Case Study: Urine Analysis

Reasons Why the Dipstick Results In Specific Gravity and Protein Are Different From the Alternative Testing Methods

In this case study, the easiest and most valuable way to determine the fluid electorate status of a patient is by using evaluation of urinary concentration. During the day-to-day care of the critically ill persons as those in the intensive care unit and also outpatients. According to Vassalotti et al. (13), the concentration of the urine relies on the presence of small electrolytes, uric acid, phosphates, and urea as well as protein particles per unit area of the urine (Vassalotti et al. 19). Urine volume is dependent on the hydration of the patient and the amount of fluid that renal tubule reabsorbs. One can get the concentration of the solutes in the urine by measuring the gravity or even its osmolality.

Vassalotti et al. (17) provide that, the dipstick result for specific gravity and protein are different from alternative testing because of the presence of water in the urine component. The comparison between particular dipstick U-SG measurements compared to dipsticks show that there is a distinction between the reagent and hydrometric strips. The urine specific gravity shows the relative proportion of the solid components dissolved compared to the unit volume of the particular urine specimen. It represents the relative degree of the concentration of the urine taken. To determine the urine specific gravity, it is necessary to have minimal amounts of urine for an efficient, quick and non-invasive way to collect information on the hydration state of the patient (Vassalotti et al. 19). However, evaluating the urine osmolality by freezing point depression during lab testing is not practical when it comes to acute management of urine abnormalities. As such, the physicians rely on the dipstick.

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The Most Probable Cause for the Hexagonal Shaped Crystals and Thin Needles and Notched Plates

According to a study by Vaden et al. (63), the function ability of kidneys is that they rely on filtering the blood as well as producing urine. As such, the chemical components of the urine such as uric acids, calcium, carbon, and nitrogen contain crystals. When the functionality of the kidney becomes compromised, it can lead to crystal formation due to changes (Vaden et al. 63). Causes of crystal formation are as a result of the following:

Dehydration: limited fluid intake causes the few minerals in the urine to form crystals. When one’s body has less water, leads to an increase in composites concentration such as uric acid. The result of crystallization becomes evident in the urine (Vaden et al. 66). Another reason for crystals is when the urine PH changes. Typically, the PH levels show whether a solution is acidic or alkaline (Vaden et al. 83). As such a PH value that shows a below seven is acidic. On the other hand, PH above seven is alkaline. Crystals in urine indicate that there is a strong presence of acidic components. Where the urine is too salty, there is likely to a formation of calcium phosphate crystals. 

Ones’ diet is also another determinant for crystallization in the urine. People who eat high protein foods are likely to develop crystals in their urine. Therefore, too much protein consumption increases the chances of forming uric and calcium components (Meyer et al. 137). As a result, this creates room for crystal formation. Because there are no apparent symptoms of crystal formation, other health issues in urinary system may reveal crystallization. Lastly, urinary tract infections due to bacteria may also cause crystals to form. In this case, the most probable fact for crystal formation and notched plates is the presence of large protein composites (positive 3+).

The result confirms the presence of thin needles and notched plates. These cysteine needles indicate the presence of calcium in the urine causing a condition called cystinuria. As a result, this weakens the renal system causing kidney failure. The fact that the brothers complain of a similar situation also shows that it is an inborn error in metabolism (Meyer et al. 137). As a result, there is a tendency of forming urolithiasis. 

Action Plan before Reporting UA

Generally, before declaring a urinary test, it is safe to write the specimen requirements in a written format (Vassalotti et al. 29). The composition should include specifications such as volume, temperature as well as any individual handling notes. Therefore, the requested quantity in the case is a sufficient amount that can allow for two performances. With a small volume, it will enable for one-time analysis that includes dead instrument volume. In case of panels or essay requests, the sample should be given with the physician’s priority of determination. As such, the test’s performance will rely on that order. If there will be a request for more volume, then it will be necessary to contact the physician (Vassalotti et al. 17). It is required to strike a balance between trusting the clients and making sure that there is no contamination of the specimen. By using specimen strips, it ensures that sample collected is within body temperature for accurate results. 

In case of the need to add additional information for the interpretation of the results or specific instruction about the patients, it is essential to list along with the requirements of the specimen. It is critical to have an adequate sample submitted for analysis (Vassalotti et al. 15). In this case, the volume in the directory is enough for initial analysis as well as any confirmatory tests that will take place. However, providing the inadequate specimen will delay initial testing and the required confirmatory procedures. Primarily, having a patient/client chart on the urinalysis observation helps to validate the method. One should ensure that there is a record of the findings that are clear and accurate for natural interpretation. It is also crucial to follow the organization’s procedure when recording and reporting as it helps to avoid interpretation

Interpretation of the Results

The urinalysis test confirms that the patient has two types of fine crystals. The first crystal is hexagonal in shape and colorless. The other crystals are also colorless needles and plates with a notched corner. Moreover, a previous urinalysis test also indicated the presence of hexagonal crystals. The presence of hexagonal crystals (Crytaine crystalluria) indicates presence of protein in the urine (Hongboonkerd et al, 133). Cystine crystalluria/ urolithiasis shows that the patient has cystinuria which is a result of an error in metabolism. According to Hongboonkerd et al (119), people with this condition are born with it; hence, it is a sex-linked inheritance mainly in the males. In addition to the crystallization, the patient also shows changes in PH which is an indicator of bacterial overgrowth. Aside from medication, diet and water intake also plays a vital role in managing this condition. 

Works Cited

Meyer, Norman L., et al. “Urinary dipstick protein: a poor predictor of absent or severe 

proteinuria.” American journal of obstetrics and Gynecology 170.1 (1994): 137-141.

Thongboonkerd, Visith, et al. “Proteomic analysis of normal human urinary proteins isolated by 

acetone precipitation or ultracentrifugation.” Kidney international 62.4 (2002): 1461-1469.

Vaden, Shelly L., et al. “Effects of urinary tract inflammation and sample blood contamination 

on urine albumin and total protein concentrations in canine urine samples.” Veterinary clinical pathology 33.1 (2004): 14-19.

Vassalotti, Joseph A., Lesley A. Stevens, and Andrew S. Levey. “Testing for chronic kidney 

disease: a position statement from the National Kidney Foundation.” American journal of kidney diseases 50.2 (2007): 169-180.