What is the appropriate management for a patient with hematuria (red blood cell count of 12 x10e6/L), minimal leukocyturia (white blood cell count of < 10 x10e6/L), and elevated epithelial cells (23/uL) in their urine?

Management of Microscopic Hematuria with Elevated Epithelial Cells

The patient's urinalysis shows microscopic hematuria within normal limits (12 x10e6/L) that does not require further evaluation at this time, as the RBC count is below the threshold of 15 x10e6/L. 1

Interpretation of Urinalysis Results

• RBC count: 12 x10e6/L (normal < 15 x10e6/L)

  • This value is within normal limits according to the laboratory reference range
  • Does not meet the American Urological Association's definition of microscopic hematuria

• WBC count: < 10 x10e6/L (normal < 10 x10e6/L)

  • Normal value, no evidence of significant pyuria
  • Absence of significant pyuria suggests against active urinary tract infection 2

• Epithelial cells: 23/uL

  • Elevated epithelial cells may represent normal sloughing or contamination from the lower urinary tract
  • Not typically a significant finding in isolation when other parameters are normal

Management Approach

1. No immediate urologic workup needed

   • The RBC count is below the threshold that defines microscopic hematuria
   • According to AUA guidelines, microscopic hematuria is defined as ≥3 RBCs per high-power field from two of three properly collected urine specimens 1

2. Consider repeat urinalysis

   • If there are clinical concerns or risk factors for urologic disease
   • Repeat testing should be done after excluding transient causes such as exercise, menstruation, or sexual activity 1

3. Monitor for development of risk factors

   • Age > 40 years
   • Smoking history
   • Occupational exposure to chemicals or dyes
   • History of gross hematuria
   • Irritative voiding symptoms 1

When Further Evaluation Would Be Warranted

If any of the following were present, further evaluation would be indicated:

• RBC count ≥ 15 x10e6/L
• Persistent hematuria on repeat testing
• Presence of risk factors for significant urologic disease
• Development of:
  • Gross hematuria
  • Proteinuria
  • Hypertension
  • Renal insufficiency 1

Differential Considerations for Elevated Epithelial Cells

The elevated epithelial cell count (23/uL) likely represents:

• Normal sloughing of cells from the urinary tract
• Possible contamination during collection
• Not clinically significant when other parameters are normal 3

Pitfalls to Avoid

1. Over-investigation of normal findings

   • Pursuing extensive workup for RBC counts within normal range can lead to unnecessary testing and patient anxiety

2. Ignoring specimen quality

   • Ensure proper collection technique if repeat testing is performed
   • For women, consider catheterized specimen if clean-catch cannot be reliably obtained 1

3. Missing significant disease in high-risk patients

   • Even with borderline values, patients with risk factors may warrant closer monitoring

In conclusion, this urinalysis shows RBC and WBC counts within normal limits with some epithelial cells, which does not require further urologic evaluation at this time unless there are additional clinical concerns or risk factors present.