A 22-year-old woman comes the office due to 2 days of a burning sensation with urination. She had sexual intercourse with her partner last week and used a condom for contraception. She has also noticed scant vaginal discharge. The patient has never had these symptoms before. She has no chronic medical conditions, and she takes a combination oral contraceptive pill daily. A urine sample is obtained for urinalysis and culture. Which of the following additional findings would be most suggestive of a diagnosis of pyelonephritis?

Question

A 22-year-old woman comes the office due to 2 days of a burning sensation with urination.  She had sexual intercourse with her partner last week and used a condom for contraception. She has also noticed scant vaginal discharge.  The patient has never had these symptoms before.  She has no chronic medical conditions, and she takes a combination oral contraceptive pill daily.  A urine sample is obtained for urinalysis and culture.  Which of the following additional findings would be most suggestive of a diagnosis of pyelonephritis?

Quizplus · Accepted Answer

Eductional Objective: Both upper (eg, pyelonephritis) and lower (eg, cystitis) urinary tract infections (UTIs) can show microscopic hematuria, pyuria, and bacteriuria on urinalysis with microscopy.  However, the presence of white blood cell (WBC) casts can confirm the diagnosis of pyelonephritis in patients with UTI symptoms because WBC casts form only in the renal tubules.

A 22-Year-Old Woman Comes the Office Due to 2 Days