Leukocyturia is a pathological condition characterized by a high concentration of leukocytes in the urine. The cause may be urinary tract infections, autoimmune inflammatory diseases of the kidneys. In rare cases, leukocyturia is a sign of oncological pathology or graft rejection. By itself, leukocyturia has no clinical symptoms. Rarely, with a large number of cells, urine can become cloudy. The level of leukocytes is determined in the general analysis of urine, the study of the Nechiporenko, Kakovsky-Addis samples. Correction of this laboratory deviation is carried out in the treatment of the underlying disease.
In the urine of a healthy person, a small number of leukocytes can be detected. With microscopy of urine sediment, the norm is up to 3-5 leukocytes per field of view. The norm of leukocytes according to the Nechiporenko method is less than 200 per 1 ml, according to the Kakovsky-Addis method - up to 20000 per day.
By origin, leukocyturia is divided into:
According to the degree of severity, 2 large groups are distinguished: ordinary leukocyturia and pyuria, in which the number of cells is so large that the urine becomes cloudy, and under microscopy, leukocytes densely cover all fields of view. The presence of pyuria with a high probability indicates an infectious lesion of the urinary tract.
Separately, latent leukocyturia is distinguished, in which leukocytes are detected only when counting cells in special chambers (with the Nechiporenko and Kakovsky-Addis test), but are not detected during routine routine urine tests. Latent leukocyturia is often observed in young children, in patients with immunodeficiency states (decompensated diabetes mellitus, HIV infection).
When analyzing urine using test strips, incorrect results can be obtained:
Determination of leukocytes in urine
The most common cause of leukocyturia is a urinary tract infection. The penetration of microorganisms into the organs of the urinary tract causes an immune response - the migration of leukocytes into tissues, the development of an inflammatory process. As a result, part of the leukocytes enters the urine. A distinctive feature of infectious leukocyturia is the presence of bacteriuria, an alkaline urine reaction (pH above 7). Microscopic examination often reveals tripel phosphate crystals. Mostly neutrophils are found.
More severe forms of UTI (abscess, carbuncle of the kidney) are also accompanied by massive leukocyturia. Depending on the severity of the inflammatory process, both a moderate amount and pyuria can be observed. Leukocyturia occurs acutely, against the background of bright clinical symptoms (fever, dysuria), regresses quite quickly under the action of antibiotic therapy.
With other bacterial or viral infections, secondary kidney damage with concomitant leukocyturia is also possible. Especially often this happens in inflammatory diseases of organs that are anatomically close to the urinary tract - diseases of the female (colpitis, endometritis) and male reproductive system (balanoposthitis, prostatitis), pathologies in the abdominal cavity (appendicitis, pancreatitis).
Less commonly, leukocyturia is observed in the following diseases:
With viral infections, the degree of leukocyturia is usually moderate; with bacterial infections, pyuria is possible. Elimination of the infectious focus leads to the disappearance of leukocytes from the urine.
The inflammatory process in the kidneys of an autoimmune nature is almost always accompanied by leukocyturia. Isolated leukocyturia is rarely observed, most often erythrocytes are also found in the urine, a high protein concentration, and a decrease in specific gravity. At microscopy, leukocyte, erythrocyte cylinders, epithelial cells of the kidneys are noted. Leukocytes are predominantly represented by lymphocytes.
An increase in the percentage of lymphocytes indicates an exacerbation of the disease. The level of leukocytes decreases under the influence of specific anti-inflammatory therapy when remission is achieved, a small leukocyturia can persist for a long time. Autoimmune diseases in which leukocyturia occurs:
With malignant neoplasms of the urinary system (cancer of the kidney, bladder), leukocyturia develops gradually. It may appear long before any clinical signs appear. Lymphocytes predominate. In oncohematological pathologies (leukemias, lymphomas), immature forms of leukocytes are often found - myelocytes, promyelocytes, blasts. Leukocyturia is usually moderate, decreasing after courses of chemotherapy or surgical removal of the neoplasm.
If leukocyturia is detected, it is necessary to consult a general practitioner or nephrologist to find out the cause of its occurrence. The doctor asks the patient in detail about his complaints, the presence of diagnosed chronic diseases, about what medications the patient is taking. A physical examination is carried out - measuring body temperature, blood pressure, checking for the presence of peripheral edema, Pasternatsky's symptom.
It should be noted that urinalysis test strips detect only neutrophils. In diseases accompanied mainly by lymphocyturia (mainly autoimmune), in some patients the result will be negative. Lymphocytes and eosinophils can only be detected by microscopic examination of the native preparation or after its staining. If kidney tuberculosis is suspected, the urine sediment preparation is stained according to Ziehl-Neelsen.
To determine the source of leukocyturia, a 3-glass urine sample is performed. The predominance of leukocytes in the first portion indicates inflammation of the urethra, in the 3rd portion - about cystitis or prostatitis. The uniform presence of leukocytes in all portions is characteristic of kidney damage. For differential diagnosis of the etiological factor, an additional examination is prescribed:
Leukocytes in urine under a microscope
There are no independent methods for correcting leukocyturia. Treatment of the underlying disease is required. With interstitial nephritis caused by taking the drug, it is necessary to cancel it. Therapy can be carried out on an outpatient basis or in a hospital, it depends on the severity of the patient's condition. The following drugs are used:
In case of kidney cancer, the main method of treatment is surgical treatment - resection of the kidney or its complete removal (nephrectomy) by an open or laparoscopic method. With amyloidosis, in case of development of terminal renal failure, kidney transplantation is indicated. Patients with oncohematological pathologies undergo bone marrow transplantation.
Based on one leukocyturia, it is difficult to predict any prognosis. The outcome is determined by the disease against which this laboratory deviation arose, as well as the timeliness of its diagnosis and treatment. Therefore, when receiving a positive result of a urine test for leukocytes, you should immediately consult a doctor.