In the first-morning, clean-catch specimen from a diabetic patient, which statement is true?

• A. The number of bacteria seen would result in a positive nitrite.
• B. The major formed elements are white blood cells and yeast.
• C. The type and number of epithelial cells suggest incorrect sample collection.
• D. The red blood cells would be sufficient to give a positive blood result on the reagent strip.

Answer: (B)

In diabetics, urine can show both inflammation and fungal growth because high glucose in the urine promotes yeast (Candida) overgrowth and infections in the urinary tract. A first-morning specimen is more concentrated, which makes cells and microbes more detectable. Therefore, seeing white blood cells indicating inflammation along with yeast from a fungal overgrowth fits what you’d expect in this scenario, making these two formed elements the major components you’d observe.

The other statements don’t as reliably reflect what’s most likely in this context: bacteria are not guaranteed to produce a positive nitrite test—not all urinary bacteria reduce nitrate to nitrite, and the result depends on the organism and time. Epithelial cells can indicate sample contamination but aren’t the defining feature of the expected finding in a diabetic with possible candiduria. Red blood cells alone aren’t what drives a positive blood result on the strip, since the test detects heme activity and can be influenced by factors beyond intact RBCs.