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Lupus and High White Blood Cells in Urine

Lupus is a chronic autoimmune disease commonly affecting the kidneys and blood cells. One of the lesser-known complications of lupus is the potential for high white blood cell (WBC) levels in urine. This article will explore the relationship between lupus and high WBC in urine and what it means for lupus patients.

Donald Thomas, MD author of The Lupus Encyclopedia for Gastrointestinal symptoms in lupus blog post

This blog on “Lupus and High White Blood Cells in Urine” was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2

What is Lupus?

Lupus is an autoimmune disease that occurs when the immune system attacks healthy tissues in the body. This can result in inflammation and damage to various organs, such as the skin, joints, kidneys, heart, and lungs. Lupus symptoms can vary widely depending on the individual but may include fatigue, joint pain, skin rash, fever, and organ damage. One of the most common organs involved in lupus is the kidneys (called lupus nephritis). Lupus nephritis can be one potential cause of high white blood cells in the urine.

What is High White Blood Cells in Urine?

White blood cells (also called leukocytes) are an important part of the immune system that help fight infection and disease. Normally, there should be very few white blood cells in the urine. When there are high levels of white blood cells in the urine, it may indicate an infection or inflammation in the urinary tract. However, high white blood cells (WBC) in urine can also be a sign of kidney damage or disease. Another potential cause is due to contamination. If someone does not collect their urine sample properly, white blood cells from surrounding tissue (the penis or vaginal area) can end up in the urine sample, causing an incorrect result. It is important for all lupus patients to know how to collect a urine sample properly.

Lupus and High WBC in Urine

Lupus patients are at a higher risk of developing kidney problems, including glomerulonephritis (also called lupus nephritis), a type of kidney inflammation. This can cause protein and blood cells to leak into the urine, leading to a condition called proteinuria (excessive protein in the urine). Proteinuria can be detected through a urine test, and if left untreated, can lead to kidney damage and failure.

High WBC in urine can also be a sign of infection (urinary tract infection or UTI). The urine usually contains bacteria (bacteriuria) when there is a UTI, in addition to having high WBC in the urine. If left untreated, this can lead to kidney damage and further complications.

Diagnosing and Treating High WBC in Urine in Lupus Patients

Since lupus nephritis occurs so often in systemic lupus erythematosus (in up to 45% of patients), lupus experts usually want a urine sample every 3 months. They are primarily testing for proteinuria, which is seen in 100% of lupus nephritis patients. If high WBC levels are detected, further testing may be needed to determine the underlying cause. This may include additional urine tests (especially a urine culture), blood tests, and imaging tests such as a kidney ultrasound.

Treatment for high WBC in urine in lupus patients will depend on the underlying cause.

If you have lupus and experience symptoms such as frequent urination, painful urination, or cloudy urine, you could have a UTI. It is important to speak with your healthcare provider as soon as possible. Prompt antibiotic treatment is important. They may also recommend a urine test to check for bacteria and test different antibiotics on the bacteria to see what works best.

If a kidney biopsy is done and shows lupus nephritis, medications (such as Benlysta, Lupkynis, mycophenolate, or cyclophosphamide) are needed to reduce inflammation and protect kidney function. In some cases, more aggressive treatments such as dialysis or a kidney transplant may be needed.

Preventing High WBC in Urine in Lupus Patients

While it may not be possible to completely prevent kidney problems in lupus patients, there are steps that can be taken to reduce the risk. These may include:

High WBC in urine can be a concerning finding for lupus patients, as it may indicate kidney inflammation or infection. It is important to work closely with a healthcare provider to monitor kidney function and urine samples and detect any issues early on. With proper management and treatment, lupus patients can reduce their risk of kidney damage and maintain a good quality of life.

For more in-depth information on abnormal urine results and lupus in greater detail:

Read chapters 4 and 12 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia.

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help. 

Reviewed and edited by Donald Thomas, MD

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