Leukocyturia

Introduction White blood cell urine: refers to freshly centrifuged urine. There are more than 5 white blood cells per high power microscope field, or more than 400,000 white urine cells per hour or more than 1 million urine in 12 hours. Microscopic examination of leukocytic cells below 5 / high power field is normal. If it is higher than or equal to 5/high power field, it is called leukocyte urine. A large number of white blood cell urine, mostly urinary system infections such as bacteria, mycoplasma, chlamydia, viruses and so on. A small amount of white blood cell urine can be seen in various nephritis, such as lupus nephritis.

Cause

More common in urinary tract infectious diseases, but also caused by non-infectious diseases of the urinary system and infectious diseases of adjacent tissues.

Genitourinary diseases:

1. Kidney disease: pyelonephritis, renal pelvis, kidney abscess, kidney tuberculosis, kidney stone infection, glomerular disease, tubulointerstitial disease.

2. Ureteral disease: inflammation, stones, tumors.

3. Bladder disease: inflammation, stones, tumors, foreign bodies.

4. Urinary tract disease: inflammation, stones, tumors, foreign bodies, paraurethritis or abscesses.

5. Prostate disease: inflammation, abscess, tumor.

6. Seminal vesicle disease: inflammation, abscess.

Adjacent tissue or organ disease:

Perirenal inflammation or abscess, inflammation or abscess around the ureter, appendix abscess, tubal ovarian inflammation or abscess, colon or pelvic abscess.

an examination

Whether it is true white blood cell urine:

Pseudo-leukocyte urine is caused by purulent discharge of urine or urine specimens caused by purulent discharge of female vaginal discharge or other purulent diseases (such as vaginitis, anal fistula, perineal abscess or carbuncle, etc.), and should be noted before taking specimens. Clean the vulva and remove the middle urine. Guided specimens for catheterization or bladder puncture can avoid false positives.

To determine the location and nature of leukocyte urine:

Through the medical history and physical examination, except for the lesions of the adjacent organs of the urinary system, in addition to causing leukocyte urine, these lesions have their own characteristics, such as inflammation or abscess around the kidney, which may have systemic infection, accompanied by obvious low back pain, lumbar muscle tension, image Learn to find the perirenal abscess.

If there are no adjacent organ lesions, the urinary system itself should be considered, most of which are urinary tract infections. Medical history, physical examination, etiology and imaging examinations help to distinguish between upper and lower urinary tract infections and further clarify whether specific infections or non-specific infections.

For leukocyteuria with no urinary tract irritation and pathogen negative, the possibility of glomerulonephritis active and interstitial nephritis should be considered. A leukocytosis classification test helps determine the cause.

Differential diagnosis

Bacterial urinary: Normally, the urine is sterile, but the lower third of the urethra and the urethra are bacteriological. Therefore, urine discharged from the human body can contaminate the upper part of the bacteria. However, the amount of bacteria in the middle of the cleansing should not exceed 105/ml. If the test contains more than or equal to 105/ml of bacteria and is the same strain, and there is no urinary tract infection (frequent urination, urgency or lower abdominal discomfort), it can be diagnosed as true bacteriuria, also known as no Symptomatic bacteriuria.

Tube type urine: Tube type is an important component in urine sediment. The appearance of tube type urine often indicates substantial damage to the kidney. The increase in the type of tube in the urine is called tubular urine, and the appearance of tubular urine often indicates substantial damage to the kidney. The tubular urine is a cylindrical structure formed by solidification of proteins in the urine in the renal tubules and collecting ducts. The formation of the tubular type requires proteinuria, and the matrix formed is a TH glycoprotein. In the pathological condition, due to the increased permeability of the glomerular basement membrane, a large amount of protein enters the renal tubule from the glomerulus, and in the renal distal convoluted tubule and collecting duct, acidification (increased acidity) and cartilage due to concentration (water absorption) In the presence of sulphate, the protein condenses and precipitates in the renal tubules to form a cast.

Turbid urine: that is, urine is opaque. Normally, the newly discharged urine is mostly transparent. After placement, a slight flocculent precipitate may appear, and fresh urine may be turbid, which can be seen in:

1 Urate precipitation: After the concentrated acidic urine is cooled, the reddish urate may be precipitated, and the precipitate may be dissolved when heated or added with alkali.

2 Phosphate and carbonate precipitation: concentrated alkaline or neutral urine excreted in the body, can be precipitated with phosphate or carbonate, white, acid can be dissolved, carbonate precipitation can also produce bubbles in the presence of acid.

3 pyuria or bacteriuria: If the urine contains a lot of inflammatory exudates such as white blood cells, pus cells and bacteria, it can be turbid just after discharge. The bacteriuria is cloud-like and does not sink after standing; there may be white cloud flocculent precipitate after pyuria placement. This kind of urine does not retreat regardless of heating or acid addition.

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