
What Does The Following Urinalysis Report Indicate?

I am posting this as a new inquiry
About two weeks ago my mother had mild bladder symptoms.
She had positive for nitrites/leukocytes
Her symptoms resided as the week went on but her rbcs were 200 more and pink tinge to urine in toilet bowl.
A lab culture showed ecoli sensitive to fosfomycin.
She was given this past Sunday and her 15mg xarelto was stopped.
Within three days or this past Wednesday, she was negative for rbcs, wbcs and nitrites.
She resumed xarelto Wednesday evg and the preventative 2000mg mannose.
As of this morning, her urinalysis was negative for rbcs but positive for nitrites and leukcocytes - she has no symptoms.
How do you handle this?
Nitrites and Leukocyte without any symptoms is not a serious problem
Detailed Answer:
Hello
Thanks for query .
Your mother had UTI due to E-Coli organisms and was treated with appropriate antibiotic (Fosfomycin ) as per culture report and got completely cured. However her recent urine analysis has revealed presence of Nitrite and Leukocytes in urine .
Leukocytes ( WBC) in the the body are most important part (Like Solders in army) of defense mechanism of the our body to fight against the bacteria and help to combat infection They produce Nitrite which is detected in urine .Similarly like few solders die in the battle few of these Leukocytes are sacrificed which appear in urine as pus cells .The presence of these two factors ( Nitrites and Leukocytes) do not signify active infection but the remains of the war against the bacteria .
They are gradually eliminated through urine after infection has subsided which takes few days till then they are detected in urine analysis .
You have not to be worried for .
Take Nitrofurantoin for 2-3 weeks .
Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil.


She took the fosfomycin this Sunday.
She was negative then for nitrites, wbcs for 2 consecutive days.
And it took three days for the rbcs to be negative?
Are you implying this is still from the previous infection?
Or is the beginning of a new one?
I think its the latter.
The primary reason she was given fosfomycin was the rbcs which was not resolving. Was it the ecoli infection or the xarelto
If she has no real symptoms now - I imagine the rbcs will become an issue again.
She had an ecoli back in April - it was treated 10 days nitro and 4 days later another sympt ecoli which was still sensitive to nitro
I dont wish to be giving her antibiotics easily
She was months symptom free with 2000mg mannose. It helps to prevent but not treat
I think this new episode is going to build again like it did over a week back.
She might hopefully not have any symptoms but will have high RBCS which wont resolve on its own?
No one can provide a clear answer on the significance of the xarelto.
She was off it for 3 days on Sunday and I dont wish to keep her off it either long
but she resumed Wednesday
Hopefully it was a typo on your part.
Leukocytes don't produce nitrite but is the actual ecoli that produce nitrites from nitrates
I went to see the family doctor as the local uro is a surgeon who finds ecoli infections trivial.
Family doctor gave a prescription for nitro.
I havent given it yet.
As of this afternoon, she is still positive for nitrites/leukocytes but no rbcs
which was the primary concern before the fosfomycin was given.
Your primary comment hinged ON that the urinalysis results today are from last weeks episode - I say its a new one or beginning of new one
But at this point - no nitro.
I am hoping she remain symptom free but a 90 year old shouldnt be having pink stained urine indefiintely
Presence of RBC in the urine is promarily due to UTI by E-Coli infection.
Detailed Answer:
Hello
Thanks for follow up .
The presence of RBC in urine is primarily due to E-Coli infection which gets aggravated by blood thinner medications( anticoagulants ) like Xarelto.
It is the standard protocol to stop the anticoagulants whenever there is bleeding any where in the body as hematuria (Bleeding in urine ) or G.I bleeding .
If it is mandatory for her to take anticoagulant you can certainly start it again with consultation of your treating physician.
Thanks and Regards.
Dr.Patil.


My mother has atrial fib - she was off three days off the xarelto.
SHe is still symptom free to date and no RBC's
However there is the nitrites/leukocytes -
How can you get two days negative for these 2 parameters and then positive again
You are inferring its from last weeks episode????
She stopped xarelto for 3 days and has been back the last three days.
I thought temporarily stop the xarelto again to prevent the bleeding
I dont wish to give the antibiotic but perhaps have no other choice.
Xarelto will have to be stopped if she gets bleeding again .
Detailed Answer:
Hello
Thanks for follow up .
It is not uncommon to get repeated episodes of UTI in elderly females who are prone to have Chronic UTI .
In such situation it becomes mandatory for treating physician to with held anti coagulant temporarily till infection and hematuria gets cured .I would suggest you not to give too much importance for Xarelto as there is no evidence based untoward incidence to happen if it is withheld for a week or so by the time urinary infection gets resolved .
Thanks and Regards.
Dr.Patil.


My point is - I dont think she will have symptoms.
However will she now develop blood in the urine.
And being proactive stopping the xarelto now.
It has already been taken tonight because there are no RBCS
However, ceasing it - hoping she can eventually beat this 2nd ecoli episode
solo without a 2nd antibiotic
Do you understand the mechanics of this
Thankyou for your insight.
My mother only drinks 1 to 1.25 litres fluid daily and we have daily arguments about this
Getting Hematuria due to UTI is not uncommon
Detailed Answer:
Hello
Thanks for follow up .
Getting repeated episodes of UTI and thereby to detect RBC in urine is not uncommon in elderly female patients who are susceptible to go through these issues repeatedly which needs to be treated with appropriate antibiotics as per culture report
However in order to get fast control over infection it is mandatory to stop anticoagulants temporarily for few days .This a standard protocol for us to follow which do not harm the patient even if the anticoagulants are stopped for few days ..
Please do not mix up these two different issues Hope this will clear off your doubts .
Thanks and Regards.
Dr.Patil.


However this past weeks episode had no lagging symptoms - incontinence, urgency, radiating pain.
ONLY was the elevated RBCS and pink urine about 6 days in.
Fosfomycin was given and xarelto stopped.
She was ALL CLEAR only two days ago for all applicable parameters.
Today, leukocytes and nitrites...
So if the key problem is bloodloss - I thought ceasing xarelto would have merit.
You inferred an antibiotic would be needed a second time
But you also stated in your first entry - this might just be remnants of the first fofsomycin episode.
I simply dont wish to over-use antibiotics as even though the culture report from Dec 13th only had two resistant antibiotics - she has had in the last 5 years wher almost all the antibiotics lost their effectiveness.
Do you understand Dr P
I contacted a hospital uro clinic to discuss this and got brushed off because of the holidays.
Stay clear of Canada!
If she develops UTI again will need to be given antibiotic
Detailed Answer:
Hello
Thanks for follow up and writing again .
As I stated earlier it is common for elderly females to get repeated episodes of UTI if such situation arises in future (the possibility of which can not be ruled out) she will need to be given antibiotic as per culture report .
Since she is symptom free she does not need antibiotics in present context .I have suggested NItrofurantoin which acts as a urinary antiseptic and helps to prevent recurrence of infection.
Presence of Nitrites and Leukocytes indicate remains of previous infection which will gradually wane away within few days and can be confirmed by routine urine analysis.
Thanks and Regards.
Dr.Patil.


You believe the nitrites/leukocytes are from last weeks episode.
I think its the beginning of a new one.
Why have two days of negative readings and then all of a sudden - its back.
A new culture was taken today already.
If the urinalysis shows high RBCS - then guess nitro will have to be used which I have.
I have strong beliefs in the mannose but it may prevent, it wont eliminate it once it sets in.
Like I mentioned before, this is one of the first episodes she had no true symptoms other than the blood.
Anyhow, thankyou for your opinion. I hope you are correct with the remnants arugument.
Its truly tough to deal with a 90 year old health care needs in a system thats broken. Goodnight sir
Good luck and have a speedy recovery to your mother
Detailed Answer:
Hello
Thanks for follow up .
My knowledge about Mannose is very limited as it is not available and used in our country (India)
Considering the age of your mother to be 90 years which itself is factor to get infection due to low immunity one has to be mentally prepared to accept what ever comes to her .There is no alternative than giving antibiotics as and when required .
Thanks and Regards.
Dr.Patil.


Is the nitrites/leukocytes - vaginal contamination
But I had two similiar urinalysis strips yesterday
Neg - RBCS
Positive- Nitrites/Leukocytes
The toilet water this morning still had no pink as was the case about a week ago
Thankyou
Correction this morning - the toilet water had no pink tinge today contrary to last week which it did. Then the fosfomycin was given.
The urinalysis strip was still negative for rbcs this morning but positive for the nitrites/leukocytes. But visually the urine sample looks a bit better than yesterday.
I shall hold off the nitro for the time being but your insight to the significance of the urine microscopy
Let us wait for results of Urine Culture and take a call about antibiotic
Detailed Answer:
Hello
Thanks for follow up
Her recent urine analysis report that you have uploaded reveals presence of Nitrites and Leukocytes but in view of shw being symptom free let us take a call about giving antibiotics after getting the results of Urine Culture .
There is no harm in giving Nitrofurantoin along with urine alkalizer .
Thanks and Regards.
Dr.Pail.


You helped out over a week back.
Unfortunately this site did not allow me to post more questions.
As you may recall the 1st ecoli episode was not resolved by the fosfomycin.
Though the nitro has suppressed the ecoli since Dec 25th and xarelto was stopped for three days, after it was begun again for 1 evg, she showed hemolyzed rbcs 200plus the following morning. She has now been off the xarelto for three nights
and the morning urinalysis Dec 30,31, Jan1st have been negative.
However she has been on and off xarelto three times now since Dec 19th.
Another online source has stated stay off it for 5 consecutive days
You made the initial comment that a weeks time would not be a big concern
However, I dont know if the combination of days on and off make a big difference.
I am getting paranoid about this as far as the atrial fib risk
I have chronicled the events below
Dec 13 - Mild bladder symptoms - Urine sample taken with culture
showing > 100 * E6 cfu/L and sensitivity to fosfomycin and
nitrofuran, lab urinalysis showing already 0.3 mg/L ethrocytes
Bladder symptoms resolve within a couple of days
Dec 18 -Home urinalysis strips showing 200 RBC's,
nitrites/wbcs positive - brown urine
Fosfomycin 3grams given, xarelto 15mg stopped
Dec 21 -Nitrites and rbcs negative, xarelto resumed after 3 days
Dec 23 -Nitrites/leukcocytes positive, rbcs negative
Urine culture shows same high ecoli count and sensitivity
to fosfomycin/nitrofuran later on
Dec 25 -RBC >200, strong pink urine tinge, Nitrofuran 200mg daily started for 10 days
Xarelto stopped again
Dec 28 - RBCs, Nitrites, WBCs - Negative, Xarelto resumed
Dec 29 Nitrites/WBCs - negative, RBCs >200, brown urine
Stop xarelto
Dec 30, Dec 31st - Urinalysis negative for all parameters
Consult your Cardiologist regarding stopping Xarelto
Detailed Answer:
Hello
Thanks for follow up .
Let me state that her problem of getting RBC is related to Xarelto and you should not have trial of stopping for few days and starting it again of your own .
You should rather take opinion of a concerned cardiologist regarding doses and waning of Xarelto .His sound guidance will help you to deal with the situation .
I have faced very serious situations of gross hematuria and blood loss in a patients who are on blood thinners needed to give blood transfusion .
Thanks and Regards.
Dr.Patil.


I see the family doctor tomorrow. Urology clinic - who knows when they show interest. I respect your opinion as I imagine with a few decades worth of experience - you have seen a few issues.
Two other online cardiologists mirror the same 7 day window to stay off the blood thinner to let the tissue heal.
However, one younger urologist inferred that the pink or brown tinged urine regardless of the > 200 RBC count is not significant. Gross hematuria is really only true blood (red) coming out with pain which would warrant stopping the blood thinner regardless of the cardiac risk.
He implied it would settle on its own.
My mother basically had two bouts since Dec 13th where the original fosfomycin sensitive eoli resurfaced and then treated with nitro. It appeared the second round of blood tinge came on stronger/faster.
She began the nitro and ceased the xarelto for three days where rbcs were negative. She began the 15mg in the evg again and by morning, the urine was brown tinged with 200 plus RBCs
Did that warrant then ceasing what is now day 5 without it. As the urine rbcs was again negative only 1 day after stopping it which seems also a bit unusual
that it went from 200RBC to negative within 1 day.
Anyhow, imagine your experience implies you dont gamble that pink tinged urine could all of a sudden become true blood.
I am going to receive criticism tomorrow from the family doctor I imagine.
goodnight
We always try to assess the situation and advise accordingly
Detailed Answer:
Hello
Thanks for appreciation
We always try to analyse the situation and suggest or opine based on our experience .There is no rule book in medical science and signs ,symptoms and results vary from patient to patient .
Any way wish your mother to be in good health and free from RBC in urine
Thanks and Regards.
Dr.Patil.

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