Pyuria resident survival guide

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

Overview

Pyuria is a urinary condition characterized by a high number of white blood cells in the urine. It is generally characterized as the presence of 10 or more white blood cells per cubic millimeter in a sample of urine, 3 or more white cells per high-power field of unspun urine, a positive result on Gram's staining of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase. Pyuria most commonly occurs in urinary tract infections (UTI) and/or sepsis. Other causes include sterile pyuria, STDs, pneumonia, interstitial cystitis, kidney stones, pelvic infections and urinary fistulas. Long-term usage of some medications, including aspirin, diuretics, nitrofurantoin, PPIs and NSAIDs, induces pyuria. There may be visible changes in the urine, which may appear cloudy or thick or look like pus.

Causes

Life Threatening Causes

Life-threatening causes of pyuria include

• Sepsis

Common Causes

• Sterile Pyuria
  • STDs such as chlamydia, gonorrhea, genital herpes, human papillomavirus infection, syphilis and HIV
  • Viral Infections such as adenovirus, BK polyomavirus, and cytomegalovirus
  • Genitourinary tuberculosis
  • Fungal infection such as Candida albicans
  • Parasitic infection such as Trichomonas vaginalis
• Interstitial cystitis
• Painful bladder syndrome
• Pelvic infections
• Intra-abdominal infections
• Radiation cystitis
• Pneumonia
• Foreign bodies in the urinary tract
• Transvaginal mesh
• Urinary fistulas
• Intrinsic renal diseases
• Renal transplant rejection
• Polycystic kidney disease
• Kidney stones
• Autoimmune diseases, such as Kawasaki disease

Diagnosis

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Patient with Pyuria

Patient with pelvic pain, urinary symptoms and urethral symptoms

Patient with fever, systemic symptoms, urinary symptoms, abdominal or pelvic pain

Evaluate for: STDs, Prostatitis, PID

Reassess for bacterial infection by means of aerobic and anaerobic culture

If not detected, consider: Urinary stone, Foreign body, Interstitial cystitis, Bladder tumor, Schistosomiasis

No bacteria detected

Evaluate for: Tuberculosis If patient is a immigrant from tuberculosis endemic country Fungal infection If patient is immunocompromised, check for candida, aspergillus or cryptococcus infection

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

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Don'ts

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References

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