Leukocyte is a term associated with white blood cells, those which are responsible for fighting off infection and clearing them from the body. Leukocytes can be broken down into two types, those that stain under microscopic examination, exhibiting granules and those without granules. Regardless of their appearance, they function as part of the immune system and are sent to any part of the body where infection is suspected
The presence of leukocytes in urine is generally indicative of a urinary tract infection. When a urinalysis is ordered, it may be ordered as part of a panel of multiple constitutes monitoring for abnormal levels; or as a single test called leukocyte esterase. The esterase is an enzyme released by the white blood cells and when detectable indicates the presence of leukocytes in urine. An infection within the urinary tract evident by leukocytes in urine can occur in one or multiple sections including:
• Urethra (urethritis)
• Bladder (cystitis)
• Ureters (ureteritis)
• Kidney (nephritis, pyelonephritis, or glomerulonephritis depending on the area within the kidney).
Symptoms Associated with the Presence of Leukocytes in Urine
A small amount of leukocytes in the urine is considered normal. The body is continual fighting infections preventing illness and therefore the detection of leukocytes, when in small quantities, is generally not of concern. However, when levels of leukocytes in urine are beyond acceptable normal levels, an infection may be present. Considering leukocytes in urine are a sign of a urinary tract infection other symptoms need to be assessed and evaluated.
Such symptoms may include:
• Burning or painful sensation upon urinations
• An increase in urinary frequency or unable to empty out the bladder completely
• A foul or fishy smelling odor to the urine
• Cloudy urine that may or may not have whitish sediment present
• A change in the color of the urine
• Lower back or flank pain
• Feeling weak and fatigued
• The presence of a fever, often times low grade or it may remain within normal levels
• Nausea and vomiting could be present
• Symptoms of confusion normally not present (particularly with elderly individuals)
Tests and Diagnosis for Leukocytes in Urine
The most prominent reason for leukocytes to be present in urine is due to a urinary tract infection. First and foremost, a urine culture and sensitivity examination will be ordered to determine if any bacteria is present. The sensitivity part of the test will determine which antibiotics will be effective against the organism. Depending on the results of the culture and sensitivity tests, other tests and exams that may be ordered include:
• Blood tests and cultures to determine if infection is present in other parts of the body
• Abdominal and or pelvic ultrasound; or a specific ultrasound called a KUB (Kidney, ureter and bladder)
• Abdominal CAT Scan
More invasive exams may be required due to severity of symptoms and level of leukocytes in urine:
• A special xray examination called an Intravenous Pyelogram may be required for suspected upper urinary tract infections. Radioactive dye is infused into a vein and passed through the kidneys upon filtration and thus visualized on xray.
• Cystoscopy. This is an invasive diagnostic, which includes a specialized small camera to be inserted through the urethra to visualize the bladder, ureters, and prostate in men.
A Potential for False Positives
A urinalysis or a leukocyte esterase examination, and culture and sensitivity test may be ordered several times before confirming leukocyte presence and making of an official diagnosis of infection. This is to prevent the risk of false positives and to reduce the need for potentially unnecessarily tests and further examinations.
• Urine contaminated with vaginal discharge can falsely increase the levels of leukocytes in urine.
• Some medications and antibiotics increase white blood cell activity and therefore leukocyte levels in urine may be inaccurate.
Who is Most at Risk for Leukocytes in Urine?
Considering leukocytes in urine are highly suggestive of a urinary tract infection, women are mostly at risk. This is due to the close location between the urethra and the anus as well as the relatively short length of the urethra when compared to a man’s. Young women and infant girls are at the highest risk. While men can experience urinary tract infections with subsequent leukocytes in urine, their infections are usually more serious. The elderly are also at risk to high levels of leukocytes in urine due to their limited ability to complete thorough hygiene and weaker immune system. The elderly are also more likely to require catheterization, which significantly increases risk of bacterial transmission to the urinary tract system thus increasing the likelihood of high levels of leukocytes in urine. People diagnosed with diabetes are also more prone to increased levels of leukocytes as their immune system is greatly affected by the disease.
Treatments for Abnormal Levels of Leukocytes in Urine
Small elevations in leukocyte levels are generally nothing to be concerned about. However when higher than normal levels are accompanied by other symptoms indicative of infection, including a positive culture and sensitivity test, antibiotics are generally ordered. When it comes to antibiotic therapy, the most important factor is to complete the entire course of medication to reduce the risk of antibiotic resistant organisms and to also prevent a reoccurrence of the infection due to improper medication. If high levels of leukocytes are present, regardless if medications or other exams are ordered, it is prudent to commit to self-care measures.
• Drink lots of water in order to flush your body and kidneys of bacteria and toxins
• Go to the washroom routinely and ensure the bladder is emptied completely
• Perform proper and regular hygiene by washing your hands and using proper technique of cleaning from front to back after urination and moving your bowels.
Such everyday self-care measures can greatly reduce risk for transmission of bacteria to the urinary tract system thus diminishing the presence of leukocytes in urine.