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Urinalysis with microscopy has been an invaluable tool for the clinician. Urine dipstick tests and microscopy are useful for diagnosing several genitourinary and systemic conditions.

White Blood Cells In Urine Normal Range

White Blood Cells In Urine Normal Range

This article presents a series of case scenarios that demonstrate how primary care physicians can use the urinalysis in common clinical situations.

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Initial evaluation of patients with asymptomatic microscopic hematuria should include renal function tests, urinary tract imaging, and cystoscopy.

Microscopic hematuria is common and has a wide differential diagnosis, ranging from completely benign causes to possible invasive malignancy. The causes of hematuria can be classified as glomerular, renal, or urological

The American Urological Association (AUA) defines asymptomatic microscopic hematuria as three or more red blood cells per high-power field in a properly collected specimen in the absence of obvious causes such as infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or a recent urological procedure.

A 58-year-old lorry driver with a 30-year history of smoking one pack of cigarettes a day presents for a physical examination. He reports increased urination and nocturia, but has no gross hematuria. Physical examination reveals an enlarged prostate. The results of his urinalysis with microscopy are shown in Table 2.

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Based on this patient’s history, symptoms, and urinalysis findings, which of the following is the most appropriate next step?

For the patient in case 1, due to his age, clinical history, and lack of other clear causes, the most appropriate course of action is to obtain blood urea nitrogen and creatinine levels, perform computed tomographic urography, and refer the patient for cystoscopy.

An algorithm for the diagnosis, evaluation and follow-up of patients with asymptomatic microscopic hematuria is presented in Figure 1.

White Blood Cells In Urine Normal Range

The AUA does not recommend repeating urinalysis with microscopy before surgery, especially in patients who smoke, because tobacco use is a risk factor for urothelial cancer (Table 3).

Leukocytospermia Or Pyospermia

A previous article in American Family Physician reviewed the American College of Radiology’s Appropriateness Criteria for the radiologic evaluation of microscopic hematuria.

It has three stages that can detect various causes of hematuria. The unenhanced phase is the best contrast for detecting stones in the urinary tract; the nephrographic phase is useful for detecting renal masses, such as renal cell carcinoma; and the lag phase delineates the collecting system of the urinary tract and can help detect urothelial malignancies in the upper urinary tract.

Although the delayed phase may detect some bladder masses, it should not replace cystoscopy in the evaluation for bladder malignancy.

After a negative microscopic hematuria, the patient should continue to be followed with annual urinalysis until at least two consecutive normal results are obtained.

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In patients with microscopic hematuria, repeat urinalysis in six months or empirical treatment with antibiotics may delay treatment of curable diseases. It is unwise to assume that benign prostatic hyperplasia is the explanation for hematuria, especially because patients with this condition usually have risk factors for malignancy. Although urine cytology is usually part of the urological workup, it should be performed at the time of cystoscopy; the AUA does not recommend urine cytology as the initial test.

The stent has one coil that lies in the bladder and another that lies in the renal pelvis. Patients with ureteral stents may experience urinary frequency, urgency, dysuria, flank pain, and hematuria.

They may have a dull pain on the side that goes away suddenly with a void. This phenomenon occurs because the ureteral stent bypasses the normal non-refluxing uretero-vesical junction, resulting in pressure transfer to the renal pelvis with voiding. Approximately 80% of patients with a ureteral stent experience stent-related pain that affects their daily activities.

White Blood Cells In Urine Normal Range

A 33-year-old woman with a history of nephrolithiasis presents with a four-week history of urinary frequency, urgency, urge incontinence, and dysuria. He recently underwent ureteroscopy with lithotripsy of a 9-mm obstructing left ureteral stone; he does not know if a ureteral stent was placed. She has constant dull pain on the left flank that goes away suddenly with voiding. The results of his urinalysis with microscopy are shown in Table 4.

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The presence of a ureteral stent causes mucosal irritation and inflammation; therefore, leukocyte esterase findings with white and red blood cells are not diagnostic for urinary tract infection, and a urine culture is required. In this setting, plain radiography of the kidneys, ureters and bladder would be useful to determine the presence of a stent. If a neglected ureteral stent is identified by a primary care physician, prompt urological referral for removal is indicated. Retained ureteral stents can become covered, and subsequent stone formation can lead to obstruction.

Flank discomfort and a recent history of urinary tract manipulation suggest that this is not a simple urinary tract infection; therefore, a three-day course of antibiotics is insufficient. Although flank pain and urinalysis suggest possible pyelonephritis, this patient should not be treated for simple pyelonephritis in the absence of stent radiography. Metabolic stone workup may be useful for future prevention of kidney stones, but has not been indicated in the acute setting. Finally, although computed tomography would detect a ureteral stent, it is no better than radiography because it exposes the patient to unnecessary radiation. Microscopic hematuria typically requires follow-up to ensure there is no underlying treatable etiology. In this case, the etiology is probably the patient’s recent ureteroscopy with lithotripsy.

A 49-year-old man with a history of neurogenic bladder due to spinal cord injury and performing a clean intermittent catheterization visits your clinic for evaluation. He reports frequent strong-smelling urine, but no dysuria, urge incontinence, fever, or suprapubic pain. The results of his urinalysis with microscopy are shown in Table 5.

Although urinalysis results are consistent with a urinary tract infection, the clinical history suggests asymptomatic bacteriuria. Asymptomatic bacteriuria is the isolation of bacteria in a properly collected urine specimen from a person without symptoms of a urinary tract infection.

Wbc (pus Cells) In Urine

The presence of bacteria in the urine after prolonged catheterization has been well described; one study of 605 consecutive weekly urine specimens from 20 patients with a chronic catheter found that 98% contained high concentrations of bacteria, and 77% were polymicrobial.

Similar results have been reported in patients performing clean intermittent catheterization; another study of 1,413 urine cultures obtained from 407 patients undergoing clean intermittent catheterization found that 50.6% contained bacteria.

Guidelines from the Infectious Diseases Society of America recommend against treating asymptomatic bacteriuria in nonpregnant patients with spinal cord injury undergoing clean intermittent catheterization or in those using a chronic indwelling catheter.

White Blood Cells In Urine Normal Range

In the absence of symptoms of urinary tract infection or nephrolithiasis, there is no need to culture the urine, treat with antibiotics, refer to a urologist, or perform abdominal and pelvic imaging. There is no reason to suspect acute kidney injury in this setting; therefore, measurement of serum creatinine level is also unnecessary.

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Data Sources: Literature searches were performed in PubMed using the terms urinalysis review, urinalysis interpretation, microscopic hematuria, CT urogram, urinary crystals, indwelling ureteral stent, asymptomatic bacteriuria, and bacteriuria with catheterization. Guidelines from the American Urological Association were also reviewed. Search dates: October 2012 and June 2013.

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C3 6 mg/dL (avg: 90 – 180 mg / dL); C4 8 mg/dL (avg: 10 – 40 mg/dL). Great choice, we should look for complement mediated diseases in patients like this with a nephritic picture.

This test is a low yield here. Our patient presents with nephritis, and anti-PLA2R is more helpful in narrowing down our differential from nephrotic syndrome.

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1:1080 (reference <1:80). Yikes! This patient has a significantly higher ANA titer, which can help us further narrow our difference.

<5 IU/mL (reference <14IU/mL). It is not unreasonable to send this test to look for cryoglobulinemic glomerulonephritis, although it may be less likely in this case.

You obviously noticed this patient’s cytopenias (low cell count). However, a bone marrow biopsy is an invasive test and may not give us the diagnosis. For now, our colleagues in hematology are advising other diagnostic tests to help this patient.

White Blood Cells In Urine Normal Range

A negative test, but reasonable to have sent this young patient with evidence of nephritis, especially given his recent febrile illness. White blood cells (WBCs) are also called leukocytes. They protect the body from infections by fighting foreign invaders such as viruses, bacteria, fungi, or parasites. Phagocytes and lymphocytes are forms of white blood cells (WBCs).

Leukocytes In Urine: What Does Leukocyte Esterase In Urine Mean?

Phagocytes ingest foreign particles such as bacteria. Lymphocytes recognize the foreign particles based on previous encounters. Lymphocytes make up our body’s adaptive immunity. They also produce

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