, and increased urinary frequency. She reports her symptoms began approximately 2 days prior to presentation. She has had similar symptoms 5 months ago. She is sexually active and uses condoms inconsistently. Physical examination is unremarkable. Urinalysis is positive for pyuria and bacteruria. Urine culture demonstrates ≥ 100,000 colony forming units (CFU) /mL.
  • Introduction
    • Process
      • a fresh urine specimen is obtained and subsequently centrifuged
        • the supernatant is placed in a separate tube
          • a urine dipstick is placed in the supernatant to analyze for
            • pH
              • normal is between 5-6.5
              • clinical correlate
                • urine pH >7.5 can suggest a urinary tract infection (UTI) secondary to urea-splitting microbe
            • glucose
              • clinical correlate
                • urine glucose can be detected in the urine in poorly controlled diabetes mellitus
            • ketones
              • clinical correlate
                • urine ketones can be seen in poorly controlled diabetes mellitus
            • nitrite
              • clinical correlate
                • can be a reasonably good screening test for UTI
            • heme
              • clinical correlate
                • typically indicative of blood in the urine
                  • however, the urine can be heme positive in the setting of intravascular hemolysis and rhabdomyolysis
            • protein
              • clinical correlate
                • elevated protein in the urine can suggest a nephrotic syndrome
          • specific gravity
            • reflects the weight of a solution compared to the weight of distilled water
              • the solution and distilled water must be of equal volume
              • when the urine contains large solutes (e.g., glucose) the specific gravity increases
          • urine osmolality
            • measures the amount of dissolved particles per unit of water found in urine
        • the sediment should be resuspended and then transferred to a slide for analysis
          • urine casts
            • these represent protein and cell precipitates generated within the tubular lumen
          • red blood cells (RBCs)
            • red cell morphology
              • dysmorphic RBCs
                • suggests glomerular bleeding
              • round and uniform RBCs
                • suggests extrarenal bleeding (e.g., ureter and bladder)
          • white blood cells (WBCs)
            • seeing WBCs in the urine is termed pyuria and suggests an infection or inflammatory process in the urinary tract
            • neutrophils are more commonly seen
              • eosinophiluria can be see in drug-induced acute intestitial nephritis
          • epithelial cells
          • crystals
      • Urine Casts
      • Casts
      • Associated Conditions
      • Glomerulonephritis
      • Vasculitis
      • Malignant hypertension
      • WBC casts
      • Tubulointerstitial inflammation
      • Acute pyelonephritis
      • Transplant rejection
      • Fatty casts
      • Nephrotic syndrome
      • "Maltese cross" sign 
      • Granular casts
      • Acute tubular necrosis
      • Waxy casts
      • End-stage renal disease
      • Chronic renal failure
      • Hyaline casts
      • Non-specific
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