From the Guidelines
The presence of proteinuria, leukocytosis, and numerous WBCs in an asymptomatic 24-year-old female's urinalysis suggests a possible urinary tract infection (UTI) or kidney damage, and further evaluation is necessary to determine the underlying cause. According to the National Kidney Foundation practice guidelines for chronic kidney disease, persistently increased protein excretion is usually a marker of kidney damage 1. The guidelines recommend obtaining 24-hour urine collections only for special clinical circumstances, and under most circumstances, untimed urine samples should be used to detect and monitor proteinuria (level A recommendation) 1.
The patient's proteinuria, leukocytosis, and numerous WBCs may indicate asymptomatic bacteriuria, which generally requires treatment only in pregnant women or before urologic procedures 1. However, the patient's age and asymptomatic status suggest that further evaluation is necessary to determine the underlying cause of the abnormal urinalysis results.
Key findings to consider include:
- Proteinuria, which may indicate kidney damage or disease
- Leukocytosis, which may indicate a urinary tract infection or other inflammatory condition
- Numerous WBCs, which may indicate a urinary tract infection or other inflammatory condition
The patient should be asked about pregnancy status, as treatment would be indicated if pregnant (typically with nitrofurantoin 100mg twice daily for 5 days or cephalexin 500mg four times daily for 5-7 days) 1. If not pregnant, treatment is usually unnecessary unless symptoms develop. The patient should increase fluid intake and follow up if symptoms develop, including dysuria, frequency, urgency, or suprapubic pain. The culture results, which were reflexed, will provide definitive information about any bacterial growth and antibiotic sensitivities.
It is essential to note that the American College of Physicians recommends confirming heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults 1. However, in this case, the patient's proteinuria, leukocytosis, and numerous WBCs suggest that further evaluation is necessary to determine the underlying cause of the abnormal urinalysis results.
Further evaluation, including a repeat urinalysis, urine culture, and possibly imaging studies, is necessary to determine the underlying cause of the patient's abnormal urinalysis results. The patient's age, asymptomatic status, and abnormal urinalysis results suggest that a comprehensive evaluation is necessary to determine the underlying cause of the proteinuria, leukocytosis, and numerous WBCs.
From the Research
Significance of Urinalysis Results
The presence of proteinuria, leukocytosis, and numerous WBCs in an asymptomatic 24-year-old female's urinalysis may indicate several potential issues, including:
- Persistent proteinuria, which requires further work-up 2
- Urinary tract infection (UTI), as indicated by the presence of leukocytes and nitrite in dipstick urinalysis 3
- Other abnormalities, such as hematuria, which can be a cause of microhematuria and may require further evaluation 2, 4
Proteinuria
Proteinuria can be a benign condition, but persistent proteinuria requires further work-up 2. The reliability of urinalysis for identification of proteinuria is reduced in the presence of other abnormalities, including high specific gravity and hematuria 4.
Leukocytosis and WBCs
The presence of numerous WBCs in urinalysis can indicate a UTI, and the sensitivity and specificity of WBCs in dipstick urinalysis are higher than those of nitrite 3. A reflex urine culture program can be an effective strategy to decrease the rates of unnecessary urine culture and their associated costs, especially when urinalysis parameters such as nitrite and leukocyte esterase are used to predict urine culture results 5.
Clinical Implications
The results of urinalysis should be evaluated in conjunction with other clinical and laboratory data, such as the patient's age, physical findings, renal function, and results of microscopic urinalysis 6. In patients with renal or urinary tract disease, microscopic examination of urinary sediment is important 6.