Pus Cells in Urine (Pyuria)
Causes, Symptoms & Treatment
What is Pyuria?
Pyuria refers to the presence of white blood cells (WBCs) in urine, a laboratory finding that may indicate inflammation or infection in the urinary tract. It is detected through a urinalysis and can be associated with urinary tract infections (UTIs), kidney diseases, sexually transmitted infections (STIs), or even autoimmune disorders affecting the urinary system.
Normal & Abnormal Levels of White Blood Cells in Urine
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Normal levels: 0-5 WBCs per high-power field (hpf).
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Mild increase: (6-10 hpf) May be linked to mild irritation or an early-stage infection.
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High levels: (>10 hpf) Often indicate infection, inflammatory conditions, or kidney disease and require further evaluation.
Causes and Risk Factors of Elevated White Blood Cells in Urine
The presence of elevated white blood cells (WBCs) in urine is an indication of inflammation or infection in the urinary tract. It is detected through a urinalysis and may be associated with infections, kidney diseases, or even sexually transmitted infections (STIs).
Urinary Tract Infections (UTIs, Cystitis, Pyelonephritis)
UTIs are the most common cause of increased WBCs in urine. The bacterium Escherichia coli (E. coli) is responsible for 80% of cases. Key symptoms include:
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Frequent urination (polyuria)
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Fever and lower back pain (in pyelonephritis cases)
Sexually Transmitted Infections (Chlamydia, Gonorrhea, Mycoplasma)
Certain STIs can trigger an inflammatory response, leading to increased white blood cells in urine. These infections may be asymptomatic or cause mild urethral irritation.
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Men: Possible urethral discharge
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Women: May experience increased vaginal discharge and painful urination
Kidney Diseases (Glomerulonephritis, Kidney Stones - Nephrolithiasis)
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Glomerulonephritis is an inflammatory kidney condition that may lead to proteinuria, hematuria, and elevated WBCs in urine.
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Kidney stones can cause micro-injuries in the urinary tract, leading to increased WBC levels and often hematuria (blood in urine).
Autoimmune Diseases and Chronic Inflammation
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Lupus (Systemic Lupus Erythematosus - SLE) frequently affects the kidneys, causing lupus nephritis. In such cases, pyuria is often accompanied by proteinuria and hematuria.
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Interstitial nephritis (which may be triggered by autoimmune diseases or allergic reactions to medications) is another potential risk factor.
Conclusion
The presence of elevated WBCs in urine is a significant finding that requires further evaluation. A urinalysis and urine culture, along with specific STI or kidney disease tests, can help determine the underlying cause and lead to appropriate treatment.
Signs and Symptoms of Elevated White Blood Cells in Urine
The presence of elevated white blood cells (WBCs) in urine may be accompanied by various symptoms, depending on the underlying cause. The most common symptoms include:
Changes in clarity or odor may indicate an infection or inflammation in the urinary tract.
Burning Sensation During Urination
A frequent symptom of urinary tract infections (UTIs) or urethral irritation.
Fever and Chills
These occur in more severe infections, such as pyelonephritis, and indicate a systemic immune response.
A hallmark symptom of cystitis and lower urinary tract infections (UTIs).
Lower Back or Abdominal Pain
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Lower back pain may be related to kidney infections or kidney stones.
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Abdominal pain may suggest bladder inflammation (cystitis).
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Blood in the Urine (Hematuria)
In severe cases, inflammation or irritation of the urinary tract can cause bleeding.
Early Recognition is Key
Identifying these symptoms early and receiving a proper diagnosis is essential for effective treatment and prevention of complications.
Diagnosis of Elevated White Blood Cells in Urine
The detection of white blood cells (WBCs) in urine requires a thorough evaluation through laboratory and imaging tests to identify the underlying cause.
Key Diagnostic Tests
✔ Urinalysis:
Detects the presence of WBCs, bacteria, proteins, blood, and other elements that may indicate an infection or kidney damage.
✔ Urine Culture:
Performed when WBCs are detected to identify the responsible bacteria and determine antibiotic sensitivity.
✔ WBC Test with Negative Urine Culture:
If elevated WBCs are present but no bacteria are detected, it may indicate autoimmune diseases, glomerulonephritis, or other inflammatory conditions.
Imaging Tests
✔ Kidney and Bladder Ultrasound:
Used to detect kidney stones, anatomical abnormalities, or signs of inflammation.
✔ CT Scan (Computed Tomography):
Recommended in cases where kidney stones, tumors, or urinary obstructions are suspected.
✔ Cystoscopy:
A procedure used to examine the bladder in cases of recurrent infections or hematuria (blood in urine).
Accurate Diagnosis is Essential
A proper diagnosis is crucial in selecting the appropriate treatment, especially in cases where WBCs in urine are not associated with infection but with other medical conditions.
Treatment of Elevated White Blood Cells in Urine
The treatment approach depends on the underlying cause of the elevated white blood cells (WBCs) in urine.
1. Bacterial Urinary Tract Infections (UTIs, Cystitis, Pyelonephritis)
✔ Antibiotic therapy based on urine culture and antibiotic sensitivity tests.
✔ Commonly used antibiotics:
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Nitrofurantoin, Fosfomycin (for simple UTIs).
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Cephalosporins, Quinolones (for severe or recurrent infections).
✔ Increased fluid intake to help flush out bacteria.
2. Sexually Transmitted Infections (Chlamydia, Gonorrhea, Mycoplasma)
✔ Antibiotic treatment, depending on the pathogen:
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Doxycycline or Azithromycin for Chlamydia.
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Ceftriaxone + Azithromycin for Gonorrhea.
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Moxifloxacin for persistent Mycoplasma infections.
✔ Partner treatment to prevent reinfection.
3. Kidney Stones (Nephrolithiasis)
✔ Increased water intake to promote stone passage.
✔ Pain relief with analgesics and anti-inflammatory medications.
✔ Tamsulosin to relax the ureters and facilitate stone passage.
✔ Lithotripsy or endoscopic removal for large stones.
4. Autoimmune Diseases & Kidney Disorders (Glomerulonephritis, Lupus Nephritis)
✔ Immunosuppressive therapy or corticosteroids (e.g., Prednisolone) to reduce inflammation.
✔ Dietary adjustments and kidney function monitoring in cases of kidney damage.
📌 Conclusion:
Early diagnosis and treatment are essential to prevent complications, especially in cases of infection or serious kidney diseases. If WBCs in urine persist, specialized medical evaluation is required.
Prevention of Elevated White Blood Cells in Urine
Maintaining urinary tract health is essential to prevent infections and inflammation that can lead to the presence of white blood cells (WBCs) in urine.
Key Preventive Measures
Adequate Hydration
✔ Drink 2-3 liters of water daily to flush out bacteria and prevent infections.
✔ Limit excessive caffeine and alcohol, as they can cause dehydration.
Genital Hygiene
✔ Daily cleansing with mild soaps and avoid irritants.
✔ Proper hygiene before and after sexual activity.
✔ Women should wipe front to back to prevent bacteria from spreading from the intestine to the urinary tract.
Regular Urination
✔ Do not hold urine for long periods, as stagnant urine increases the risk of infections.
✔ Urinate after sexual activity to flush out bacteria from the urethra.
Use of Protection
✔ Condoms help prevent sexually transmitted infections (STIs) that can cause inflammation in the urinary tract.
✔ Regular STI screenings, especially for individuals with multiple partners.
Balanced Diet
✔ Eat plenty of fruits, vegetables, and antioxidant-rich foods to support kidney health.
✔ Avoid excessive salt and processed foods, which strain kidney function.
✔ Increase vitamin C intake (lemons, oranges) to help prevent infections.
📌 Conclusion
Maintaining healthy habits and addressing symptoms early can significantly reduce the risk of inflammation and infections in the urinary system, preventing the presence of WBCs in urine.
FAQs on White Blood Cells in Urine (Pyuria)
Are white blood cells in urine always a cause for concern?
Not necessarily. A small number of white blood cells (leukocytes) in urine can be normal, especially in cases of mild dehydration or urethral irritation. However, elevated levels may indicate an infection or an underlying medical condition requiring further evaluation.
How many white blood cells in urine are considered normal?
Typically, 0-5 white blood cells per high-power field (hpf) are considered normal in a urinalysis. Levels above 8-10 hpf are considered abnormal and may indicate inflammation or infection.
Are cloudy urine and elevated white blood cells related?
Yes. An increased number of white blood cells in urine can contribute to cloudiness, particularly in urinary tract infections (UTIs). In such cases, additional symptoms like burning during urination, foul-smelling urine, and fever may be present.
What do elevated white blood cells in urine with a negative urine culture mean?
When white blood cells are present in urine but bacteria are not detected in a culture, possible explanations include:
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Aseptic inflammation, such as in autoimmune diseases (e.g., lupus, interstitial cystitis).
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Viral infections, where bacteria are not present.
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Use of certain medications, such as antibiotics or non-steroidal anti-inflammatory drugs (NSAIDs), which may cause kidney irritation.
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Kidney stones (nephrolithiasis), which can cause inflammation without an active bacterial infection.
📌 Conclusion:
If white blood cells are detected in urine, a thorough evaluation by a urologist is recommended, considering additional symptoms and further diagnostic tests.
Θεραπεία των Πέτρων στα Νεφρά (Νεφρολιθίαση)
Η θεραπεία για τις πέτρες στα νεφρά εξαρτάται από το μέγεθος, τη θέση, τη χημική σύσταση της πέτρας, τα συμπτώματα του ασθενούς και τυχόν επιπλοκές που έχουν προκύψει. Στόχος της θεραπείας είναι η απομάκρυνση της πέτρας, η ανακούφιση των συμπτωμάτων και η πρόληψη υποτροπών.
1. Συντηρητική Θεραπεία
Αναμονή και Αυθόρμητη Αποβολή
- Μικρές πέτρες (διάμετρος έως 5-6 χιλιοστά) συχνά αποβάλλονται μόνες τους μέσω των ούρων.
- Συνιστάται:
- Αυξημένη κατανάλωση υγρών για την προώθηση της πέτρας μέσω του ουροποιητικού.
- Αναλγητικά φάρμακα (π.χ. ιβουπροφαίνη) για την ανακούφιση του πόνου.
- Φάρμακα για τη χαλάρωση του ουρητήρα (π.χ. α-αδρενεργικοί ανταγωνιστές) για τη διευκόλυνση της αποβολής.
Διατροφική Αλλαγή και Φαρμακευτική Θεραπεία
- Εξατομικευμένη δίαιτα με περιορισμό τροφών που συμβάλλουν στο σχηματισμό λίθων, όπως οξαλικά (σπανάκι, παντζάρια), ζωικές πρωτεΐνες και αλάτι.
- Φαρμακευτική αγωγή για τη μείωση της δημιουργίας λίθων, ανάλογα με τη χημική σύστασή τους:
- Διουρητικά θειαζιδικά για λίθους ασβεστίου.
- Αλλοπουρινόλη για λίθους ουρικού οξέος.
- Κιτρικά άλατα για την αύξηση των επιπέδων κιτρικών στα ούρα.
2. Επεμβατικές Θεραπείες
Όταν οι πέτρες δεν αποβάλλονται φυσικά ή προκαλούν σοβαρά συμπτώματα ή επιπλοκές, μπορεί να απαιτηθεί επεμβατική αντιμετώπιση:
Λιθοτριψία με Κρουστικά Κύματα (ESWL)
- Μη επεμβατική μέθοδος που χρησιμοποιεί κρουστικά κύματα για τη διάσπαση της πέτρας σε μικρότερα κομμάτια, τα οποία αποβάλλονται μέσω των ούρων.
- Ιδανική για πέτρες μικρού ή μεσαίου μεγέθους.
- Μπορεί να προκαλέσει παροδικό πόνο ή αιματουρία.
Ενδοσκοπική Λιθοτριψία (URS)
- Μέσω ενός λεπτού ενδοσκοπίου, η πέτρα εντοπίζεται και αφαιρείται ή διασπάται με laser.
- Ιδανική για πέτρες στον ουρητήρα ή στην ουροδόχο κύστη.
Διαδερμική Νεφρολιθοτριψία (PCNL)
- Χρησιμοποιείται για μεγάλες ή πολύπλοκες πέτρες στους νεφρούς.
- Πραγματοποιείται μέσω μικρής τομής στο δέρμα, με τη χρήση ειδικών εργαλείων για τη διάσπαση και αφαίρεση της πέτρας.
Λαπαροσκοπική Χειρουργική
- Σπάνια απαιτείται και συνήθως επιλέγεται σε περιπτώσεις πολύ μεγάλων λίθων ή ανατομικών ανωμαλιών του ουροποιητικού συστήματος.
3. Θεραπεία Επιπλοκών
- Τοποθέτηση ουρητηρικού καθετήρα (Pig-tail) για την ανακούφιση της απόφραξης.
- Αντιβιοτική αγωγή σε περίπτωση λοίμωξης του ουροποιητικού συστήματος.
4. Πρόληψη Υποτροπών
Μετά την απομάκρυνση της πέτρας, είναι σημαντικό να υιοθετηθούν μέτρα πρόληψης:
- Αυξημένη κατανάλωση νερού για τη διατήρηση αραιών ούρων.
- Διατροφικές τροποποιήσεις με τη βοήθεια διαιτολόγου ή ειδικού.
- Τακτική παρακολούθηση με απεικονιστικές και εργαστηριακές εξετάσεις για την έγκαιρη ανίχνευση νέων λίθων.
Η σωστή θεραπεία της νεφρολιθίασης εξαρτάται από την έγκαιρη διάγνωση και την εξατομικευμένη προσέγγιση, ώστε να επιτευχθεί η μέγιστη ανακούφιση και πρόληψη των υποτροπών.