Urinalysis Results: When to Consult a Specialist

Q: Urinalysis Results: When to Consult a Specialist

Hello： The results of your urine test do suggest a possible urinary tract infection; however, since you do not have symptoms such as fever, painful urination, lower abdominal pain, or back pain, it is advisable to increase your fluid intake rather than immediately resorting to an

Urinalysis

Hello, during a recent routine check-up, several urine test results were found to be above the normal range:
- Leukocytes: (++), 100/uL
- Occult Blood: (++), 50/uL
- RBC: 6-9 HPF (reference value: 0-5)
- WBC: 20-29 HPF (reference value: 0-5)
- Crystals: Ammonium urate (2+) HPF
Other values were normal.
The doctor mentioned there might be an infection and advised to drink plenty of water without medication.
I have a history of hypertension and heart disease, and I had a 0.3 cm kidney stone around October last year.
Currently, my blood pressure is normal, and I do not experience any urinary discomfort, abdominal pain, or back pain.

Should I consult a nephrologist or urologist for further evaluation regarding the urine test results?

Ah Hui, 40~49 year old female. Ask Date: 2023/08/09

Dr. Lin Zhebin reply Family Medicine

Hello: The results of your urine test do suggest a possible urinary tract infection; however, since you do not have symptoms such as fever, painful urination, lower abdominal pain, or back pain, it is advisable to increase your fluid intake rather than immediately resorting to antibiotic treatment.
Additionally, considering your history of heart and blood pressure issues, as well as past kidney stones, we will also evaluate for potential problems related to the kidneys, bladder, and uric acid based on your urine test results.
Further examinations may include blood tests to assess kidney function and uric acid levels, ultrasound of the kidneys and bladder to check for structural abnormalities and monitor kidney stones, routine urine tests, and possibly a urine culture.
If you have any concerns, it is recommended that you consult with a family medicine physician or a nephrologist.

Reply Date: 2023/08/09

More Info

Based on your urinalysis results, it appears that there are several abnormalities that warrant further investigation. The presence of leukocytes, occult blood, and red blood cells (RBCs) in your urine suggests that there may be an underlying issue that needs to be addressed. Here’s a breakdown of your results and why consulting a specialist may be beneficial.

1. Leukocytes (++): The presence of leukocytes in the urine typically indicates an infection or inflammation in the urinary tract. A count of 100/uL is significantly elevated compared to the normal range (0-5). This could suggest a urinary tract infection (UTI) or possibly inflammation of the bladder or kidneys.

2. Occult Blood (++): The presence of blood in the urine (hematuria) can be caused by various conditions, including infections, kidney stones, or more serious issues such as tumors. A count of 50/uL is also above the normal range and should not be taken lightly.

3. Red Blood Cells (6-9 HPF): The normal range for RBCs in urine is 0-5 per high power field (HPF). Your count indicates that there is a significant amount of blood present, which aligns with the occult blood result. This could be related to the same issues causing the leukocytes to be elevated.

4. Crystals (Amo.urate 2+): The presence of uric acid crystals can indicate a risk for kidney stones, particularly if you have a history of stones, as you mentioned. While not immediately alarming, it is a factor that should be monitored.

Given your medical history of hypertension and previous kidney stones, it is advisable to consult a nephrologist (kidney specialist) or a urologist (urinary tract specialist). Here are a few reasons why:
- Potential Infection: If you have a urinary tract infection, it may require antibiotic treatment. Ignoring it could lead to more severe complications, including kidney infections.

- Kidney Stones: Since you have a history of kidney stones, it’s important to evaluate whether the current findings are related to stone formation or if there are new stones developing.

- Monitoring Kidney Health: Given your existing health conditions, it’s crucial to monitor your kidney function closely. A specialist can provide a comprehensive evaluation and recommend appropriate imaging studies or further tests if necessary.

- Preventive Care: Regular follow-ups with a specialist can help manage your overall kidney health, especially considering your hypertension and previous issues.

In summary, while your doctor suggested that increased fluid intake may suffice, the combination of leukocytes, blood, and RBCs in your urine suggests that further evaluation is warranted. It’s always better to err on the side of caution, especially with your medical history. Consulting a specialist will provide you with peace of mind and ensure that any potential issues are addressed promptly.

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