Q. My urine test shows presence of pus cells and RBC. Please explain my result.

Answered by
Dr. Peter Grutas
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 08, 2020

Hello doctor,

I want to know what is wrong with the test results. I have done blood test, urine, liver, and kidney function tests. Urine test shows pus cell 4-6 and RBC 1-3.

Dr. Peter Grutas

General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

I have reviewed the lab results (attachment removed to protect patient identity), that you have sent and I see that the urinalysis shows RBC 1-3 and pus cells of 4-6. But there were few epithelial cells seen. May I ask how did you get the sample? Did you get it midstream? Because a poor catch may yield unreliable results.

Your CBC (complete blood count) also showed relative lymphocytosis but aside from that, all rests are within acceptable limits. Any recent history of cough or colds? In addition to that, may I also know your symptoms and why were the tests requested? Do you have painful urination or back pain? Any other medical condition such as hypertension or diabetes? I would be needing this to clinically correlate your test results.


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Thank you doctor,

No there is no cough or cold, no painful urination, no lower back pain. What prompted the test was my wife was saying she feeling a little pain in the belly area, then she said the pain is lower and then lower, eventually she was getting like a spike near the urine/ vaginal area that lasted for a few second and then comes back again. This lasted for a day however for the past 48 hours she said that she is not complaining of anything and the spikes feeling has gone. Befor three years, she removed a kidney stone. And after six months, she had a UTI after giving birth that we took a course of antibiotics (Monuril). She believes it was some sand or a kidney stone that passed. However, the 4-6 pus cells are suspicious to me. Do I need to visit and urologists or a kidney specialist?

Dr. Peter Grutas

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

I understand. Presence of pus cells in the urine may be caused by infection. But other possible cause of appearance of pus cells includes dehydration, diet or maybe a poor catch. That is why I was asking how was it taken because there were few epithelial cells seen. Although the epithelial cells seen may still be acceptable.

RBC of 1-3 may indicate also the presence of stone but may still be acceptable as well. As I mentioned previously, these results need to be correlated clinically. Since you mentioned she does not have painful urination, back pain, nor any other symptoms such as fever, I am not considering urinary tract infection at this point. There is no need to use antibiotics at this time. I would recommend though that she undergo KUB (kidney, ureter, bladder) ultrasound to assess any presence of urinary stones. Drink cranberry juice once a day, take Vitamin C 500 mg once a day and drink two to three liters of water per day. If symptoms persist, worsen or new onset of symptoms such as fever, painful urination and back pain, further consult is advised.


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Thank you doctor,

I did notice her previous blood test and the current one shows her total WBC count is at 5.6. Is this a low number? Should I be concerned? Is there anything to worry about?

Dr. Peter Grutas

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

The total leukocyte count of 5.6 is still within the acceptable range of the normal reference value (4-11) of the laboratory where she did the test. It also means she does not have an infection that is why I am not considering UTI (urinary tract infection). At this point, you and your wife has nothing to worry about. I would recommend she observe her condition first, follow what I suggested above, and if symptoms persist, worsen or new onset of symptoms has been noted, further consult is still advised.


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Thank you doctor,

I just got back the urine culture it seems clean. However, if the culture is clean what could be the cause of the pus cells and the lymphocytosis? Could this be a kidney infection? Should I investigate more or (wait and see) drink fluids and repeat in a month?

Dr. Peter Grutas

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

If the urine culture is clean then there is no infection. As I mentioned previously, other possible cause of pus cells in the urine includes dehydration, diet and poor catch. Presence of stones can also cause pus cells in the urine without any signs of infection. As I also mentioned above, lymphocytosis may just be caused by recent viral cough or colds. Dehydration can also cause lymphocytosis. Since the total leukocyte count is within the normal range, there is no indication of acute infection.

Based on her history, symptoms and lab results, she is least likely to have UTI at this point. I would recommend you observe the condition first and follow what I recommended above. But if her symptoms persist or worsen, then further consult is then advised.


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