Differential Diagnosis for Urine with Small Leukocytes and Trace Red Blood Cells

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI): This is the most common cause of leukocytes and red blood cells in the urine. The presence of small leukocytes indicates an inflammatory response, which is typical in UTIs. Trace red blood cells can also be present due to the infection causing minor damage to the urinary tract lining.

Other Likely Diagnoses

• Kidney Stones: Small stones can cause microscopic hematuria (trace red blood cells) and leukocytes if there is associated infection or inflammation. The stones can irritate the urinary tract, leading to an inflammatory response.
• Interstitial Nephritis: This condition involves inflammation of the spaces between the renal tubules and can be caused by infections, medications, or other factors. It can lead to the presence of leukocytes and sometimes red blood cells in the urine.
• Prostatitis: In men, prostatitis (inflammation of the prostate) can cause leukocytes and occasionally red blood cells in the urine due to the proximity of the prostate to the urinary tract.

Do Not Miss Diagnoses

• Glomerulonephritis: Although less common, glomerulonephritis (inflammation of the glomeruli) is a serious condition that can present with hematuria and leukocytes. It requires prompt diagnosis and treatment to prevent long-term kidney damage.
• Tuberculosis (TB) of the Urinary Tract: TB can infect the urinary tract and cause a range of symptoms, including hematuria and leukocytes. It's crucial to consider TB in the differential diagnosis, especially in endemic areas or in individuals with risk factors.
• Malignancy: Although rare, urinary tract malignancies (e.g., bladder or kidney cancer) can cause hematuria and leukocytes. Early detection is critical for effective treatment.

Rare Diagnoses

• Vasculitis: Certain types of vasculitis, such as granulomatosis with polyangiitis, can affect the kidneys and urinary tract, leading to hematuria and leukocytes. These conditions are rare but require prompt recognition and treatment.
• Sickle Cell Disease: In individuals with sickle cell disease, sickling of red blood cells can occur in the low-oxygen environment of the kidney, leading to hematuria. Leukocytes might be present due to associated infections or inflammation.
• Alport Syndrome: A genetic disorder that affects the type IV collagen in the kidneys, leading to chronic kidney disease and sometimes hematuria. It's a rare condition but should be considered in the differential diagnosis of persistent or recurrent hematuria.