Urine For Pus cells

What sample is needed for Urine Pus cells?

• The test sample is urine.

Indication Urine For Pus cells

• To find the urinary tract infection.

How will you discuss the pathophysiology of Urine For Pus Cells?

WBC (White blood cells, Pyuria):

1. WBCs may originate from any part of the urinary tract.
2. 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 to be 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. WBCs in the urine indicate infection or inflammation in the urinary tract.
10. There may be sterile pyuria.

Eosinophils (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. Increased numbers of lymphocytes may be seen in the early stages of renal transplantation rejection.
4. For mononuclear cells, the supravital stain is needed.
5. Or, Add acetic acid to enhance nuclear details.

Lymphocytes:

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

What are the symptoms of a urinary tract infection?

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

What are the causative agents of UTI?

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.

What is the 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.

What are the normal WBCs (Urine For Pus cells)?

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

What are the causes of increased WBCs in urine?

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, there are WBCs and very few RBCs.

Normal urine picture:

• Please see more details in the Urine analysis.

Questions and answers: