Pyuria: Difference between revisions

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<br><br>'''To view a comprehensive algorithm of common findings of urine composition and urine output, click [[Urine#Algorithm of Common Urinary Findings|here]]'''<br>
| [[File:Siren.gif|30px|link=Pyuria resident survival guide]]|| <br> || <br>
| [[Pyuria resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Pyuria}}
{{CMG}} {{AE}} {{SSH}}
<br><br>'''To view a comprehensive algorithm of common findings of urine composition and urine output, click [[Urine#Algorithm of Common Urinary Findings|here]]'''
==Overview==
==Overview==
Pyuria refers to urine which contains pus. Defined as the presence of 10 or more [[neutrophils]] per high power field of unspun, voided mid-stream urine. It can be a sign of a bacterial [[urinary tract infection]]. Pyuria may be present in the septic patient, or in an older patient with [[pneumonia]]. Sterile pyuria is urine which contains [[white blood cell]]s (pus) while appearing sterile by standard culture techniques. Sterile pyuria is listed as a side-effect from some medications such as [[paracetamol|paracetamol (acetaminophen)]].
Pyuria is a condition in which urine contains 10 or more white cells/mm³. [[Gram staining|Gram stain]] and [[leukocyte esterase]] might be positive. Pyuria might be a sign of a bacterial or non bacterial [[urinary tract infection]], genitourinary abnormalities, inflammatory disorders, and systemic diseases. Pyuria may be classified into sterile pyuria or [[bacteriuria]]. Treatment is not required for pyuria. However, underlying diseases must be treated.


===Definition===
==Definition==
Pyuria is defined as the presence of 10 or more white cells per cubic millimeter in a urine specimen, 3 or more white cells per high-power field of unspun urine, a positive result on Gram’s stain of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase<ref>{{Cite journal| doi = 10.1016/j.ajic.2008.03.002| issn = 1527-3296| volume = 36| issue = 5| pages = 309–332| last1 = Horan| first1 = Teresa C.| last2 = Andrus| first2 = Mary| last3 = Dudeck| first3 = Margaret A.| title = CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting| journal = American Journal of Infection Control| date = 2008-06| pmid = 18538699}}</ref>
Pyuria is a condition in which urine contains pus. Definition of pyuria is as follow:<ref>{{Cite journal| doi = 10.1016/j.ajic.2008.03.002| issn = 1527-3296| volume = 36| issue = 5| pages = 309–332| last1 = Horan| first1 = Teresa C.| last2 = Andrus| first2 = Mary| last3 = Dudeck| first3 = Margaret A.| title = CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting| journal = American Journal of Infection Control| date = 2008-06| pmid = 18538699}}</ref>
* Presence of 10 or more white cells/mm³ in a urine specimen
* Positive result on Gram’s stain of an unspun urine specimen
* Positive leukocyte esterase on urinary dipstick test
Pyuria might be a sign of a bacterial or non bacterial [[urinary tract infection]].


===Classification===
==Classification==
Pyuria may be classified based on the presence/absence of detectable infection as shown below:
Pyuria may be classified based on the presence of detectable infection as shown below:<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref><ref>{{Cite journal| doi = 10.1309/AJCP4KVGQZEG1YDM| issn = 1943-7722| volume = 137| issue = 5| pages = 778–784| last1 = Kwon| first1 = Jennie H.| last2 = Fausone| first2 = Maureen K.| last3 = Du| first3 = Hongyan| last4 = Robicsek| first4 = Ari| last5 = Peterson| first5 = Lance R.| title = Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients| journal = American Journal of Clinical Pathology| date = 2012-05| pmid = 22523217}}</ref>
*'''Sterile pyuria''': the persistent finding of white cells in the urine in the absence of bacteria, as determined by means of aerobic laboratory techniques (on a 5% sheep-blood agar plate and MacConkey agar plate)<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref>
{|
*'''Bacteriuria''': bacterial colony counts of more than 1000 colony-forming units (CFU) per milliliter in urine<ref>{{Cite journal| doi = 10.1309/AJCP4KVGQZEG1YDM| issn = 1943-7722| volume = 137| issue = 5| pages = 778–784| last1 = Kwon| first1 = Jennie H.| last2 = Fausone| first2 = Maureen K.| last3 = Du| first3 = Hongyan| last4 = Robicsek| first4 = Ari| last5 = Peterson| first5 = Lance R.| title = Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients| journal = American Journal of Clinical Pathology| date = 2012-05| pmid = 22523217}}</ref>== Causes==
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Classification of pyuria
===In Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
|-
*[[Colpitis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Group
*[[Cystitis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell count
*[[Epididymitis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteria
*[[tuberculosis|Genitourinary tuberculosis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
*[[Interstitial Nephritis]]
|-
*[[Neoplasm]]
! align="center" style="background:#DCDCDC;" + |Sterile pyuria
*[[Prostitis]]
| align="center" style="background:#F5F5F5;" + | ↑
*[[Pyelonephritis ]]
| align="center" style="background:#F5F5F5;" + | -
*[[Renal Carcinoma]]
| align="left" style="background:#F5F5F5;" + |Might have infectious or non-infectious etiologies.
*[[Renal papillary necrosis]]
|-
*[[Urethritis]]
! align="center" style="background:#DCDCDC;" + |Bacteriuria
*[[Vaginitis]]
| align="center" style="background:#F5F5F5;" + | ↑
*[[Vulvitis]]
| align="center" style="background:#F5F5F5;" + |Positive bacterial colony >1000 colony-forming units/ml
| align="left" style="background:#F5F5F5;" + |Mostly have infectious etiologies.
|}


===Causes by Organ System===
==Pyuria Differential Diagnosis==
'''Differentiating the diseases that can cause pyuria:'''<ref name="WiseLongo2015">{{cite journal|last1=Wise|first1=Gilbert J.|last2=Longo|first2=Dan L.|last3=Schlegel|first3=Peter N.|title=Sterile Pyuria|journal=New England Journal of Medicine|volume=372|issue=11|year=2015|pages=1048–1054|issn=0028-4793|doi=10.1056/NEJMra1410052}}</ref><ref name="Stamm1983">{{cite journal|last1=Stamm|first1=Walter E.|title=Measurement of pyuria and its relation to bacteriuria|journal=The American Journal of Medicine|volume=75|issue=1|year=1983|pages=53–58|issn=00029343|doi=10.1016/0002-9343(83)90073-6}}</ref><ref name="GroahPerez-Losada2015">{{cite journal|last1=Groah|first1=Suzanne|last2=Perez-Losada|first2=Marcos|last3=Caldovic|first3=Ljubica|last4=Ljungberg|first4=Inger|last5=Sprague|first5=Bruce|last6=Castro-Nallar|first6=Eduardo|last7=Shah|first7=Neel|last8=Hsieh|first8=Michael|last9=Pohl|first9=Hans|title=MP20-08 PYURIA AND ASYMPTOMATIC BACTERIURIA IS ASSOCIATED WITH NOVEL AND SPECIFIC URINE MICROBIOMES|journal=The Journal of Urology|volume=193|issue=4|year=2015|pages=e226|issn=00225347|doi=10.1016/j.juro.2015.02.980}}</ref><ref name="ShaikhShope2016">{{cite journal|last1=Shaikh|first1=N.|last2=Shope|first2=T. R.|last3=Hoberman|first3=A.|last4=Vigliotti|first4=A.|last5=Kurs-Lasky|first5=M.|last6=Martin|first6=J. M.|title=Association Between Uropathogen and Pyuria|journal=PEDIATRICS|volume=138|issue=1|year=2016|pages=e20160087–e20160087|issn=0031-4005|doi=10.1542/peds.2016-0087}}</ref>


 
'''To review differential diagnosis of sterile pyuria, click [[Sterile pyuria differential diagnosis|here]].'''
 
{|
{|style="width:80%; height:100px" border="1"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
! rowspan="5" |Category
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
! colspan="3" rowspan="5" |Disease
! colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="8" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para−clinical findings
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
! rowspan="16" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infectious diseases
! rowspan="14" align="center" style="background:#DCDCDC;" + |[[Urinary tract infection|UTI]]<ref name="pmid18061020">{{cite journal |vauthors=Neal DE |title=Complicated urinary tract infections |journal=Urol. Clin. North Am. |volume=35 |issue=1 |pages=13–22; v |date=February 2008 |pmid=18061020 |doi=10.1016/j.ucl.2007.09.010 |url=}}</ref>
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Bacteria|Bacterial]]
! align="center" style="background:#DCDCDC;" + |[[Asymptomatic bacteriuria]]<ref name="Nicolle2014">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic bacteriuria|journal=Current Opinion in Infectious Diseases|volume=27|issue=1|year=2014|pages=90–96|issn=0951-7375|doi=10.1097/QCO.0000000000000019}}</ref><ref name="Nicolle2015">{{cite journal|last1=Nicolle|first1=Lindsay E.|title=Asymptomatic Bacteriuria and Bacterial Interference|journal=Microbiology Spectrum|volume=3|issue=5|year=2015|issn=2165-0497|doi=10.1128/microbiolspec.UTI-0001-2012}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Urine|Urinalysis]]
| align="left" style="background:#F5F5F5;" + |
*Increased risk in [[pregnancy]]
*Must be treated prior to an invasive urologic procedure
|-
! align="center" style="background:#DCDCDC;" + |[[Cystitis]]<ref name="pmid28613784">{{cite journal |vauthors=Sabih A, Leslie SW |title= |journal= |volume= |issue= |pages= |date= |pmid=28613784 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite]] +
*[[Leukocyte esterase]] +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Urine|Urinalysis]]
| align="center" style="background:#F5F5F5;" + |NA
|-
! align="center" style="background:#DCDCDC;" + |[[Pyelonephritis]]<ref name="pmid28087935">{{cite journal |vauthors=Pietrucha-Dilanchian P, Hooton TM |title=Diagnosis, Treatment, and Prevention of Urinary Tract Infection |journal=Microbiol Spectr |volume=4 |issue=6 |pages= |date=December 2016 |pmid=28087935 |doi=10.1128/microbiolspec.UTI-0021-2015 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |WBC cast
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite]] +
*[[Leukocyte esterase]] +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |NA
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Virus|Viral]]<ref name="pmid23816478">{{cite journal |vauthors=Aboumohamed A, Flechner SM, Chiesa-Vottero A, Srinivas TR, Mossad SB |title=Disseminated adenoviral infection masquerading as lower urinary tract voiding dysfunction in a kidney transplant recipient |journal=Clin. Nephrol. |volume=82 |issue=5 |pages=332–6 |date=November 2014 |pmid=23816478 |doi=10.5414/CN107977 |url=}}</ref><ref name="pmid25667584">{{cite journal |vauthors=Santiago-Rodriguez TM, Ly M, Bonilla N, Pride DT |title=The human urine virome in association with urinary tract infections |journal=Front Microbiol |volume=6 |issue= |pages=14 |date=2015 |pmid=25667584 |pmc=4304238 |doi=10.3389/fmicb.2015.00014 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |PCR viral load
| align="left" style="background:#F5F5F5;" + |
* Increased risk in immunosuppressed [[Kidney transplantation|kidney transplant]] patients
*[[Cytomegalovirus infection|CMV]], [[Epstein Barr virus|EBV]], [[BK virus]], [[Adenoviridae|adenovirus]] might be seen
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Tuberculosis]]<ref name="pmid26123266">{{cite journal |vauthors=Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A |title=Urinary tuberculosis: a cohort of 79 adult cases |journal=Ren Fail |volume=37 |issue=7 |pages=1157–63 |date=August 2015 |pmid=26123266 |doi=10.3109/0886022X.2015.1057460 |url=}}</ref><ref name="pmid27865246">{{cite journal |vauthors=Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A |title=Renal tuberculosis presenting as acute pyelonephritis - A rarity |journal=Indian J Tuberc |volume=63 |issue=3 |pages=210–213 |date=July 2016 |pmid=27865246 |doi=10.1016/j.ijtb.2015.07.010 |url=}}</ref><ref name="pmid23303798">{{cite journal |vauthors=Daher Ede F, da Silva GB, Barros EJ |title=Renal tuberculosis in the modern era |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=1 |pages=54–64 |date=January 2013 |pmid=23303798 |pmc=3541747 |doi=10.4269/ajtmh.2013.12-0413 |url=}}</ref><ref name="pmid28784884">{{cite journal |vauthors=Czapka M, Shukla S, Slosar-Cheah M |title=Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=August 2017 |pmid=28784884 |doi=10.1136/bcr-2017-220440 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Positive mycobacterial urine culture
| align="left" style="background:#F5F5F5;" + |
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |[[Tuberculosis|Pulmonary TB]] on chest CT
| align="center" style="background:#F5F5F5;" + |Urine mycobacterial [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Past history of [[Tuberculosis|pulmonary TB]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fungal]]<ref name="pmid22025959">{{cite journal |vauthors=Kim J, Kim DS, Lee YS, Choi NG |title=Fungal urinary tract infection in burn patients with long-term foley catheterization |journal=Korean J Urol |volume=52 |issue=9 |pages=626–31 |date=September 2011 |pmid=22025959 |pmc=3198237 |doi=10.4111/kju.2011.52.9.626 |url=}}</ref><ref name="pmid11980593">{{cite journal |vauthors=Carvalho M, Guimarães CM, Mayer JR, Bordignon GP, Queiroz-Telles F |title=Hospital-associated funguria: analysis of risk factors, clinical presentation and outcome |journal=Braz J Infect Dis |volume=5 |issue=6 |pages=313–8 |date=December 2001 |pmid=11980593 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | + after several weeks of follow up
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Hydronephrosis]] on ultrasound
| align="center" style="background:#F5F5F5;" + |[[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
*Increased risk in patients with long−term foley [[Catheter|catheters]]
*[[Candidiasis|Candida]] as the most prevalent fungus
|-
! rowspan="7" align="center" style="background:#DCDCDC;" + |[[Sexually transmitted disease|STD]]
! align="center" style="background:#DCDCDC;" + |[[Chlamydia]]<ref name="MatthewsBonigal1990">{{cite journal|last1=Matthews|first1=R.S.|last2=Bonigal|first2=S.D.|last3=Wise|first3=R.|title=Sterile pyuria and Chlamydia trachomatis|journal=The Lancet|volume=336|issue=8711|year=1990|pages=385|issn=01406736|doi=10.1016/0140-6736(90)91936-5}}</ref><ref name="pmid8733337">{{cite journal |vauthors=Tayal SC, Pattman RS |title=Sterile pyuria: consider chlamydial infection |journal=Br J Clin Pract |volume=50 |issue=3 |pages=166–7 |date=1996 |pmid=8733337 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic [[Causes of pelvic pain|pelvic pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
*[[Adnexa|Adnexal]] motion [[tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Females might have concurrent chlamydial [[cervicitis]]
*Must be considered in young, sexually active males
|-
! align="center" style="background:#DCDCDC;" + |[[Gonococcus]]<ref name="pmid6799059">{{cite journal |vauthors=Clarke M, Maskell R |title=Gonorrhoea presenting as "sterile" pyuria |journal=Br Med J (Clin Res Ed) |volume=283 |issue=6305 |pages=1546 |date=December 1981 |pmid=6799059 |pmc=1507898 |doi= |url=}}</ref><ref name="pmid9389943">{{cite journal |vauthors=Jephcott AE |title=Microbiological diagnosis of gonorrhoea |journal=Genitourin Med |volume=73 |issue=4 |pages=245–52 |date=August 1997 |pmid=9389943 |pmc=1195851 |doi= |url=}}</ref><ref name="pmid26063863">{{cite journal |vauthors=Tomas ME, Getman D, Donskey CJ, Hecker MT |title=Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department |journal=J. Clin. Microbiol. |volume=53 |issue=8 |pages=2686–92 |date=August 2015 |pmid=26063863 |pmc=4508438 |doi=10.1128/JCM.00670-15 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Chronic [[Causes of pelvic pain|pelvic pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
*[[Adnexa|Adnexal]] motion [[tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
High false negative result
| align="left" style="background:#F5F5F5;" + |
*Intracellular gram−negative [[Diplococcus|diplococci]] on [[Gram staining|gram stain]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Nucleic acid amplification technique|Nucleic acid amplification]] testing (NAAT)
| align="left" style="background:#F5F5F5;" + |
*Females might have concurrent cervical [[Gonorrhea|gonococcal infection]]
*Must be considered in young, sexually active males
|-
! align="center" style="background:#DCDCDC;" + |[[Ureaplasma urealyticum]]<ref name="pmid18614434">{{cite journal |vauthors=Nassar FA, Abu-Elamreen FH, Shubair ME, Sharif FA |title=Detection of Chlamydia trachomatis and Mycoplasma hominis, genitalium and Ureaplasma urealyticum by polymerase chain reaction in patients with sterile pyuria |journal=Adv Med Sci |volume=53 |issue=1 |pages=80–6 |date=2008 |pmid=18614434 |doi=10.2478/v10039-008-0020-1 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*Gram stain −
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with complications of pregnancy
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
! align="center" style="background:#DCDCDC;" + |[[Herpes simplex virus]]<ref name="pmid16926356">{{cite journal |vauthors=Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ, Berman SM, Markowitz LE |title=Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States |journal=JAMA |volume=296 |issue=8 |pages=964–73 |date=August 2006 |pmid=16926356 |doi=10.1001/jama.296.8.964 |url=}}</ref>
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*Painful [[Genital ulcer|genital ulcers]]
*Tender local inguinal [[lymphadenopathy]]
*Acute [[urinary retention]]
*Loss of sacral sensation
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Viral culture +
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with extragenital complications, like [[Meningitis|aseptic meningitis]]
*High risk of recurrence 
|-
|-
|-bgcolor="LightSteelBlue"
! align="center" style="background:#DCDCDC;" + |[[Herpes zoster]]<ref name="ChenHsueh2002">{{cite journal|last1=Chen|first1=Po-Hong|last2=Hsueh|first2=Hsiu-Fang|last3=Hong|first3=Chang-Zern|title=Herpes zoster–associated voiding dysfunction: A retrospective study and literature review|journal=Archives of Physical Medicine and Rehabilitation|volume=83|issue=11|year=2002|pages=1624–1628|issn=00039993|doi=10.1053/apmr.2002.34602}}</ref>
| '''Dental'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
*[[Rash]]
*Acute [[neuritis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="left" style="background:#F5F5F5;" + |
*Associated with lumbosacral [[dermatome]] involvement
|-
|-
|-bgcolor="LightSteelBlue"
! align="center" style="background:#DCDCDC;" + |[[Human papillomavirus|HPV]]<ref name="pmid16819332">{{cite journal |vauthors=Guo CC, Fine SW, Epstein JI |title=Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases |journal=Am. J. Surg. Pathol. |volume=30 |issue=7 |pages=883–91 |date=July 2006 |pmid=16819332 |doi=10.1097/01.pas.0000213283.20166.5a |url=}}</ref>
| '''Dermatologic'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Genital warts|Genital wart]]
*[[Cancer|Cancerous]] lesions of the [[Sex organ|genitalia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Polymerase chain reaction|PCR]]
| align="center" style="background:#F5F5F5;" + |
*Associated with [[Bladder cancer|bladder carcinoma]]
*Prevented by [[HPV Vaccine|HPV vaccination]]
|-
|-
|-bgcolor="LightSteelBlue"
! align="center" style="background:#DCDCDC;" + |[[Human Immunodeficiency Virus (HIV)|HIV]]<ref name="pmid20338962">{{cite journal |vauthors=Parkhie SM, Fine DM, Lucas GM, Atta MG |title=Characteristics of patients with HIV and biopsy-proven acute interstitial nephritis |journal=Clin J Am Soc Nephrol |volume=5 |issue=5 |pages=798–804 |date=May 2010 |pmid=20338962 |pmc=2863972 |doi=10.2215/CJN.08211109 |url=}}</ref>
| '''Drug Side Effect'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| [[Thalidomide]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*Painful mucocutaneous ulceration
*[[Lymphadenopathy]]
*[[Meningitis|Aseptic meningitis]] 
*[[Diarrhea]]
*[[Weight loss]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Combination antigen/antibody immunoassay + PCR [[Human Immunodeficiency Virus (HIV)|HIV]] viral load test
| align="center" style="background:#F5F5F5;" + |
*Might be gone to chronic [[Human Immunodeficiency Virus (HIV)|HIV]] infection with or without evidence of the [[Immunodeficiency|acquired immunodeficiency syndrome]] ([[HIV AIDS|AIDS]])
*Associated with acute [[interstitial nephritis]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Prostatitis]]<ref name="pmid23519458">{{cite journal |vauthors=Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, Schagdarsurengin U, Dansranjavin T, Schuppe HC, Weidner W |title=Bacterial prostatitis |journal=World J Urol |volume=31 |issue=4 |pages=711–6 |date=August 2013 |pmid=23519458 |doi=10.1007/s00345-013-1055-x |url=}}</ref>
| '''Ear Nose Throat'''
| align="center" style="background:#F5F5F5;" + | Pelvic or perineal pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Dribbling of urine
*Firm and tender [[prostate]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |
*Cloudy urine
*Positive [[Gram staining|gram stain]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |
*Increased risk of [[bacteremia]], prostatic abscess, and metastatic infection
*Might be acute or chronic infection
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="3" align="center" style="background:#DCDCDC;" + |[[Balanitis]]<ref name="pmid25596845">{{cite journal |vauthors=Hsu CY, Lin CL, Kao CH |title=Balanitis is a risk factor for herpes zoster |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=34 |issue=5 |pages=985–90 |date=May 2015 |pmid=25596845 |doi=10.1007/s10096-015-2314-0 |url=}}</ref>
| '''Endocrine'''
| align="center" style="background:#F5F5F5;" + |Penile pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Pruritus]]
*Erythematous lesions on the glans and/or the foreskin
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |
*Associated with [[reactive arthritis]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="3" align="center" style="background:#DCDCDC;" + |[[Appendicitis]]<ref name="pmid11343547">{{cite journal |vauthors=Lee SL, Walsh AJ, Ho HS |title=Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis |journal=Arch Surg |volume=136 |issue=5 |pages=556–62 |date=May 2001 |pmid=11343547 |doi= |url=}}</ref><ref name="pmid25345259">{{cite journal |vauthors=Mahattanobon S, Samphao S, Pruekprasert P |title=Clinical features of complicated acute appendicitis |journal=J Med Assoc Thai |volume=97 |issue=8 |pages=835–40 |date=August 2014 |pmid=25345259 |doi= |url=}}</ref>
| '''Environmental'''
| align="center" style="background:#F5F5F5;" + |Right lower abdominal pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*Right lower [[Tenderness (medicine)|abdominal tenderness]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*Urine [[specific gravity]] >1.020
| align="center" style="background:#F5F5F5;" + |Enlarged appendiceal diameter on CT scan or ultrasound
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |NA
|-
|-
|-bgcolor="LightSteelBlue"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
| '''Gastroenterologic'''
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
|bgcolor="Beige"| No underlying causes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
|-
|-bgcolor="LightSteelBlue"
! rowspan="19" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Non−infectious diseases
| '''Genetic'''
! rowspan="7" align="center" style="background:#DCDCDC;" + |[[Urinary tract|Urinary tract disorders]]
|bgcolor="Beige"| No underlying causes
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary catheter|Urinary catheterization]]<ref name="ForsterHaslam2017">{{cite journal|last1=Forster|first1=C.S.|last2=Haslam|first2=D.B.|last3=Jackson|first3=E.|last4=Goldstein|first4=S.L.|title=Utility of a routine urinalysis in children who require clean intermittent catheterization|journal=Journal of Pediatric Urology|volume=13|issue=5|year=2017|pages=488.e1–488.e5|issn=14775131|doi=10.1016/j.jpurol.2017.01.016}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*[[Leukocytosis]] ±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Leukocyte esterase]] ±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="left" style="background:#F5F5F5;" + |
*Predicting [[Urinary tract infection|UTI]] in children who required clean intermittent [[Catheter|catheterization]] by routine [[Urine|urinalysis]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary stone|Urinary tract stone]]<ref name="pmid23283137">{{cite journal |vauthors=Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z |title=Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States |journal=Kidney Int. |volume=83 |issue=3 |pages=479–86 |date=March 2013 |pmid=23283137 |pmc=3587650 |doi=10.1038/ki.2012.419 |url=}}</ref><ref name="pmid26349951">{{cite journal |vauthors=Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE, Lieske JC, Rule AD |title=Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1356–65 |date=October 2015 |pmid=26349951 |pmc=4593754 |doi=10.1016/j.mayocp.2015.07.016 |url=}}</ref>
| '''Hematologic'''
| align="center" style="background:#F5F5F5;" + |Colicky pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Visible stone on [[Computed tomography|CT scan]]
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |
*Might cause renal obstruction
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Urinary tract neoplasm]]<ref name="pmid23664207">{{cite journal |vauthors=Azuma T, Nagase Y, Oshi M |title=Pyuria predicts poor prognosis in patients with non-muscle-invasive bladder cancer |journal=Clin Genitourin Cancer |volume=11 |issue=3 |pages=331–6 |date=September 2013 |pmid=23664207 |doi=10.1016/j.clgc.2013.04.002 |url=}}</ref>
| '''Iatrogenic'''
| align="center" style="background:#F5F5F5;" + | +
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Visible [[tumor]] on [[Computed tomography|CT scan]]
| align="center" style="background:#F5F5F5;" + |[[Cystoscopy]]  + [[biopsy]]
| align="center" style="background:#F5F5F5;" + |
*Associated with non−muscle−invasive [[bladder cancer]] (NMIBC)
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fistulae|Urinary fistula]]<ref name="pmid25565512">{{cite journal |vauthors=Hampton BS, Kay A, Pilzek A |title=Urinary fistula and incontinence |journal=Semin. Reprod. Med. |volume=33 |issue=1 |pages=47–52 |date=January 2015 |pmid=25565512 |doi=10.1055/s-0034-1395279 |url=}}</ref>
| '''Infectious Disease'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Urinary incontinence]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |[[Fistula]] on [[cystoscopy]] or [[IVP]]
| align="center" style="background:#F5F5F5;" + |Physical examination
| align="center" style="background:#F5F5F5;" + |
*History of recent surgery
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Interstitial cystitis]]<ref name="pmid22177158">{{cite journal |vauthors=Konkle KS, Berry SH, Elliott MN, Hilton L, Suttorp MJ, Clauw DJ, Clemens JQ |title=Comparison of an interstitial cystitis/bladder pain syndrome clinical cohort with symptomatic community women from the RAND Interstitial Cystitis Epidemiology study |journal=J. Urol. |volume=187 |issue=2 |pages=508–12 |date=February 2012 |pmid=22177158 |pmc=3894739 |doi=10.1016/j.juro.2011.10.040 |url=}}</ref>
| '''Musculoskeletal/Orthopedic'''
| align="center" style="background:#F5F5F5;" + |Chronic bladder pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Tenderness (medicine)|Abdominal tenderness]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |Associated with other chronic pain syndromes
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Vesicoureteral reflux]]<ref name="pmid24012582">{{cite journal |vauthors=Hubert KC, Kokorowski PJ, Huang L, Prasad MM, Rosoklija I, Retik AB, Nelson CP |title=New contralateral vesicoureteral reflux after unilateral ureteral reimplantation: predictive factors and clinical outcomes |journal=J. Urol. |volume=191 |issue=2 |pages=451–7 |date=February 2014 |pmid=24012582 |pmc=4123205 |doi=10.1016/j.juro.2013.08.076 |url=}}</ref>
| '''Neurologic'''
| align="center" style="background:#F5F5F5;" + | +
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hydronephrosis]]<ref name="pmid26194290">{{cite journal |vauthors=Dancz CE, Walker D, Thomas D, Özel B |title=Prevalence of Hydronephrosis in Women With Advanced Pelvic Organ Prolapse |journal=Urology |volume=86 |issue=2 |pages=250–4 |date=August 2015 |pmid=26194290 |doi=10.1016/j.urology.2015.05.005 |url=}}</ref>
| '''Nutritional/Metabolic'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
|-
|-bgcolor="LightSteelBlue"
! rowspan="5" align="center" style="background:#DCDCDC;" + |[[Renal disease|Renal diseases]]
| '''Obstetric/Gynecologic'''
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Polycystic kidney disease|Polycystic kidney disease]]<ref name="pmid25186187">{{cite journal |vauthors=Paul BM, Vanden Heuvel GB |title=Kidney: polycystic kidney disease |journal=Wiley Interdiscip Rev Dev Biol |volume=3 |issue=6 |pages=465–87 |date=2014 |pmid=25186187 |pmc=4423807 |doi=10.1002/wdev.152 |url=}}</ref>
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | Flank or [[back]] [[pain]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*[[Polyuria]]
*[[Nocturia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hypocitraturia]]
*[[Hyperuricemia]]
*[[Hyperoxaluria]]
*[[Urine|Low urine pH]]
*[[Microscopic hematuria]]
*[[Proteinuria]] <1 g/day
| align="center" style="background:#F5F5F5;" + |Multiple cysts on [[ultrasound]]
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal vein thrombosis]]<ref name="pmid18158362">{{cite journal |vauthors=Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, Navis G, van der Meer J |title=High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study |journal=Circulation |volume=117 |issue=2 |pages=224–30 |date=January 2008 |pmid=18158362 |doi=10.1161/CIRCULATIONAHA.107.716951 |url=}}</ref>
| '''Oncologic'''
| align="center" style="background:#F5F5F5;" + |Flank pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
*Signs of [[Acute kidney injury|acute renal failure]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |[[Thrombosis]] on CT scan
| align="center" style="background:#F5F5F5;" + |Renal [[venography]]
| align="center" style="background:#F5F5F5;" + |
*Increased risk in [[nephrotic syndrome]] and [[Thrombophilia|hypercoagulable state]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Interstitial nephritis]]<ref name="pmid25079860">{{cite journal |vauthors=Raghavan R, Eknoyan G |title=Acute interstitial nephritis - a reappraisal and update |journal=Clin. Nephrol. |volume=82 |issue=3 |pages=149–62 |date=September 2014 |pmid=25079860 |pmc=4928030 |doi= |url=}}</ref>
| '''Ophthalmologic'''
| align="center" style="background:#F5F5F5;" + |[[Low back pain|Lower back pain]]
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Weight loss]]
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |
*[[Eosinophilia]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Isosthenuria]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Eosinophiluria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[Urine|urinalysis]]
| align="center" style="background:#F5F5F5;" + |
*Associated with [[medications]], particularly [[Antibiotic|antibiotics]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[IgA nephropathy]]<ref name="pmid24861083">{{cite journal |vauthors=Roberts IS |title=Pathology of IgA nephropathy |journal=Nat Rev Nephrol |volume=10 |issue=8 |pages=445–54 |date=August 2014 |pmid=24861083 |doi=10.1038/nrneph.2014.92 |url=}}</ref>
| '''Overdose/Toxicity'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Biopsy]]
| align="center" style="background:#F5F5F5;" + |
*History of [[Acute viral nasopharyngitis (common cold)|upper respiratory infection]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Kidney transplantation|Renal transplant rejection]]<ref name="pmid29789350">{{cite journal |vauthors=Martin-Moreno PL, Tripathi S, Chandraker A |title=Regulatory T Cells and Kidney Transplantation |journal=Clin J Am Soc Nephrol |volume= |issue= |pages= |date=May 2018 |pmid=29789350 |doi=10.2215/CJN.01750218 |url=}}</ref>
| '''Psychiatric'''
| align="center" style="background:#F5F5F5;" + |Flank pain
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Increased graft size on ultrasound
| align="center" style="background:#F5F5F5;" + |Renal allograft [[biopsy]]
| align="center" style="background:#F5F5F5;" + |
*Acute rise in the [[Creatinine|serum creatinine]]
*History of [[Organ transplant|transplant]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
| '''Pulmonary'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
|bgcolor="Beige"| No underlying causes
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
|-
|-bgcolor="LightSteelBlue"
! rowspan="4" align="center" style="background:#DCDCDC;" + |[[Systemic disease]]
| '''Renal/Electrolyte'''
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diabetic nephropathy]]<ref name="pmid24983394">{{cite journal |vauthors=Bjornstad P, Cherney D, Maahs DM |title=Early diabetic nephropathy in type 1 diabetes: new insights |journal=Curr Opin Endocrinol Diabetes Obes |volume=21 |issue=4 |pages=279–86 |date=August 2014 |pmid=24983394 |pmc=4138314 |doi=10.1097/MED.0000000000000074 |url=}}</ref>
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Might be asymptomatic
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Albuminuria]]
*[[Microscopic hematuria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + laboratory tests
| align="center" style="background:#F5F5F5;" + |
*History of [[retinopathy]] and [[neuropathy]]
*Slow and progressive [[Renal insufficiency|renal failure]]
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Lupus nephritis]]<ref name="SchwartzGoilav2014">{{cite journal|last1=Schwartz|first1=Noa|last2=Goilav|first2=Beatrice|last3=Putterman|first3=Chaim|title=The pathogenesis, diagnosis and treatment of lupus nephritis|journal=Current Opinion in Rheumatology|volume=26|issue=5|year=2014|pages=502–509|issn=1040-8711|doi=10.1097/BOR.0000000000000089}}</ref>
| '''Rheumatology/Immunology/Allergy'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Oral ulcer]]
*[[Arthritis]]
| align="center" style="background:#F5F5F5;" + |
*[[Pancytopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hematuria]]
*[[Proteinuria]]
| align="center" style="background:#F5F5F5;" + |Enlarged kidneys on CT scan
| align="center" style="background:#F5F5F5;" + |[[Biopsy]]
| align="center" style="background:#F5F5F5;" + |
* Abnormal results of specific serologic tests
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Sjögren's syndrome|Sjögren’s syndrome]]<ref name="de PaivaRocha2015">{{cite journal|last1=de Paiva|first1=Cintia S.|last2=Rocha|first2=Eduardo Melani|title=Sjögren syndrome|journal=Current Opinion in Ophthalmology|volume=26|issue=6|year=2015|pages=517–525|issn=1040-8738|doi=10.1097/ICU.0000000000000208}}</ref>
| '''Sexual'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Dryness of all [[mucous membranes]] 
| align="center" style="background:#F5F5F5;" + |
*[[Pancytopenia]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Hematuria]]
*[[Proteinuria]]
| align="center" style="background:#F5F5F5;" + |Abnormal diffuse [[Adipose tissue|fat tissue]] deposition and diffuse punctate [[calcification]] on parotid gland CT scan
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + laboratory tests
| align="center" style="background:#F5F5F5;" + |
* Abnormal results of specific serologic tests
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Kawasaki's disease]]<ref name="pmid14745638">{{cite journal |vauthors=Wirojanan J, Sopontammarak S, Vachvanichsanong P |title=Sterile pyuria in Kawasaki disease |journal=Pediatr. Nephrol. |volume=19 |issue=3 |pages=363 |date=March 2004 |pmid=14745638 |doi=10.1007/s00467-003-1394-8 |url=}}</ref>
| '''Trauma'''
| align="center" style="background:#F5F5F5;" + |−
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Rash]]
*[[Irritability]]
*[[Desquamation]] of skin and mucous membranes
| align="center" style="background:#F5F5F5;" + |
*[[Normocytic normochromic anemia]]
*[[Thrombocytosis]]
*[[Leukocytosis]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyponatremia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Vessels involvement on [[Angiogram|angiography]]
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |Associated with multiple organ involvement including [[heart]]
|-
|-
|-bgcolor="LightSteelBlue"
! rowspan="2" align="center" style="background:#DCDCDC;" + |[[Medication]]/[[toxin]]
| '''Urologic'''
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Analgesic nephropathy]]<ref name="pmid28341428">{{cite journal |vauthors=Henderickx MMEL, Brits T, De Baets K, Seghers M, Maes P, Trouet D, De Wachter S, De Win G |title=Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis |journal=J Pediatr Urol |volume=13 |issue=3 |pages=250–256 |date=June 2017 |pmid=28341428 |doi=10.1016/j.jpurol.2017.01.020 |url=}}</ref>
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |Flank pain
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |
*Chronic [[headache]]
*[[Low back pain]]
| align="center" style="background:#F5F5F5;" + |
*[[Eosinophilia]]
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Isosthenuria]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Proteinuria]]
*[[Eosinophiluria]]
| align="center" style="background:#F5F5F5;" + |Renal impairment on CT scan
| align="center" style="background:#F5F5F5;" + |Imaging
| align="center" style="background:#F5F5F5;" + |
*Characterized by [[Renal papillary necrosis|papillary necrosis]] and chronic [[interstitial nephritis]]
*Caused by the chronic use of [[analgesic]] agents
|-
|-
|-bgcolor="LightSteelBlue"
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Contrast induced nephropathy|Contrast−induced nephropathy]]<ref name="PatschanBuschmann2018">{{cite journal|last1=Patschan|first1=D.|last2=Buschmann|first2=I.|last3=Ritter|first3=O.|title=Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures|journal=International Journal of Nephrology|volume=2018|year=2018|pages=1–8|issn=2090-214X|doi=10.1155/2018/5727309}}</ref>
| '''Miscellaneous'''
| align="center" style="background:#F5F5F5;" + | +
|bgcolor="Beige"| No underlying causes
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Oliguria]]
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |
*[[Hyperkalemia]]
*[[Acidosis]]
*[[Hyperphosphatemia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
* [[Fractional sodium excretion]] (FENa) <1%
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + exclusion of other causes of AKI
| align="center" style="background:#F5F5F5;" + |
*Associated with reversible type of [[acute kidney injury]]
*Acute increase in the [[Creatinine|serum creatinine]]
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
! colspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |N/V
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urgency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gross hematuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other PE
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Electrolytes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cast
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Culture
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other UA findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard for diagnosis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|}
|}


==Sterile Pyuria==
== Treatment ==
===Definition===
*Sterile pyuria is defined as the persistent finding of white cells in the urine in the absence of detectable bacteria, as determined by means of aerobic laboratory techniques (on a 5% sheep-blood agar plate and MacConkey agar plate)<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref>
*Note that sterile pyuria may still be caused by an infectious agent, but the inability to detect the agent on regular urine gram-stain and culture is diagnostic of sterile pyuria.
===Causes===
Pyuria may have either an infectious or a non-infectious etiology:<ref>{{Cite journal| issn = 0098-8243| volume = 26| issue = 3| pages = 150–152| last = Dieter| first = R. S.| title = Sterile pyuria: a differential diagnosis| journal = Comprehensive Therapy| date = 2000| pmid = 10984817}}</ref>
*'''Infectious etiologies'''
:* Gynecologic infection
:* Urethritis due to chlamydia, Neisseria gonorrhoeae, mycoplasma, or ureaplasma
:* Prostatitis
:* Balanitis
:* Appendicitis
:* Viral infection of the lower genitourinary tract
:* Genitourinary tuberculosis
:* Fungal infection
:* Parasitic disease such as trichomoniasis or schistosomiasis
*'''Non-infectious etiologies'''
:* Current use of antibiotics
:* Recently treated urinary tract infection (within past 2 weeks)
:* Presence or recent use of a urinary catheter
:* Recent cystoscopy or urologic endoscopy
:* Urinary tract stones
:* Foreign body such as surgical mesh in the urethra or a retained stent
:* Urinary tract neoplasm
:* Pelvic irradiation
:* Urinary fistula
:* Polycystic kidney
:* Rejection of a renal transplant
:* Renal-vein thrombosis
:* Interstitial nephritis or analgesic nephropathy
:* Papillary necrosis
:* Interstitial cystitis
:* Inflammatory disease such as systemic lupus erythematosus or Kawasaki’s disease===Antimicrobial regimen===
===Treatment===
*'''Sterile pyuria'''
*'''Sterile pyuria'''
:*. '''Pathogen-directed antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref>
:*'''Pathogen-directed antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref>
::* '''Renal Tuberculosis'''
::* '''Renal Tuberculosis'''
:::* Preferred regimen: ([[Isoniazid]] 300 mg PO qd for 2 months {{and}} [[Rifampicin]] 450-600 mg qd for 2 months {{and}} [[Ethambutol]] 15-25 mg/kg PO qd for 2 months {{and}} [[Pyrazinamide]] 1500 mg for 2 months) {{then}} ([[Isoniazid]] 300 mg PO qd for 4-6 months {{and}} [[Rifampicin]] 450-600 mg qd for 4-6 months)  
:::* Preferred regimen: ([[Isoniazid]] 300 mg PO qd for 2 months {{and}} [[Rifampicin]] 450-600 mg qd for 2 months {{and}} [[Ethambutol]] 15-25 mg/kg PO qd for 2 months {{and}} [[Pyrazinamide]] 1500 mg for 2 months) {{then}} ([[Isoniazid]] 300 mg PO qd for 4-6 months {{and}} [[Rifampicin]] 450-600 mg qd for 4-6 months)  
Line 203: Line 1,039:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Infectious disease]]
[[Category:Urine tests]]
[[Category:Urine tests]]
[[Category:Primary care]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Urology]]
[[Category:Urology]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Infectious Disease Project]]
[[Category:Infectious Disease Project]]
 
[[Category:Up-To-Date]]
{{WH}}
{{WS}}

Latest revision as of 18:30, 24 September 2020



Resident
Survival
Guide

Pyuria

Home

Overview

Definition

Classification

Pyuria Differential Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

To view a comprehensive algorithm of common findings of urine composition and urine output, click here

Overview

Pyuria is a condition in which urine contains 10 or more white cells/mm³. Gram stain and leukocyte esterase might be positive. Pyuria might be a sign of a bacterial or non bacterial urinary tract infection, genitourinary abnormalities, inflammatory disorders, and systemic diseases. Pyuria may be classified into sterile pyuria or bacteriuria. Treatment is not required for pyuria. However, underlying diseases must be treated.

Definition

Pyuria is a condition in which urine contains pus. Definition of pyuria is as follow:[1]

  • Presence of 10 or more white cells/mm³ in a urine specimen
  • Positive result on Gram’s stain of an unspun urine specimen
  • Positive leukocyte esterase on urinary dipstick test

Pyuria might be a sign of a bacterial or non bacterial urinary tract infection.

Classification

Pyuria may be classified based on the presence of detectable infection as shown below:[2][3]

Classification of pyuria
Group Cell count Bacteria Etiology
Sterile pyuria - Might have infectious or non-infectious etiologies.
Bacteriuria Positive bacterial colony >1000 colony-forming units/ml Mostly have infectious etiologies.

Pyuria Differential Diagnosis

Differentiating the diseases that can cause pyuria:[4][5][6][7]

To review differential diagnosis of sterile pyuria, click here.

Category Disease Clinical manifestations Para−clinical findings Gold standard for diagnosis Associated findings
Symptoms Physical examination
Lab Findings Imaging
Pain Fever N/V Urinary symptoms BP Other CBC Electrolytes Urinalysis
Dysuria Frequency Urgency Gross hematuria Cell Cast Bacteriuria Culture Other
Infectious diseases UTI[8] Bacterial Asymptomatic bacteriuria[9][10] Nl Nl Nl ± + NA NA Urinalysis
  • Increased risk in pregnancy
  • Must be treated prior to an invasive urologic procedure
Cystitis[11] + + + Nl Nl Nl + + + NA Urinalysis NA
Pyelonephritis[12] + + + + + + Nl Nl + WBC cast + + NA Clinical manifestation + urinalysis NA
Viral[13][14] + + + + ± Nl Nl Nl + NA NA PCR viral load
Tuberculosis[15][16][17][18] ± + + + + Nl Nl Nl ± Positive mycobacterial urine culture Pulmonary TB on chest CT Urine mycobacterial PCR
Fungal[19][20] + + Nl Nl Nl ± + after several weeks of follow up NA Hydronephrosis on ultrasound Urine culture
  • Increased risk in patients with long−term foley catheters
  • Candida as the most prevalent fungus
STD Chlamydia[21][22] Chronic pelvic pain + + Nl Nl Nl + + NA NA PCR
  • Females might have concurrent chlamydial cervicitis
  • Must be considered in young, sexually active males
Gonococcus[23][24][25] Chronic pelvic pain + + Nl Nl Nl + +

High false negative result

NA Nucleic acid amplification testing (NAAT)
  • Females might have concurrent cervical gonococcal infection
  • Must be considered in young, sexually active males
Ureaplasma urealyticum[26] + + Nl Nl Nl +
  • Gram stain −
NA PCR
  • Associated with complications of pregnancy
Herpes simplex virus[27] + + + + Nl Nl Nl + Viral culture + NA NA Clinical manifestation + PCR
  • Associated with extragenital complications, like aseptic meningitis
  • High risk of recurrence 
Herpes zoster[28] + + Nl Nl Nl + NA Clinical manifestation + PCR
  • Associated with lumbosacral dermatome involvement
HPV[29] + Nl Nl Nl + NA NA Clinical manifestation + PCR
HIV[30] + + + + Nl Nl + NA NA Combination antigen/antibody immunoassay + PCR HIV viral load test
Prostatitis[31]  Pelvic or perineal pain + + + + + Nl or ↑
  • Dribbling of urine
  • Firm and tender prostate
Nl + ± + NA Clinical manifestation + urinalysis
  • Increased risk of bacteremia, prostatic abscess, and metastatic infection
  • Might be acute or chronic infection
Balanitis[32] Penile pain + + + + Nl
  • Pruritus
  • Erythematous lesions on the glans and/or the foreskin
Nl Nl + ± NA NA Clinical manifestation
Appendicitis[33][34] Right lower abdominal pain + + + + + Nl Nl + Enlarged appendiceal diameter on CT scan or ultrasound Clinical manifestation NA
Category Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Imaging Gold standard for diagnosis Associated findings
Non−infectious diseases Urinary tract disorders Urinary catheterization[35] + + Nl Nl + + + Clinical manifestation + urinalysis
Urinary tract stone[36][37] Colicky pain + + + + ± Nl Nl Nl + Visible stone on CT scan Clinical manifestation
  • Might cause renal obstruction
Urinary tract neoplasm[38] + + + + + + + Nl Nl Nl + Visible tumor on CT scan Cystoscopy  + biopsy
Urinary fistula[39] + + Nl Nl Nl + NA Fistula on cystoscopy or IVP Physical examination
  • History of recent surgery
Interstitial cystitis[40] Chronic bladder pain + + + Nl Nl Nl + NA NA Clinical manifestation Associated with other chronic pain syndromes
Vesicoureteral reflux[41] + + Nl Nl Nl + Imaging
Hydronephrosis[42] + Nl Nl Nl + Imaging
Renal diseases Polycystic kidney disease[43]  Flank or back pain + + + Nl Nl + Multiple cysts on ultrasound Imaging
Renal vein thrombosis[44] Flank pain + + + + + + Nl or ↑ + Thrombosis on CT scan Renal venography
Interstitial nephritis[45] Lower back pain + + Nl or ↑ + + Nl Clinical manifestation + urinalysis
IgA nephropathy[46] + Nl or ↑
  • Might be asymptomatic
Nl Nl + Nl Biopsy
Renal transplant rejection[47] Flank pain + + + + + + Nl + + Increased graft size on ultrasound Renal allograft biopsy
Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Imaging Gold standard for diagnosis Associated findings
Systemic disease Diabetic nephropathy[48] ±
  • Might be asymptomatic
Nl Nl + Nl Clinical manifestation + laboratory tests
Lupus nephritis[49] + + + + + Nl + + Enlarged kidneys on CT scan Biopsy
  •  Abnormal results of specific serologic tests
Sjögren’s syndrome[50] + + Nl + + Abnormal diffuse fat tissue deposition and diffuse punctate calcification on parotid gland CT scan Clinical manifestation + laboratory tests
  •  Abnormal results of specific serologic tests
Kawasaki's disease[51] + + + + Nl + Vessels involvement on angiography Clinical manifestation Associated with multiple organ involvement including heart
Medication/toxin Analgesic nephropathy[52] Flank pain + + + + + + + + Renal impairment on CT scan Imaging
Contrast−induced nephropathy[53] + + + Nl Nl + + NA Clinical manifestation + exclusion of other causes of AKI
Category Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Imaging Gold standard for diagnosis Associated findings

Treatment

  • Sterile pyuria
  • Pathogen-directed antimicrobial therapy[54]
  • Renal Tuberculosis
  • Gonorrhea
  • Chlamydia
  • Mycoplasma and Ureaplasma
  • Genital herpes
  • Trichomoniasis
Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient.
  • Fungal infections[55]
  • Preferred regimen, Candida albicans: Fluconazole 100 mg PO qd for 2-5 days
  • Preferred regimen, non-albicans Candida: Amphotericin B 0.1 mg/kg/day IV for 2-5 days OR Amphotericin B bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days
  • Schistosomiasis
  • Preferred regimen: Praziquantel 20 mg/kg PO bid for 1–2 days

References

  1. Horan, Teresa C.; Andrus, Mary; Dudeck, Margaret A. (2008-06). "CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting". American Journal of Infection Control. 36 (5): 309–332. doi:10.1016/j.ajic.2008.03.002. ISSN 1527-3296. PMID 18538699. Check date values in: |date= (help)
  2. Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
  3. Kwon, Jennie H.; Fausone, Maureen K.; Du, Hongyan; Robicsek, Ari; Peterson, Lance R. (2012-05). "Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients". American Journal of Clinical Pathology. 137 (5): 778–784. doi:10.1309/AJCP4KVGQZEG1YDM. ISSN 1943-7722. PMID 22523217. Check date values in: |date= (help)
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