CEA Nursing Practice Exam

Which of the following findings confirms a diagnosis of pyelonephritis?

1. Gram positive bacteria in bloodstream

2. RBC casts on urinalysis with microscopy

3. Enterococcus in urine

4. WBC casts on urinalysis with microscopy

The correct answer is: WBC casts on urinalysis with microscopy

The presence of white blood cell (WBC) casts on urinalysis with microscopy is a significant finding that supports the diagnosis of pyelonephritis. Pyelonephritis is an infection of the kidney, often resulting from ascending urinary tract infections. When the kidneys become inflamed due to infection, WBCs migrate into the renal tubules. These cells can form casts as they are shed into the urinary tract, indicating kidney involvement and an inflammatory process. WBC casts are specifically associated with kidney disease or infections affecting the renal parenchyma, distinguishing pyelonephritis from lower urinary tract infections, where such casts would not typically be present. The presence of WBC casts in the urine is therefore a strong indicator of pyelonephritis and confirms that there is a renal inflammatory process occurring, likely due to bacterial infection. While other options may suggest different conditions or infections, only WBC casts are directly indicative of pyelonephritis and its associated renal inflammation. For instance, finding Gram-positive bacteria in the bloodstream suggests a systemic infection, not specifically pyelonephritis. Similarly, the presence of red blood cell casts may point to glomerular disease rather than a renal infection, and detecting Enterococcus in