From the Guidelines
The urinalysis results showing leucine of 117 and erythrocytes of 1392 indicate significant abnormalities that require prompt medical attention, and I strongly recommend immediate consultation with a urologist for further evaluation and management, as the elevated erythrocyte count suggests potential bladder cancer or other serious urologic conditions. The elevated leucine level may indicate metabolic disorders or liver dysfunction, while the markedly elevated erythrocyte count suggests bleeding within the urinary tract, which could result from kidney stones, glomerulonephritis, trauma, or malignancy, as noted in the recent guideline updates on microhematuria 1. According to the updates to microhematuria: aua/sufu guideline (2025) published in The Journal of Urology, delays in diagnosis of bladder cancer have been suggested to contribute to a 34% increased risk of cancer-specific mortality and a 15% increased risk of all-cause mortality 1.
Key considerations in the management of this patient include:
- The need for cystoscopy, as most cancers diagnosed among persons with hematuria are bladder cancers, optimally detected with cystoscopy 1
- The importance of limiting unnecessary risks and costs associated with the over-evaluation of patients who are at low risk for malignancy, while addressing delays in diagnosis of important urologic conditions caused by widespread under-evaluation and variations in care 1
- The potential for significant variability in current guidelines and consensus statements regarding microhematuria, particularly the definition of microhematuria, criteria for evaluation, as well as the appropriate components of the evaluation, including the optimal imaging modality 1
Additional diagnostic tests should be performed, including complete blood count, comprehensive metabolic panel, urine culture, and possibly imaging studies such as ultrasound or CT scan of the kidneys and urinary tract. While awaiting specialist consultation, increased fluid intake (unless contraindicated) may help dilute the urine and reduce irritation. The combination of these abnormal findings warrants thorough investigation as they could indicate serious underlying pathology requiring specific treatment based on the definitive diagnosis.
From the Research
Urinalysis Results
- Leucine: 117
- Erythrocytes: 1392
Interpretation of Results
The urinalysis results show a high level of erythrocytes, which indicates hematuria, a condition characterized by the presence of blood in the urine 2, 3. The presence of leucine in the urine may also indicate a urinary tract infection or other conditions.
Diagnostic Considerations
The diagnosis of hematuria involves a range of tests, including imaging studies such as CT scans and ultrasound, as well as laboratory tests such as urinalysis and urine cytology 2, 3, 4. The choice of diagnostic tests depends on the underlying cause of the hematuria and the patient's clinical presentation.
Establishing Cut-offs for Urine Erythrocyte and Leukocyte Dipstick Tests
A study published in 2018 established cut-off limits for urine erythrocyte and leukocyte dipstick tests using probit regression 5. The study found that the estimated concentration that yields 50% positive results (C50) of the erythrocyte weak+, 1+, 2+, 3+, and 4+ dipstick results were 14.6,40.4,51.6,136.3, and 219.0 × 10^6/L, respectively. The estimated C50 of the leukocyte 1+, 2+, and 3+ dipstick results were 22.7,67.9, and 283.9 × 10^6/L, respectively.
Performance Characteristics of Urinary Cytology
A study published in 2021 investigated the performance characteristics of urinary cytology in patients presenting with gross and microscopic hematuria 4. The study found that urinary cytology had low sensitivity and positive predictive value for urothelial carcinoma, regardless of smoker status, hematuria type, or gender. The study concluded that urine cytology should not be routinely used in a hematuria screening population.