Urine For Pus cells

Sample Urine For Pus cells

• The test sample is urine.

Indication Urine For Pus cells

• To find the urinary tract infection.

Pathophysiology of Urine For Pus Cells

WBC (White blood cells)

1. WBCs may originate from any part of the urinary tract.
2. The size of WBC is larger than RBC, around 12 µm in diameter.
3. The predominant white cells are neutrophils.
4. Identifying neutrophils is easy because of the granular cytoplasm and multilobate nucleus.
5. These are reported an average of 10 fields under high power.
6. Neutrophils lyse rapidly in alkaline urine and lose nuclear details.
7. WBCs can migrate to the site of infection or inflammation.
8. An increase in WBCs in urine is called Pyuria.
9. The presence of WBCs in the urine indicates infection or inflammation in the urinary tract.
10. There may be sterile pyuria.

Eosinophiluria

1. Eosinophil is suggestive of interstitial nephritis and does not favor urinary tract infections.
2. Eosinophils are also seen in drug-induced interstitial nephritis.
3. Few eosinophils may be seen in urinary tract infections and renal transplantation rejection.
4. The urine sediment slide is prepared by cytospin and stained with Wright’s stain or Hansel’s stain.
5. The percentage of >1% eosinophils in urine is significant.

Mononuclear cells

1. Mononuclear cells like lymphocytes, macrophages, and histiocytes may be present in small numbers.
2. These cells are not identified in the wet preparation.
3. Lymphocyte increased numbers may be seen in the early stages of renal transplantation rejection.
4. For mononuclear cells, the supravital stain is needed Or.
   1. Add acetic acid to enhance nuclear details.

Lymphocytes

1. These are seen in kidney transplant rejection.
2. An increased number of lymphocytes indicate early signs of kidney rejection.
3. Also, plasma cells may be seen along with lymphocytes.

Symptoms of the urinary tract infection show:

1. Increased infrequent urination.
2. There is blood in the urine (hematuria).
3. The urine color is cloudy.
4. There is a burning sensation.

Causative agents of UTI are:

1. The most common is E.coli. About 80% of UTIs are due to these bacteria.
2. Staphylococcus is a common cause in young sexually active females.
3. Klebsiella and Enterobacter are also common causative agents.
4. Sometimes Candida may also cause UTI.

Evidence of pyuria :

1. There is a positive leukocyte esterase test. The sensitivity is 70 to 95%.
2. There is a positive nitrite test even in fresh urine. This test specificity is quite high, but sensitivity is only 50%
3. There is a reagent strip that finds evidence of urinary tract infection.
4. The ultimate diagnosis is culture:
   1. A count of 100,000 bacteria is a significant number to call a urinary tract infection.
   2. A count of 10,000 bacteria is considered contamination.

Normal WBCs (Urine For Pus cells: )

• Male = pus cell(WBC) = < 4 /HPF.
• Female = pus cell (WBC) = 5 to 7 /HPF.

Increased WBCs in urine are seen in the following:

1. Bacterial infection of the urinary tract.
2. Cystitis.
3. Prostatitis.
4. Urethritis.
5. Acute Appendicitis.
6. Chronic pyelonephritis.
7. Glomerulonephritis.
8. Tuberculosis.
9. Bladder Tumors.
10. An autoimmune disease like SLE.

• Note: When there are clumps of WBCs, these should be reported, suggesting urinary tract infection.
• In Urinary bladder infection, mainly there are WBCs and very few RBCs.

Normal urine picture:

Physical features	Chemical features	Microscopic findings
Color = Pale yellow or amber Appearance = Clear to slightly hazy pH = 4.5 to 8.0 Specific gravity = 1.015 to 1.025	Blood = Negative Glucose = Negative Ketones= Negative Protein = Negative Bilirubin = Negative Urobilinogen = Negative (±) Leucocyte esterase = Negative Nitrite for bacteria = Negative	RBCs = Rare or Negative WBC = Rare or Negative Epithelial cells = Few Cast = Negative (Occasional hyaline) Crystal = Negative (Depends upon the pH of the urine) Bacteria = Negative

• Please see more details in the Urine analysis.

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