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Medicine

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Kidney

Question
7 out of 17
 

A boy is suffering from acute pyelonephritis. Most specific urinary finding will be- (AIIMS May -07)



A W.B.C. casts
B Leucocyte esterase test

C Nitrite test
D Bacteria in gram stain

Ans. D Bacteria in gram stain

Significance of bacteria in UTI

A. Determination of the number and type of bacteria in the urine is an extremely important diagnostic procedure.

The detection of bacteria in a urine culture is the diagnostic "gold standard" for UTI;

B. In symptomatic patients, bacteria are usually present in the urine in large numbers (105/mL).

C. Similarly, the presence of bacteriuria of any degree in suprapubic aspirates or of 102 bacteria/ml of urine obtained by catheterization usually indicates infection.

D. Microscopic bacteriuria, which is best assessed with Gram-stained uncentrifuged urine, is found in >90% of specimens from patients whose infections are associated with colony counts of at least 105/ml, and this finding is very specific.

E. The leukocyte esterase "dipstick" method is less sensitive than microscopy in identifying pyuria but is a useful alternative when microscopy is not feasible.

Important Points: Leukocytes in Urine

A. An increase in the leukocyte count in the urine most commonly implies infection.

B. If number of WBCs in UN centrifuged Q midstream urine in women is >10/mm3, it is abnormal

C. 3 – 10/mm3, it is of doubtful significance.

D. If number of WBCs in uncentrifuged midstream urine in men is > 3/mm3, it is abnormal.

E. If the number of WBCs in centrifuged midstream urine both men and women is > 5 WBCs/HPF, it is abnormal

F. When pyuria is present without bacteria (sterile pyuria), three – fourth of the patients show an underlying urinary tract abnormality.

Extra Edge: Cause of non infective (Sterile pyuria) WBCs in urine

A. C. trachomatis, B. U. urealyticum, C. M. tuberculosis D. Fungi E. Calculi

F. Nephrocalcinosis, G. Vesicoureteral reflux H. interstitial nephritis I. Polycystic disease.

Crystals

A. Large bizarre crystals of any type including calcium oxalate and uric acid usually indicate increased urinary excretion and may indicate calculus disease.

B. Cystine crystals are always abnormal and indicate cystinuria. (MCQ)

Kidney Flashcard List

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