Elevated Leukocytes in Urine: Causes and What the Values Mean

You have received your urine test result, and the leukocyte count is higher than the reference value. Such an elevation means there is inflammation in the urinary tract, but the number itself does not identify its cause.

What leukocytes in urine are and what the normal range is

Leukocytes are blood cells that are the first to arrive at the site of inflammation. They enter the urine from the kidneys, ureters, bladder, or urethra. Normally, in a single urine sample, leukocytes per high-power field are 0–2 in men and up to 5 in women. In laboratory practice this is called leukocyturia.

Laboratories use different units and counting methods. Values differ between laboratories, so the result should be discussed with a doctor. By the number of cells, a distinction is made between microleukocyturia — fewer than 200 per high-power field — and pyuria — more than 200.

Is it awkward to write about this? There is no need for shame here. A urine test is a routine procedure, and its result says nothing about the person.

When to see a doctor

Elevated leukocytes in urine are a reason to discuss the result with a doctor. Seek medical help urgently if:

• your temperature is high or very low, and you have chills;
• you have pain in the lower abdomen or in the back below the ribs;
• blood is visible in the urine;
• your symptoms are rapidly worsening;
• you are a man, are pregnant, have diabetes, have a weakened immune system, or have a catheter in the bladder.

An elevated leukocyte count in urine by itself is not a reason to call an ambulance. Call 103 or 112 if the person is confused, drowsy, or has difficulty speaking.

Elevated leukocytes in urine: what it means

High leukocytes in urine are a sign of inflammation, but not of its cause. Most often the cause is a urinary tract infection: bacteria from the intestine enter the urethra, and in women it is shorter, so bacteria can more easily reach the bladder and kidney.

The infection affects the bladder (cystitis), the urethra (urethritis), or the kidney. Kidney inflammation is dangerous, including the risk of sepsis. Besides infection, an abnormal test result can occur with kidney disease, stones, poorly controlled diabetes, or tumors of the bladder or kidney.

A urine cytogram clarifies the direction of the search: neutrophils — infection, including pyelonephritis and tuberculosis; mononuclear cells — glomerulonephritis and interstitial nephritis; lymphocytes — systemic lupus erythematosus and rheumatoid arthritis; eosinophils — an allergic reaction. Leukocyturia can be bacterial or abacterial: the first is associated with infection and tuberculosis, the second with an interstitial process in kidney tissue.

Leukocytes 10–15, 20–30, and 500: how the values differ

10–15 and 20–30 per high-power field are above normal in both women and men. Both values remain within the range of microleukocyturia — they are below 200. A value of 500 crosses the threshold of pyuria: there are very many cells.

The number itself does not point to an organ. A value of 25 in a woman does not indicate where the inflammation is — in the urethra, bladder, or kidney. Symptoms and additional tests help distinguish this.

Causes of elevated leukocytes in urine in women and men

In women the risk is higher because of the short urethra. Pregnancy, menopause, spermicides in contraceptives, the habit of wiping from back to front, and insufficient fluid intake add to it. In men, some cases are associated with an enlarged prostate: it prevents the bladder from emptying completely.

Common factors include kidney stones and other obstacles to urine outflow, a catheter, a weakened immune system, for example with poorly controlled diabetes or chemotherapy, and constipation in children. By location, causes are divided as follows: kidney — pyelonephritis, tuberculosis, carbuncle, developmental anomalies, hydronephrosis; ureter — duplication, diverticulum, megaureter, reflux; bladder — cystitis, stones, diverticulum; urethra — urethritis, stricture, phimosis.

How the cause is clarified: additional tests

The doctor will tell you which type of sample is needed. In the laboratory the sample is examined under a microscope: cells are counted, and crystals, casts, mucus, and bacteria are looked for, while test strips provide a chemical picture.

The doctor compares the numbers with the symptoms. If kidney infection or an obstacle to urine outflow is suspected, the doctor refers you for additional tests; for recurrent episodes, to a specialist.

This is a reference article; it does not replace a doctor's consultation: discuss your own number from the form with your doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer