White Blood Cells In Urine Normal

[dmccarty]

I know this is a strange question and I'm not looking for Medical
advice from our resident Doctors but is it normal to have
white blood cells in urine? Or colonies in urine?

Without going into a lot of details one of my daughters has
bladder reflux(VUR) and is on preventative antibiotics. She just
had urinalysis and urine culture. The urinalysis came back
with a moderate amount of white blood cells on the dip stick.
The microscopic "test" had a "few" white blood cells. The
urine culture came back with either 1,000 or 10,000 colonies my
wife can't remember which.

OK, so maybe I did go into some details. /forums/images/graemlins/grin.gif

Obviously we should be asking our doctor these questions but
she keeps sending us to the nurse for answers. Two different
nurses have said it was ok for these results. We question
the answers we are being given to say the least. There is far
more history with my daughters health than I'm going into but
we have reason to be concerned with these results.

We have a call into our pediatric urologist but they
closed before we got to the doctor so we won't be able to talk
to him until Monday. We are not worried the this is an
emergency but we figured this was a simple question that OUR
doctor should be able to answer.... /forums/images/graemlins/confused.gif

Thanks for any help,
Dan McCarty

 

[DocHeb]

Urinary reflux is the result of the bladder contracting and forcing urine backwards into the tubes that drain the kidneys into the bladder. This increases the chance of bacteria causing an infection in the urinary tract. A urinary tract infection is diagnosed by the clinical picture in conjunction with a urinalysis. A urinalysis looks primarily for Red Blood Cells, White Blood Cells, Other Types of Cells, Protein, Glucose, and bacteria. The urine is incubated on growth media, and then the number of bacterial "colonies" are counted to tell how may bacteria are present.

White Blood Cells in the urine, with only 1000-10,000 colonies, does not fit the definition of a typical urinary infection. A colony count of 100,000 (of the same type of germ, not multiple types) is generally considered an infection. If you daughter feels well, is not having any fever, and isn't having pain on urination I would agree those lab tests are probably not of concern.

There are a few confounding variables:

1. If the urine is sampled by just catching the stream as it came out, there may be some contamination of the urine sample by urine flowing over the skin, causing WBC's and bacteria to be introduced into the sample. This generally is shown by having "Epithelial Cells" on the results, which indicates a higher chance for contamination as the cause of the colony count results and WBC results.

2. If the urine is sampled by using a small catheter to get the urine, those results may be significant, since there is less chance of skin contamination. Again, the clinical picture of your daughter is important. This is the most reliable way to collect a urine sample, and gives the easiest to interpret results.

3. The least reliable urine sample is the type collected by placing a bag over the genitals and catching the urine. This is usually done for infants. If the sample was collected this way, it most likely accounts for the test results.

4. If the urine sat for a while (hours) before testing, the colony count may be falsely elevated due to bacteria's growth after collection.

5. Chronic antibiotic prophylaxis has been shown to decrease the chance of developing bad urinary tract infections. However, if germs do grow, there is a greater chance that they will be "resistant", or immune to the type of antibiotic that your daughter is taking.

The phrase:
</font><font color="blue" class="small">( There is far
more history with my daughters health than I'm going into )</font>
may indicate there are further confounding variables.

I hope this answers your questions.

 

[dmccarty]

DocHeb,

First of all thank you for the info. Thank you very much!

</font><font color="blue" class="small">( 2. If the urine is sampled by using a small catheter to get the urine, those results may be significant, since there is less chance of skin contamination. Again, the clinical picture of your daughter is important. This is the most reliable way to collect a urine sample, and gives the easiest to interpret results.
)</font>

Thank goodness we did not have to do this again. Its been
done to the baby more than once. 8-( But she did not have
to endure this again.

</font><font color="blue" class="small">( 3. The least reliable urine sample is the type collected by placing a bag over the genitals and catching the urine. This is usually done for infants. If the sample was collected this way, it most likely accounts for the test results. )</font>

This is how the sample was taken. We did know this was the
least "clean" way to get the sample but its very nice to have
confirmation.

</font><font color="blue" class="small">( 4. If the urine sat for a while (hours) before testing, the colony count may be falsely elevated due to bacteria's growth after collection. )</font>

Have no way of knowing this one... 8-(

</font><font color="blue" class="small">( 5. Chronic antibiotic prophylaxis has been shown to decrease the chance of developing bad urinary tract infections. However, if germs do grow, there is a greater chance that they will be "resistant", or immune to the type of antibiotic that your daughter is taking. )</font>

</font><font color="blue" class="small">( The phrase:
( There is far
more history with my daughters health than I'm going into )
may indicate there are further confounding variables. )</font>

This is one of our concerns. The doctor is not concerned about
this and has not ordered follow up tests. Our daughter, she is
10 months old, has a grade 3 or 4 reflux and was put in the
hospital with RSV and a kidney infection Christmass week. She
has been on antibiotics ever since. So our concern is that
there might be a problem with the antibiotic. My wife, who will
be tested for reflux on Monday, has a UT infection. The
tests found white blood cells so her doctor put her on
antibiotics.

Since my wife's results where similar to our baby's but the
doctors treatements are different we had questions that our
child's doctor would/could not answer.

</font><font color="blue" class="small">( I hope this answers your questions. )</font>

You answered them clearly and consicely. I sure wish OUR
doctor would do so. /forums/images/graemlins/confused.gif You really put our mind at ease.

We will follow up with the pediatric urologist on Monday. Since
our daughter is a baby is hard to know if she has pain peeing
and we are afraid of a resistant infection or an infection with
no symptoms. My other daughter also has reflux, a lesser
grade but on the same side. We expect mom to have it as
well and suspect that other family members
have this as well...

Again, thank you very much for the info.....
Dan McCarty

 

[dmccarty]

I also would like to thank Hakim and Muhammed for having
such a great community in TBN. We have been trying to get in
touch with two different doctors all day with these questions. At
the end of the day I told the wife, "Lets try TBN with the
quesitons." We had an answer in one hour after getting nothing
all day.

TBN, Thank you.
McCarty Family

 

[DocHeb]

</font><font color="blue" class="small">( Since our daughter is a baby is hard to know if she has pain peeing
and we are afraid of a resistant infection or an infection with
no symptoms. )</font>

At this age we use fever as the sign of a significant infection, rather than painful urination. If a high fever develops, a urine specimen obtained by catheter is preferable since antibiotic choice would depend on what type of germ grows. No fever usually means no big problem in regards to infection.

 

[frank_f15]

DOCHERB: I feel beter reading your ans. to the question and i am sure he feels much more at ease than i do, i hope all works out for them and it never ceases to amaze me the amt of knowledge that can be imparted from a bunch of tractor nuts /forums/images/graemlins/grin.gif

 

[RockyMnt1]

Hey Doc Heb,

Thanks for taking the time and effort to help this person. I am sure that you put their mind at ease and taught us all something at the same time. Your response was greatly appreciated, especially since you didn't have to respond at all.