(Solved): CASE STUDY 12.3 A 45-year-old man has been a paraplegic since being involved in a motorcycle acciden ...

CASE STUDY 12.3 A 45-year-old man has been a paraplegic since being involved in a motorcycle accident 20 years ago. He has a history of recurrent urinary tract infections. (UTIs) as a result of infection from an indwelling catheter. He now has severe back pain, with fever, chills, and vomiting. He has been exposed to "the flu" and seeks medical attention. A midstream urine specimen is collected for examination and culture. The following routine urinalysis results were obtained: Physical Appearance Color: Yellow Transparency: Cloudy Chemical Screening pH: 6.5 Specific gravity: 1.010 Protein (reagent strip):

Blood: Moderate Nitrite: Negative Leukocyte esterase: Positive Glucose: Negative Ketones: Negative Bilirubin: Negative Urobilinogen: Normal Microscopic Examination RBCs: 2-5/hpf WBCs: 10-25/hpf Casts: 5-10 WBC casts/lpf Bacteria: Moderate rods Multiple Choice Questions (Answers are in Appendix A) This patient's proteinuria is probably caused by which of the following? a. Glomerular damage b. Lower urinary tract disorder c. Prerenal disorder d. Tubular (or interstitial) damage Concerning the positive leukocyte esterase and the negative nitrite in this patient, which of the following statements is correct? a. The leukocyte esterase test is probably a false-positive reaction. b. The negative nitrite reaction is probably caused by insensitivity of the test or lack of sufficient incubation of urine in the bladder. c. The positive leukocyte esterase reaction indicates that an upper UTI is present, d. The presence of a bacterial infection is ruled out because of the negative nitrite reaction. Concerning the positive reagent strip test for blood and the relatively low level of RBCs seen in the urine sediment of this patient, which of the following statements is correct? a. The presence of hematuria is not consistent with the disease exhibited by this patient. b. The presence of protein is probably interfering with the chemical test for blood. c. The reagent strip test is extremely sensitive and consistent with the microscopic findings. d. The reagent strip test is probably falsely positive because of the presence of ascorbic acid.