When nitrates are positive in your urine, it probably means that a urinary tract infection caused by gram-negative bacteria is present. On the other hand, leukocytes are cells of the immune system that respond to a pathologic microorganism. When they are found in someone’s urine, a urinary tract infection is also most likely the reason. But what happens if you have been told by your physician that you have leukocytes in your urine but no nitrates?

Leukocytes in Urine No Nitrates: Causes

1. False Positive Result

In some cases, leukocytes can be found in a urine sample without actually having a urinary tract infection, which may be due to an incorrect technique or bad hygiene when collecting the sample. This is highly suspected if there are no nitrites present in the urine at the time. If this is the case, further laboratory testing can be performed to be certain.

In order to avoid a false-positive result, you need to thoughtfully clean your genitals and the area around your urethral opening with clean water; make sure to hold back your foreskin if you are a man or keep your genital labia aside if you are a woman.

Let your urine flow for 2 seconds and then start collecting the sample, so that the first urine that may be contaminated can be discarded, therefore not risking to compromising the final result.

2. Infection and Other Underlying Causes

Leukocytes in urine no nitrates does not immediately discard a urinary tract infection. If the leukocytes levels are between 0 and 10 lev/vl, then it is considered a normal result. Nevertheless, if those levels reach 20 lev/vl or more, then searching for the cause and starting medical treatment will be necessary. Some of the most common causes of leukocytes without nitrates in a urine sample are:

• Underlying urinary tract infection or inflammation
• Pregnancy. In this case, the hormonal and physical changes that normally occur at this stage can increase the risk of having leukocytes in urine; however, if the levels are too high or urinary symptoms occur, then you must immediately seek medical attention. A urine tract infection or underlying condition during pregnancy can put the fetus and even the mother at grave risk.
• Hematuria. Sometimes an elevated number of leukocytes can result from a condition called hematuria, commonly known as the presence of blood in urine. This can be due to various issues such as trauma, kidney and/or bladder stones, tumors, prostate hypertrophy, among others.
• Sexual intercourse. It can cause bacteria to pass from one infected person to its partner’s urethra, therefore increasing the risk of urinary tract infections and leukocytes in urine.
• Frequently resisting the urge to urinate. This can lead you to have weaker and overstretched bladder muscles, causing a little amount of urine remaining inside the bladder. With time, this retained urine can become infected, causing you to have chronic conditions and leukocytes in urine.
• Medical conditions. Some diseases and conditions are only marked by the presence of a great number of leukocytes in urine; this includes kidney infections and pyelonephritis. This usually starts with a mild lower urinary tract infection; when left untreated, it finds its way up to the upper urinary tract, affecting the kidneys. This happens more frequently in chronic urinary catheter users and in person with some type of immunodeficiency.

Leukocytes in Urine No Nitrates: Treatments

The treatment will vary, depending on the cause for having an elevated number of leukocytes in your urine. If your physician determines that is due to an infection, then antibiotics will be prescribed for you.

There are many things you can do to help prevent and/or improve the recovery speed of an infection. Maintain a good ingestion of vitamins such as C and B to boost your immune system; these nutrients can be found in foods like cranberries, oranges, tangerine, lemon, lime, ginger, arugula, among others. You can also take oral supplements.

Proper hygiene is necessary. Change your underwear and clean your genitals on a daily basis; in some cases, washing your undergarments and towels with a disinfectant will be needed as well. Avoid touching your genitals more than necessary through the day and if you do so, then make sure to wash your hands before and after.

In the case of an active infection or leukocytes in your urine, you should not have sex until completely cleared. Failing to do so can lead to further bacteria spread and treatment failure.

Leukocytes in Urine No Nitrates: Home Remedies

Although your physician will most likely prescribe specific antibiotics to treat your infection, certain natural remedies can help you recover faster. 

• Low-Oxalate Diet: Oxalate is a chemical substance frequently found in the urine of people prone to produce kidney stones. Foods rich in oxalates include almonds, peanut, sesame seeds, dried figs, spinach, rhubarb, beets, Swiss chard, buckwheat, among others. Foods that have a low amount of oxalate include eggs, beef, turkey, chicken, avocado, arugula, lemons, cherries, limes, onions, coconut, thyme, zucchini, and ginger, among others.
• Uva Ursi: Uva ursi is a widely used plant because of its diuretic, pain-killer, disinfectant and cleansing properties. Besides urinary tract infections, it can also help treat kidney stones. However, hydroquinone can be harmful to the liver, so Uva ursi must be taken carefully and with previous medical consent.
• Cranberry: This fruit is widely used to help prevent urinary tract infections because of its antibiotic properties which are probably given by a compound named hippuric acid.
• Homeopathy: Some homeopathic remedies are believed to produce excellent results when used for the treatment of urinary tract infections and even kidney stones. Nux vomica is used for the treatment of kidney stones, especially when accompanied by symptoms such as nausea, vomiting, cramps and lumbar pain. Aconitum napellus can be used to treat bladder infections when taken in early stages of the disease.