Leukocyturia

Leukocyturia is evidence of an inflammatory process in the urinary tract, pelvis and kidney tissues. Leukocyturia can not be considered a disease, it is a definite indicator of many diseases - cystitis, tuberculosis, nephritis, pyelonephritis, prostatitis and other infections of the genitourinary sphere.

[1], [2], [3], [4], [5], [6]

Causes of the leukocyturia

Since leukocyturia is not a diagnosis, but merely indicative of inflammatory pathology, its causes can be very diverse. Moreover, asymptomatic leukocyturia may not be accompanied by bacterial infections, but be an indicator of extrarenal pathology, for example, helminthic invasion or urinal allergosis

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

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

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

• Glomerular level (renal) is a sign of glomerulonephritis, nephritis of interstitial tissues. 
• Calyx and pelvis (renal level) - acute or chronic pyelonephritis, septic infarction of the kidney (carbuncle of the kidney), abnormal position of the kidneys, tuberculosis, polycystic kidney, kidney hypoplasia, hydronephrosis, including congenital. 
• The level of the ureters (extrarenal level) is an indicator of the diverticulum of the ureter, an inflection or doubling of the ureter. 
• The level of the bladder is cystitis, including acute, stones, tuberculosis of the bladder. 
• The urethral level is an indicator of the possible pathology of the urethra, phimosis.

[7], [8], [9], [10]

Symptoms of the leukocyturia

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

In healthy people, in the study of urine, subject to personal hygiene, it is also possible to detect traces of white blood cells in urine, the norm for men is 2-3.5, for women, 2-5.6 in the field of vision. Small leukocyturia is the detection of titers exceeding 6-10, if there is an indicator of 20 in the field of vision, the leukocyturia is considered undeniable and indicates an obvious or latent infection of the urinary tract or kidney. There is also a massive leukocyturia, which is more correctly called pyuria, when purulent flakes are clearly visible in the urine.

Forms

[11], [12], [13], [14]

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 localization of the inflammatory focus, leukocyturia can be: 

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

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

• Small leukocyturia (microlideicuria) - less than 200 in the field of view. 
• Piuria - from 200 to 3,000,000 in sight.

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

Aseptic leukocyturia is characterized by the presence of lymphocytes and eosinophils, as well as the lack of a large number of bacteria, hence the name of the species is aseptic, that is, without infection. Obviously, the presence of lymphocytes that have the property of detecting and neutralizing harmful antigens, as well as eosinophils, that provide effective destruction of foreign protein compounds, play a role in aseptic inflammation.

To diagnose the cause of the appearance of leukocytes in the urine, it is extremely important to differentiate these two types. Infectious leukocyturia requires repeated studies and comprehensive antibiotic 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.

[15], [16], [17]

Leukocyturia in children

Leukocyturia in children, especially in girls and adolescents, can be false and associated with inflammation of not internal organs or the genitourinary sphere, but with non-observance of personal hygiene and inflammation of the tissues (skin) adjacent to the genital organs. 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 in what way the material was collected (urine), whether there is diaper rash or inflammation in the genital area. There is also an anamnesis, including a family one, and it turns out whether dysuria was a disorder, a violation of the process of urination. Elevated body temperature, possible injuries, physiological factors, such as dentition in children under one year, can be useful information for differentiation of the leukocyturia species. In addition, the level of leukocyturia is determined by the method of a two-glassed sample. For all children with leukocytes found in the urine, ultrasound examination of the bladder and kidneys is mandatory. Among the reasons why there may be leukocyturia in children, the most common are the following: 

• Acute or chronic pyelonephritis (obstructive, non-obstructive). 
• Interstitial nephritis. 
• Acute nephrosis. 
• Balanoposthitis. 
• Vulvit. 
• Enterobiosis. 
• Urethritis. 
• Cystitis, acute or chronic. 
• Crystalluria. 
• Urinary allergosis. 
• Intertrigo.

Leukocyturia in pregnant women

Pregnancy is always accompanied by anxiety for 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 immunity directs all resources to adapt the body to a new, yet unusual for him state. It is for this reason that it is important to be examined in a timely manner and to fulfill all the prescriptions of the treating gynecologist. It is also important to know what the leukocyturia means in pregnancy.

Any indicator exceeding the norm limits is evidence of a possible disease, an increase in the number of white blood cells in the urine is also a sign of inflammation in the body. Leukocyturia in pregnant women may indicate an infection in the vagina, kidneys or urinary tract. In order for the analyzes to be truly demonstrative, not false, it is important to properly prepare the material - urine. False leukocyturia can be associated with non-compliance with personal hygiene rules, when urine enters vaginal discharge, respectively, the level of leukocytes will be raised for quite understandable reasons, not related to the disease. If vulvitis is absent, vaginitis is also not observed, and white blood cells in urine are increased, a more comprehensive urological examination should be performed to determine the type of leukocyturia - infectious or aseptic.

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

The most dangerous variant, which may indicate leukocyturia in pregnant women, is nephropathology, which threatens both the health of the future mother and the health of the baby. The most dangerous are gestosis in the third semester, which can provoke intrauterine pathologies, fetal hypotrophy or hypoxia during childbirth. Also pyelonephritis, clinically manifested by low back pain, leukocyturia, is dangerous. Treatment of a pregnant woman with pyelonephritis is assumed only inpatient, when a woman is under constant medical supervision and there is an opportunity to minimize risks to the fetus.

Treatment of the leukocyturia

Treatment, which involves leukocyturia, is aimed at treating the underlying disease, that is, eliminating the focus of inflammation and infection.

Treatment of leukocyturia is primarily a differentiation of the type of leukocyturia, an accurate diagnosis of the cause and the definition of a strategy for therapeutic interventions.

Infectious leukocyturia treatment involves only antibacterial. The appointment of antibiotics for the cephalosporin group is indicated, as a rule, the course should last no less than 10-14 days. Fluoroquinolols are effective, the course of which is slightly less - from 5 to 7 days. It is also possible to assign a classical penicillin group under the "cover" of additional drugs - enzymes, to reduce the risk of side effects. Leukocyturia treatment of urogenital pathologies also includes the administration of macrolides, a tetracycline group, especially if pathogens such as chlamydia or ureoplasma are identified. Treatment, which involves leukocyturia during pregnancy, is mainly preparations of a new generation of cephalosporin group, which do not have serious side effects and are relatively safe for the mother and fetus.

Aseptic leukocyturia treatment involves mainly local - in the form of irrigation and syringing antiseptic drugs. Also, the appointment of immunomodulators, B vitamins and ascorbic acid and the observance of personal hygiene rules are shown.

To reduce the risk of relapses of inflammatory infections, preventive courses of sparing antibiotic therapy are shown within 7 days after the basic treatment.

Persistent, recurrent leukocyturia indicates undiagnosed sources of infection. In such cases, hospitalization is needed for more comprehensive examination, clarifying the diagnosis and compiling a new, more effective therapeutic course.