Elevated Leukocyte Esterase in Urine: When to Seek Further Testing - Family Medicine

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Elevated leukocyte esterase in urine can be a significant indicator of underlying health issues, particularly related to urinary tract infections (UTIs) or inflammation within the urinary system. Leukocyte esterase is an enzyme produced by white blood cells (leukocytes), and its presence in urine suggests that there may be an inflammatory response occurring, often due to infection.

In your case, you mentioned that your urine test showed a leukocyte esterase level of "++," which indicates a moderate presence of this enzyme. While you are not experiencing any symptoms such as dysuria (painful urination), hematuria (blood in urine), or increased frequency of urination, it is still essential to consider the context of your results. The timing of your sample collection, being just days before your menstrual period, could potentially influence the results, as hormonal changes can affect urinary composition.


When to Seek Further Testing
Given that you have no accompanying symptoms, it may not be immediately necessary to seek further testing. However, it is advisable to monitor your situation closely. If you begin to experience any symptoms such as:
- Pain or burning sensation during urination
- Increased urgency or frequency of urination
- Lower abdominal pain
- Fever or chills
You should definitely seek medical attention. In the absence of these symptoms, a follow-up urine test in a few weeks could be a reasonable approach to see if the leukocyte esterase levels normalize.


Other Causes of Positive Leukocyte Esterase
There are several other factors that can lead to a positive leukocyte esterase test, including:
1. Contamination: If the urine sample was contaminated, perhaps due to improper collection techniques, it could lead to false positives. This is particularly relevant for women during menstruation, as menstrual blood can introduce leukocytes into the urine.

2. Non-infectious Inflammation: Conditions such as interstitial cystitis or other forms of urinary tract inflammation can also cause elevated leukocyte esterase levels without the presence of an infection.

3. Kidney Stones: The presence of kidney stones can irritate the urinary tract and lead to inflammation, resulting in elevated leukocyte esterase.

4. Recent Physical Activity: Strenuous exercise can sometimes lead to transient changes in urine composition, including the presence of leukocytes.

5. Other Infections: Infections elsewhere in the body can sometimes lead to elevated leukocyte levels in urine, even if the urinary tract itself is not infected.


Conclusion
In summary, while your current lack of symptoms is reassuring, the presence of elevated leukocyte esterase warrants attention. It is wise to remain vigilant for any changes in your urinary habits or discomfort. If symptoms arise, or if the leukocyte esterase remains elevated in subsequent tests, further evaluation by a healthcare provider would be necessary. They may recommend a urinalysis with culture to identify any potential infections or other underlying issues. Always consult with your healthcare provider for personalized advice based on your specific situation.