Pus cells in urine microscopy

The presence of pus cells in the urine, also known as pyuria, is a sign of infection and inflammation in the urogenital system. Pus cells refers to presence of leukocytes in urine .It is produced by the body’s immune system to fight infection.

what is normal range of pus cells in urine?

A normal urine sample will have 0 – 5 WBC’s per HPF. Women may have slightly higher count of pus cells.

Leucocytes in unstained urine sediments typically appear as round and granular. Neutrophils are the most common type of WBC found in urine .The details of nuclear shape often are difficult to discern due to degenerative changes .The supra vital stain facilitates identification of the aids in the differentiation of polymorphonuclear leucocytes from lymphocytes, histiocytes, plasma cells, and renal tubular cells. 

what are glitter cells in urine?

Glitter cells are also known as Sternheimer-Malbin cells, are polymorphonuclear leukocytes (PMNs) with their granules showing Brownian movement when viewed under a microscope. They are typically found in urine with a low specific gravity (hypotonic urine). these cells stain poorly with supravital stain, leucocyte esterase positive dipstick helps in confirmation of pyuria in such cases

Also note leucocytes are rapidly lysed in hypotonic and alkaline urine , approximately 50% leucocytes are lost in 2-3 hours ,if sample kept at room temperature.

What is significance of Eosinophils in urine?

Eosinophil is suggestive of interstitial nephritis and drug-induced nephritis. Eosinophils are better demonstrated by Hansel’s stain. Few eosinophils may be seen in urinary tract infections and renal transplantation rejection. The percentage of >1% eosinophils in urine is significant.

What is significance of lymphocytes in urine?

small lymphocytes are normally present in urine . Raised lymphocyte count in urine is seen in renal transplant rejection, lupus nephritis.

More than 30% Macrophages and plasma cells in urine signify chronic inflammation.

Conditions that can cause pyuria, including:

• Urinary tract infection (UTI): This is the most common cause of pyuria. UTIs can be caused by bacteria, viruses, or fungi. most common cause of UTI is E. coli bacterial infection
• Prostatitis
• Kidney stones
• Pelvic inflammatory disease (PID)
• Sexually transmitted infections (STIs): Some STIs, such as gonorrhea and chlamydia, can cause pyuria.
• Autoimmune disorders : Autoimmune diseases, such as lupus and rheumatoid arthritis can cause inflammation and pyuria

symptoms

• Painful urination
• Frequent urination
• Burning sensation during urination
• Cloudy or bloody urine
• Fever
• Chills
• Nausea
• Vomiting

what is sterile pyuria?

Sterile pyuria is the persistent finding of white cells in the urine in the absence of bacteria, as determined by means of aerobic laboratory techniques

causes of sterile pyuria

Reference –

Henry clinical diagnosis and management by laboratory methods

https://www.nejm.org/doi/full/10.1056/NEJMra1410052