Hello dear, Understand your concern. Topamax is a anti seizure drug, also used in migraine. It aggravate the kidney and bladder problems as a side effect. You should consult doctor if severe pain in your side or lower back, painful or difficult urination. So I think you should do Pelvic Xray or Pelvic USG to confirm the kidney stone as it will aggravate due to tropamax. Note normal urine report: Color – Yellow (light/pale to dark/deep amber) Clarity/turbidity – Clear or cloudy pH – 4.5-8 Specific gravity – 1.005-1.025 Glucose - ≤130 mg/d Ketones – None Nitrites – Negative Leukocyte esterase – Negative Bilirubin – Negative Urobilirubin – Small amount (0.5-1 mg/dL) Blood - ≤3 RBCs Protein - ≤150 mg/d RBCs - ≤2 RBCs/hpf WBCs - ≤2-5 WBCs/hpf Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf Casts – 0-5 hyaline casts/lpf Crystals – Occasionally Pus cell – None Yeast - None But in your case you have 2-4 pus cell, it suggests you are suffering from urinary tract infection. Causative factor: E. coli, Staphylococcus saprophyticus (10 to 15 percent). Enterococcus, Klebsiella, Enterobacter, and Proteus Diabetes mellitus, neurologic conditions, chronic institutional residence, Treatment are below 1. Tablet septarn (trimethoprim/sulfamethoxazole) three times a day for three days 2. Drink plenty of water 3. Take fruit juice of orange and cranberry 4. Tablet paracetamol 500 mg if fever. Hope this may help you. Best regards Dr. Sagar