Normal Range and High Levels

A urinalysis (urine test) can detect leukocytes (white blood cells) in the urine. These cells can be counted with microscopic examination. They can also be detected with a urine dipstick test indicating whether leukocyte esterase (an enzyme in certain white blood cells) is in the sample.

There should be no or very few white blood cells in urine. A leukocyte esterase dipstick test is considered normal when negative, meaning leukocyte esterase is not detected. With microscopic testing, a normal range is 0 to 5 per high-powered field (hpf).

White blood cells in urine are a sign of inflammation and may mean there is an infection in the kidneys or urinary tract (bladder or urethra).

This article will discuss leukocyte levels in a urine chart, what normal leukocyte levels in urine say about health, causes of high leukocytes in urine, and the next steps after a high leukocyte count is found in a urine test.

Leukocyte Levels in Urine Chart

Urine tests (urinalysis) can detect and measure substances such as blood, cells (like white blood cells), sugar, bacteria, electrolytes, and proteins.

Urine is analyzed in a number of ways, including:

• A visual exam to check color and clarity
• A dip test in which a test strip is dipped in the urine and displays color changes depending on what it detects
• A microscopic analysis in which a sample is examined under a microscope

Pyuria (an elevated number of white blood cells, or pus cells, in the urine) suggests inflammation in the kidneys or urinary tract, possibly caused by an infection.

A leukocyte esterase test gives positive results (the substance is present) or negative results (the substance was undetected). If the test is positive, the sample may be analyzed using a microscope to look for white blood cells and other indications of infection.

Normal Range

White blood cells are not typically present in urine. Having no or very few white blood cells is considered a normal result.

Some measures indicate a normal white blood cell count for urine is 0–5 per hpf (examined under a microscope). Men typically have a count of less than 2 per hpf. Women typically have less than 5 per hpf.

High Range

The range can vary, but any of the following criteria has defined pyuria:

• 10 or more white blood cells per cubic millimeter in a urine specimen
• Three or more cells per hpf of unspun urine (urine that has not been centrifuged)
• A positive result on Gram’s staining of an unspun urine specimen
• A positive urinary leukocyte esterase dipstick test

Sterile pyuria (persistent finding of white blood cells in the urine, but without the presence of bacteria) may be measured as more than 5 to 8 leukocytes per hpf, with the absence of infection.

Another measure of sterile pyuria is 20 leukocytes per microliter, with no bacteria.

These measures may differ from those used by your lab or healthcare provider. Refer to their specifications.

What Normal Leukocytes in Urine Says About Health

Leukocyte levels in urine are just one measure your healthcare provider uses to determine your health. Your healthcare provider will consider these results and other factors such as medical history, overall health, and symptoms you are experiencing.

Certain factors can interfere with a leukocyte esterase test.

A false-positive result—when the test incorrectly indicates a condition is present—may happen because of:

• Trichomonas infection (such as trichomoniasis, a sexually transmitted infection, or STI, caused by a parasite)
• Vaginal secretions (such as heavy mucus discharge or blood)

A false-negative result—when a test incorrectly indicates the substance is not present—may happen because of:

• High level of protein
• High level of vitamin C

Pyuria can be a sign of a urinary tract infection (UTI), but it is possible to have a UTI without pyuria.

A 2016 study of 1,181 children diagnosed with UTI found that pyuria was present in 87% of the children and absent in 13%. Compared with children with Escherichia coli (E. coli, a common bacterial cause of UTIs), pyuria was found to be less likely in children with certain species of bacteria, such as:

• Enterococcus
• Klebsiella
• Pseudomonas aeruginosa

Causes of High Leukocytes in Urine

UTIs are a common cause of leukocytes in urine. They are caused by bacteria entering the urethra (the tube that transports urine out of the body). The risk of contracting a UTI can be increased by:

• Having a vulva (the urethra is shorter in people who have a vulva than in those with a penis, making it more likely for bacteria to reach the bladder or kidneys)
• Sexual intercourse
• Not drinking enough fluids
• Problems with genital hygiene (always wipe from front to back, and keep the area clean and dry)
• Pregnancy
• Conditions that make it difficult to fully empty the bladder (such as constipation or an enlarged prostate)
• Conditions that block the urinary tract (such as kidney stones)
• Urinary catheters
• Weakened immune system (such as from chemotherapy or diabetes)
• Menopause
• Certain types of birth control, like spermicide or diaphragm
• Previous UTIs
• Abnormality in the urinary tract, such as vesicoureteral reflux

White blood cells in urine can be caused by many other conditions, including:

• Cystitis (bladder infection)
• Inflammation in the vagina or under the penile foreskin
• Inflammation of the kidneys
• Systemic lupus erythematosus (SLE) (an autoimmune disease commonly referred to as lupus)
• Bladder tumor
• Glomerulonephritis (Inflammation or damage in the glomerulus, a part of the kidney)
• Kawasaki disease (a rare inflammatory disease that occurs after an infection)
• Prostatitis (inflammation of the prostate)
• Balanitis (pain and inflammation of the head of the penis)
• Renal or genitourinary tuberculosis
• STIs, such as chlamydia
• Interstitial cystitis (inflamed or irritated bladder wall)
• Carcinoma in situ (CIS) of the bladder (bladder cancer that has not spread from its original site)
• Renal tract stones
• Intraabdominal infections, such as appendicitis or diverticulitis

Leukocytes in Urine During Pregnancy

UTIs are common in pregnancy. UTIs may be symptomatic (such as a sense of urgency, painful urination, frequent urination with small volumes, straining, or a residual feeling of incomplete emptying) or asymptomatic (without symptoms).

UTIs may increase the risk of complications such as:

• Low birth weight
• Preterm birth
• Preeclampsia (high blood pressure in pregnancy)

If untreated, a UTI could develop into pyelonephritis (a kidney infection), which has been associated with complications such as:

Pregnant person:

Fetus/infant:

Routine screening for UTIs is common with prenatal care, with or without symptoms. Talk to a healthcare provider if you have symptoms of a UTI or have any concerns.

After Urine Test, What Happens Next With High Leukocytes

High leukocytes in urine are not enough on their own to make a diagnosis. Your healthcare provider will talk to you about your symptoms and your health history and may choose to run further tests.

Your healthcare provider may also do a physical examination, which may include a digital rectal exam to check for a swollen or enlarged prostate that could be blocking the bladder.

If your healthcare provider diagnoses you with a UTI, they will likely prescribe antibiotics to clear the infection and prevent it from progressing to a kidney infection. The exact treatment will depend on the cause of the UTI and your personal health considerations.

It is important to take all of your antibiotics as directed and follow your healthcare provider’s advice to ensure the infection is fully treated.

Depending on your symptoms and other factors, your healthcare provider may want to run other tests such as:

• Another urinalysis
• Urine culture (identifies bacteria)
• Blood tests
• Cystoscopy (looking inside the urethra and bladder with a camera in an inserted tube)
• X-rays
• Ultrasound
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Imaging tests using contrast agents
• Radionuclide scanning (uses a radioactive chemical)

Summary

Leukocytes are white blood cells. Leukocytes may be detected in urine using a leukocyte esterase test or with an examination under a microscope. White blood cells are not normally found in urine, so a normal level is zero or very few (typically 0–5 per hpf).

Leukocytes in urine are a sign of inflammation and may indicate an infection. They are often due to a UTI but could be caused by several other conditions.

If leukocytes are detected in your urine, your healthcare provider may make a diagnosis based on this result, along with other factors such as your symptoms and an examination. If needed, more tests may also be ordered. Talk to a healthcare provider if you have symptoms of a UTI or other concerns.