Case 4 - interpreting mid-stream urine tests

Question 1

Microscopy methods are:

Answer 1

red blood cells
white blood cells
epithelial cells

Question 2

Interpreting urine reports: microscopy - what can be seen from RBC’s?

Answer 2

Urinary tract malignancy
Bladder/kidney stone
Infection
trauma

Question 3

Interpreting urine reports: microscopy - what can be seen from WBC’s?

Answer 3

inflammation/infection

Question 4

Interpreting urine reports: microscopy - what can be seen from epithelial cells?

Answer 4

[maybe] perineal contamination

Question 5

are RBC’s present in urine [regarding MSU’s]?

Answer 5

yes, Normally, a few RBCs are present in urine (0-5 RBCs per high power field, or see range on report)

Question 6

what does more than the normal amount of RBC’s seen on MSU’s/microscopy indicate?

Answer 6

Menstruation (contamination)
Infection
Urinary tract malignancy
Bladder/kidney stone
trauma

Question 7

Haematuria is best detected by?

Answer 7

dipstick

Question 8

Sterile pyuria - can be seen from what in microscopy?

Answer 8

Elevated WBC with a negative culture

Question 9

possible causes of Sterile pyuria

Answer 9

Recent treated UTI
Current antibiotics – even one dose
Chlamydial urethritis/ other infection e.g gonorrhoea
Prostatitis
Renal tract tuberculosis – consider in patients with fever, weight loss, night sweats, anorexia with no other obvious cause
Drugs – e.g. NSAIDS, steroids, cyclophosphamide, indinavir

Question 10

‘Asymptomatic bacteriuria’ - when to treat

Answer 10

GENERAL RULE:
Do not treat – does not reduce morbidity or mortality
‘Asymptomatic bacteriuria’ is common in over-65s

Question 11

‘Asymptomatic bacteriuria’ - exceptions of when to treat

Answer 11

Exceptions:
Asymptomatic bacteriuria should be treated in pregnancy
And some exceptional circumstances eg renal transplant – discuss with specialist