White Blood Cells In Urine

You went to your doctor and had a urinalysis and he tells you that you have white blood cells in your urine and you look at him puzzled.  What does that mean?  Let’s first discuss what white blood cells are.  Essentially white blood cells are the policemen of your body so that when there is an intruder they are called into action.  There are many different types of white blood cells in your body, but you don’t need to know all the types.  All you need to know is when they are present in your urine there is a high likelihood of an infection being present.  The more white cells in your urine the greater the chance of a urinary tract infection.

In order to determine if you do indeed do have a real urinary tract infection there are specific guidelines.  First you should be having symptoms.  So what are the symptoms of a urinary tract infection?  They are burning with urination, foul smelling urine, painful urination and in some people can present more ominously with flank or back pain.  In that case the infection has already spread up the ureter and into the kidneys to cause pyelonephritis.  Pyelonephritis needs to be treated with powerful antibiotics otherwise it can lead to sepsis or spread of the bacteria into your bloodstream which can be life threatening.  Fortunately, if properly treated most urinary tract infections are benign.

The specific diagnostic criteria for a UTI include on urinalysis the present of white blood cells in the urine along with nitrite and leukocyte esterase.  What the heck does that mean?  Well all you need to know is they are byproducts of bacteria producing organisms.  But, definitive diagnosis is made with culture and great than 100,000 colony forming units on a urine culture makes the diagnosis of a UTI or urinary tract infection.  Of course you could also have a fungus like candida cause your urinary tract infection, but those are more unusual and are more likely to be non pathogenic or chronic colonizers.  However, in certain sick patients treatment for these fungal urinary tract infections does have a place.

Some patients have chronic indwelling foley catheters perhaps from a neurogenic bladder.  These people are often chronic colonizers and unless symptomatic should not be treated for bacteruria which in layman’s terms just means bacteria growing out of the urine.  If symptoms are present then treatment would be warranted.  Treatment duration for a UTI varies based on whether it is a simple or uncomplicated case vs a complicated case.  Uncomplicated UTIs can be treated with 3 days of antibiotics and compliclated UTIs up to 7 days.  Complicated UTIs include all UTIs with an indwelling foley, suprapubic catheter and interestingly enough all male UTIs.  Antiobiotic choice is wide and can be a quinolone like ciprofloxacin or levaquin, Bactrim, penicillin or cephalosporin.  The treatment needs to be tailored to each individual need based on allergies and which antibiotics the bacteria are sensitive to.

Once treated the white blood cells should disappear from the urine as the infection is gone so the body no longer needs to mount an attack on the bacteria. If the white blood cells in urine are gone then you can be sure that your urinary tract infection has been adequately treated.  In addition your symptoms should have abated.  If they haven’t it is not uncommon to develop resistance and cultures with bacterial sensitivities should be used to further guid treatment.


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