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Q. Why does my mom have a positive urine pH value, even with a negative urine culture?

Answered by
Dr. Saurabh Subhash Pandya
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 10, 2022

Hi doctor,

My mother, 63 years old, is currently on the following medications: Tablet Eltroxin 50 for hypothyroid, tablet Olmezest 40, BP staying within 130 / 80 mm Hg, pulse 70 beats per minute most of the time, tablet Gemcal Plus daily, and tablet Lumia 60K once in a month for osteoarthritis of knee joints, Tablet Fibator LS, taking since past one month, previously taken Fibator 10 for three months, before tablet Lipicard 160 for a year, Capsule Providac on alternate days for IBS, and capsule Socril twice a week, added as an iron supplement one month back. My mother got a minor UTI (ten thousand colonies of Enterococcus faecalis, 2-3 RBC / HPF) two months before, cured after five days of tablet Niftas 100 mg. We retested last month, which showed culture-negative, although there was a rise in serum creatinine to 0.99. Our medicine doctor had changed her cholesterol medication to Fibator LS and started her on a Socril capsule twice a week. We retested after five weeks, which showed an increase in Hb from 10.3 to 11.1 reduction in creatinine from 0.99 to 0.94. There is, however, an increase in ESR from 6 to 21, the number of WBCs in CBC from 6.5 to 7.8, A:G ratio from 1.5 to 1.8, serum albumin from 4.3 to 4.7, serum phosphate from 3.4 to 4.3, serum calcium from 9.1 to 9.5. She also got pain in the waist for the past three to four days and even got a minor fever (98.5-99 Fahrenheit ) along with pain and cramp in her legs last week. She also got a similar low fever with a headache around five to six weeks back, when she had just been cured of the UTI. However, in both instances, the fever got fixed in a day after taking a couple of Dolo 650 tablets. Can I request you review her past three to four months of reports attached & advise if there is anything to be investigated further? Do we suspect any possibility of kidney stones or any other kidney problem? What could be the possible findings in lab reports? Also, are there any specific or non-specific symptoms for the patient? Also, what is the significance of two to three RBCs in routine urine reports? I noticed that the two to three RBCs and HPF and three to four WBCs and HPF are still there, along with a positive urine PH value of 5.0, even when the urine culture was negative. Please help.

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Hi,

Welcome to icliniq.com.

I understand your concern.

Most of the reports are within normal limits (attachment removed to protect the patient’s identity). Minor variations can occur with normal time. Urine can have 5-6 (red blood cells) RBCs and 4-6 pus cells which is normal. Previous urine culture grew Enterococcus Faecalis, a common bacterium in the skin, so we usually consider it contamination unless it is a catheter specimen. Also, counts around 10000 are very low and suggest contamination. If she gets repeat symptoms, I suggest you can get a urine routine test done and start tablet Nitrofurantoin 100 mg twice daily for three days. If she has repeated episodes say three to four episodes in six months, we can begin prophylaxis to prevent infection. Nothing needs to be done for UTI (urinary tract infection). I suggest you can do USG KUB (ultrasonography for kidney, ureter & urinary bladder), but as I said, most reports are normal.

I hope this helps.

Hi doctor,

Thanks for your reply. In fact, during the winter months, my mother used to feel an increase in the frequency of her urination, which is much reduced from last month onwards. As you already mentioned that the presence of Enterococcus Faecalis is likely contamination, is this change in urination frequency due to a shift in cholesterol medication tablet Fenofibrate 160 mg to 72.5 mg or something else? Also, my mother mentioned that she had seen some reddish crystals in the urine, due to which we were worried about 2-3 RBC / HPF in the first-morning urine samples. Another thing I wanted to mention is my father recently developed an Escherichia Coli infection, for which he has been on repeated antibiotics for the past three to four weeks. Since they use the same western toilet, is there any specific precaution for my mother? Please help.

#

Hi,

Welcome back to icliniq.com.

I understand your concern.

An increase in frequency is normal in winter and monsoon. However, if she has urgency or frequency of more than one to two hours in the daytime and more than one time at night, she may need medication for overactive bladder for two to three months. Your father may have other reasons for UTI, for example, enlarged prostate, which a urologist can tackle. UTI is not likely to spread via commode surface. I suggest she avoid constipation. If needed, I mean she can take capsule Cranpac-D once daily. It contains cranberry extract to prevent infection and has no side effects.

I hope this helps.


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