What does it mean when white blood cells are elevated in a routine urinalysis?

Urinalysis includes assessment of white blood cells (WBCs), red blood cells (RBCs), and urinary protein. An elevated WBC count in urinalysis is indicated by a “+” sign—ranging from one “+”, two “+” signs, to three “+” signs—with more “+” signs reflecting higher WBC levels. Elevated urinary WBCs suggest possible urinary tract infection (UTI). If increased WBCs are accompanied by symptoms such as urinary frequency, urgency, or dysuria, a UTI or cystitis is likely confirmed. Inflammatory responses secondary to urinary tract stones may also elevate urinary WBCs. Management includes antimicrobial therapy, increased fluid intake, perineal hygiene, and oral anti-inflammatory medications. Following treatment, WBC levels typically decrease and associated symptoms improve.