Leukocyturia

Leukocyturia is evidence of an inflammatory process in the urinary tract, renal pelvis and kidney tissue. Leukocyturia cannot be considered a disease, it is a very definite indicator of many diseases - cystitis, tuberculosis, nephritis, pyelonephritis, prostatitis and other infections of the genitourinary system.

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Causes leukocyturia

Since leukocyturia is not a diagnosis, but merely indicates an inflammatory pathology, its causes can be quite varied. Moreover, asymptomatic leukocyturia may not be accompanied by a bacterial infection, but may be an indicator of extrarenal pathology, such as helminthic invasion or urinary allergy.

Leukocyturia may have the following causes, determined by the type of urogram:

• The presence of neutrophils performing a bactericidal phagocytic role is an indicator of possible pyelonephritis or tuberculosis.
• Mononuclear type of urogram is an indicator of possible interstitial nephritis or glomerulonephritis.
• The presence of lymphocytes is an indicator of possible systemic pathology (systemic lupus erythematosus), arthritis of rheumatoid etiology.
• Eosinophils in the urogram are an indicator of possible allergies.

Leukocyturia causes can manifest in the number of leukocytes and in the level:

• Glomerular level (renal) is a sign of glomerulonephritis, interstitial tissue nephritis.
• Calyces and pelvises (renal level) - acute or chronic pyelonephritis, septic renal infarction (renal carbuncle), abnormal position of the kidneys, tuberculosis, polycystic kidney disease, renal hypoplasia, hydronephrosis, including congenital.
• Ureteral level (extrarenal level) - an indicator of ureteral diverticulum, kink or duplication of the ureter.
• Bladder level – cystitis, including acute, stones, tuberculosis of the bladder.
• The urethral level is an indicator of possible pathology of the urethra, phimosis.

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Symptoms leukocyturia

Any pathology of infectious nature in these systems and organs is revealed by clinical symptoms - intoxication, pain, as well as laboratory parameters - leukocytosis, accelerated ESR, increased protein concentration (CRP). These are typical signs of acute inflammation, the consequence of which is leukocyturia - the presence of a large number of leukocytes in the urine, exceeding the normal limits.

In healthy people, when examining urine, provided that personal hygiene is observed, traces of leukocytes can also be detected in the urine, the norm for men is 2-3.5, for women - 2-5.6 in the field of vision. Minor leukocyturia is the detection of titers exceeding the indicators 6-10, if there is an indicator of 20 in the field of vision, leukocyturia is considered indisputable and indicates an obvious or hidden infection of the urinary tract or kidneys. There is also massive leukocyturia, which is more correctly called pyuria, when purulent flakes are clearly visible in the urine.

Forms

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Aseptic leukocyturia, infectious leukocyturia

Depending on the nature and duration of the inflammatory process, leukocyturia can have the following types:

• Infectious leukocyturia.
• Aseptic leukocyturia.

Depending on the location of the inflammatory focus, leukocyturia can be:

• Renal leukocyturia.
• Leukocyturia of the lower urinary tract.

Depending on the number of leukocytes detected, leukocyturia can be:

• Small leukocyturia (microleukocyturia) – less than 200 in the field of vision.
• Pyuria - from 200 to 3,000,000 in the visual field.

Infectious leukocyturia is always combined with the presence of bacteria in the urine - bacteriuria, when more than one hundred thousand microorganisms are detected in the material in one liter.

Aseptic leukocyturia is characterized by the presence of lymphocytes and eosinophils, as well as the absence of a large number of bacteria, hence the name of the type - aseptic, that is, not having infection. Obviously, the presence of lymphocytes, which have the ability to determine and neutralize harmful antigens, as well as eosinophils, which ensure the effective destruction of foreign protein compounds, play a role in the asepsis of the inflammatory process.

To diagnose the cause of leukocytes in urine, it is extremely important to differentiate these two types. Infectious leukocyturia requires repeated studies and complex antibacterial therapy. Aseptic leukocyturia, on the contrary, is neutralized without the use of antibiotics, which is very important for the treatment of pregnant women, elderly patients and children.

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Leukocyturia in children

Leukocyturia in children, especially in girls and adolescents, may be false and associated with inflammation of not internal organs or the genitourinary system, but with poor personal hygiene and inflammation of tissues adjacent to the genitals (skin). That is why leukocyturia in children is not always an indicator of an infectious disease and requires repeated urine tests. Usually, the doctor finds out under what conditions and how the material (urine) was collected, whether there is diaper rash or inflammation in the genital area. Anamnesis is also collected, including family history, and it is found out whether there was dysuria - a disorder, a violation of the urination process. Elevated body temperature, possible injuries, physiological factors, such as teething in children under one year old, can be useful information for differentiating the type of leukocyturia. In addition, the level of leukocyturia is determined using the two-glass test. All children with leukocytes detected in the urine must undergo an ultrasound examination of the bladder and kidneys. Among the reasons for which leukocyturia may occur in children, the most common are the following:

• Acute or chronic pyelonephritis (obstructive, non-obstructive).
• Interstitial nephritis.
• Acute nephrosis.
• Balanoposthitis.
• Vulvitis.
• Enterobiasis.
• Urethritis.
• Cystitis, acute or chronic.
• Crystalluria.
• Urinary allergy.
• Intertrigo.

Leukocyturia in pregnant women

Pregnancy is always accompanied by anxiety about the health of not only the mother, but also the fetus. Susceptibility to all kinds of infections in a pregnant woman is increased due to the fact that the immune system directs all resources to adapt the body to a new, still unusual condition. It is for this reason that it is important to undergo examinations in a timely manner and follow all the instructions of the attending gynecologist. It is also important to know what leukocyturia means during pregnancy.

Any indicator that exceeds the normal range is evidence of a possible disease, an increase in the number of leukocytes in the urine is also a sign of inflammation in the body. Leukocyturia in pregnant women may indicate an infectious process in the vagina, kidneys or urinary tract. In order for the tests to be truly indicative and not false, it is important to properly prepare the material - urine. False leukocyturia may be associated with non-compliance with personal hygiene rules, when vaginal discharge gets into the urine, accordingly, the level of leukocytes will be increased for completely understandable reasons that are not related to the disease. If vulvitis is absent, vaginitis is also not observed, and leukocytes in the urine are elevated, a more comprehensive urological examination should be performed to determine the type of leukocyturia - infectious or aseptic.

Leukocyturia may be caused by cystitis, which is noticeable by impaired urination, increased body temperature, often asymptomatic leukocyturia may be observed in pregnant women, when cloudy urine is the only visible sign of a hidden inflammatory process. There is no need to be afraid of cystitis treatment. Leukocyturia during pregnancy, provoked by cystitis, is most often treated without the use of antibiotics.

The most dangerous variant, which may be indicated by leukocyturia in pregnant women, is nephropathologies, which threaten both the health of the expectant mother and the health of the baby. The most dangerous are gestoses in the third trimester, which can provoke intrauterine pathologies, fetal hypotrophy or hypoxia during childbirth. Pyelonephritis, clinically manifested by pain in the lower back, leukocyturia, is also dangerous. Treatment of a pregnant woman with pyelonephritis is assumed only in hospital, when the woman is under constant supervision of a doctor and there is an opportunity to minimize the risks to the fetus.

Treatment leukocyturia

Treatment for leukocyturia is aimed at treating the underlying disease, that is, eliminating the source of inflammation and infection.

Treatment of leukocyturia is, first of all, differentiation of the type of leukocyturia, accurate diagnosis of the cause and determination of the strategy of therapeutic measures.

Infectious leukocyturia treatment involves only antibacterial. It is indicated to prescribe antibiotics of the cephalosporin group, as a rule, the course should last at least 10-14 days. Fluoroquinolones are effective, the course of which is slightly shorter - from 5 to 7 days. It is also possible to prescribe a classic penicillin group under the "cover" of additional drugs - enzymes, to reduce the risk of side effects. Leukocyturia treatment of urogenital pathologies also includes the appointment of macrolides, tetracycline group, especially if pathogens such as chlamydia or ureaplasma are detected. Treatment, which involves leukocyturia during pregnancy, is mainly drugs of the new generation of cephalosporin group, which do not have serious side effects and are relatively safe for the body of the mother and fetus.

Aseptic leukocyturia treatment involves mainly local treatment - in the form of irrigation and douching with antiseptic preparations. It is also recommended to prescribe immunomodulators, B vitamins and ascorbic acid, and to follow personal hygiene rules.

To reduce the risk of recurrence of inflammatory infections, prophylactic courses of gentle antibacterial therapy are indicated for 7 days one month after the main basic treatment.

Persistent, recurrent leukocyturia indicates undetected sources of infection. In such cases, hospitalization is required for a more comprehensive examination, clarification of the diagnosis and the development of a new, more effective therapeutic course.