Lupus and High White Blood Cells in Urine

posted in Nephritis, kidneys, urinary tract on May 23, 2023 by

Gavin Abson

Updated February 8, 2025

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Elevated white blood cell (WBC) counts can arise in lupus patients for various reasons. This article will delve into the connection between lupus and elevated WBC levels in urine, and what these findings signify.

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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“

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NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. By purchasing JHUP books such as The Lupus Encyclopedia, you contribute to valuable projects like Project MUSE. 

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What is High White Blood Cells in Urine?

White blood cells, or leukocytes, play an important role in our immune response, combating infection and disease. Typically, only a small number of WBCs are present in urine. Elevated WBC levels may signal infection or inflammation in the urinary tract, but they can also indicate kidney damage or diseases such as lupus nephritis.

A common cause is from 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 increased risk for kidney problems, including glomerulonephritis, commonly referred to as lupus nephritis, which is characterized by kidney inflammation. This condition can result in the leakage of proteins and blood cells into the urine, setting the stage for proteinuria, or excessive protein in the urine. Proteinuria is detectable via urine testing and can lead to significant kidney damage if not addressed promptly.

Elevated WBC counts in urine may also indicate an infection, such as a urinary tract infection (UTI). Typically, the urine contains bacteria (bacteriuria), alongside increased WBC levels when a UTI is present. Untreated UTIs can lead to serious complications.

Diagnosing and Treating High WBC in Urine in Lupus Patients

Up to 45% of patients with systemic lupus erythematosus (SLE) may experience lupus nephritis. Consequently, specialists often recommend urine samples every three months, with low-risk patients requiring testing every 6 to 12 months. The primary focus of these tests is to detect, proteinuria, a hallmark found in all lupus nephritis cases. If elevated WBC levels are noted, further investigations will likely be mandated, which could involve additional urine analyses (particularly cultures), blood tests, and imaging methods like kidney ultrasounds.

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

If you experience symptoms such as frequent or painful urination, or cloudy urine, it may indicate a UTI. It’s crucial to contact your healthcare provider promptly. Timely antibiotic treatment is vital, and your doctor may recommend urine testing to identify bacteria and determine the most effective antibiotics.

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.

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 include:

• Practice everything listed in Dr. Thomas’ “Lupus Secrets.”
• Read and do everything discussed in Dr. Thomas’ blog post “How to Succeed after a Lupus Diagnosis.”
• Regular check-ups with a healthcare provider are essential to monitor kidney function and collect urine samples to check for proteinuria, which is the earliest indicator of lupus nephritis.
• Taking medications as prescribed to manage lupus symptoms and prevent kidney damage
• Maintaining a healthy lifestyle, including a balanced (anti-inflammatory) diet and regular exercise
• Avoiding smoking
• Drink plenty of water (such as 9 glasses daily)
• Urinate immediately after sexual intercourse to reduce the risk for UTI
• Cranberry and mannose supplements may help reduce the risk for UTI

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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

For more in-depth information on Lupus and High White Blood Cells in Urine:

Read more in 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. 

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