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Raised LEUKOCYTES, blood in urine test. Can be UTI?

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About 2 months ago I had a nasty UTI which I stupidly left for about 10 days before taking antibiotics for. Subsequently for the last week or so I have had slight symptoms, low ache in my tummy, and frequent need to urinate. I went to my doctors and had a test which showed trace of blood, protein and slightly raised levels of leukocytes, but no nitrate, the levels are all only slightly raised and he has told me not to worry as it cannot be a UTI because of the normal nitrate levels. I have repeated the test several times as I have bought some test strips and the readings are all roughly the same. Do you think I have another UTI or something more scary ? I am really worried, especially as I am about to go anyway for 3 weeks. Please could you advise ? Thank you


Category: Family Physician-GP

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Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello.
Thank you for your query at DoctorSpring.com.

I understand your concern and will do my best to help you.
All your symptoms are suggestive of a Urinary Tract Infection (UTI). Along with this the trace of blood, protein and slightly raised leukocytes all point towards a UTI.
A negative Nitrite test in this scenario does not rule out a UTI.
Negative nitrite test can occur despite a UTI. The reasons for this include: insufficient bladder incubation time for conversion of nitrate to nitrite (urine present in the bladder for less than 4 hours), low urinary excretion of nitrate, inability of some infecting organisms to convert nitrate to nitrite (such as E. faecalis) and decreased urine pH (due to cranberry juice or other dietary supplements).
So you seem to have another UTI, nothing scary, probably a mild one too.

Please consult your doctor again. You would need to get a urine culture done to identify the bacteria causing the UTI and to identify the best antibiotic against it. Once the results are available, you can be started on that antibiotic. Culture is necessary since this is a recurrent infection.
You would also need to get your blood sugar levels tested in order to rule out Diabetes. Recurrent UTIs are common in Diabetes.
Meanwhile please take in plenty of fluids, 3-4 liters per day.

I hope this was helpful. Feel free to discuss further.
Regards.


Patient replied :

Thank you very much , do you think it is unlikely that I have bladder cancer ? Also last time I had my urine tested about 3 weeks ago it was sent off to the lab and came back normal although in the surgery the doctor said there was a trace blood ? But it didn't show that in the lab report ? I am a bit confused ... Also I had a parathyroid tumour removed before Christmas (benine) could that be cause ing kidney problems ..? Thank you


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello.

I would not even consider bladder cancer in your case.
Bladder cancer usually presents with painless, gross (visible to naked eye) blood in urine that is persistent. You do not have any of that, neither are you at risk of bladder cancer. (I assume you do not work with aromatic/aniline dyes etc.)
Trace blood in urine can be present occasionally and may not have been present when you got it tested.

Parathyroid tumours can sometimes cause kidney stones but once removed, that does not happen.

To put all your fears to rest, I advise you to get a urine culture as well as an Ultrasound KUB (Kidney,Ureters, Bladder) done. Ultrasound will show the presence of stones, if any.

Let me know if I can assist you any further.

Regards.


Dr. Deepu Sebin Sebastian
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Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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