pyuria (leukocyturia)
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Introduction
Pus in the urine. Defined as 10 or more leukocytes/mL, determined from fresh unspun urine by microscopy using a hemocytometer chamber.
Also: > 3-5 leukocytes/hpf
older women with urinary tract infection: 180 leukocytes/HPF
older women with asymptomatic bacteriuria: < 60 leukocytes/HPF
Etiology
- urinary tract infection
- sterile pyuria:[5]
- renal calculi
- bladder tumors
- inflammatory disorders
- allergic reactions
- acute urethral syndrome or dysuria-pyuria syndrome in women
- common in patients with indwelling catheter (foley)
- cannot be used to indicate infection
Epidemiology
Laboratory
- pyuria alone inadequate for predicting bacteriuria[6]
- urine WBC count > 25 cell/hpf is optimal cutoff to detect bacteriuria[6]
- testing for sexually-transmitted disease as indicated
- sterile pyuria
Radiology
Differential diagnosis
- increased numbers of leukocytes (> 20/hpf) are found in most diseases of the urinary tract
- > 30/hpf suggests acute infection
- repeated sterile cultures suggest tuberculosis or nephritis
- gross pyuria suggest rupture of urinary tract abscess
- leukocyte casts suggest renal origin
- sterile pyuria
Management
- specific evaluation for sexually transmitted infection[5]
- evaluation for tuberculosis[5]
Notes
- leukocytes are rapidly lysed in hypotonic or alkaline urine; 50% lyse after 2-3 hours of standing at room temperature.
More general terms
Additional terms
References
- ↑ Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 438
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 544
- ↑ 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Dieter RS. Sterile pyuria: a differential diagnosis. Compr Ther. 2000 Fall;26(3):150-2. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10984817
- ↑ 5.0 5.1 5.2 5.3 5.4 Wise GJ, Schlegel PN Sterile Pyuria. N Engl J Med 2015; 372:1048-1054 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25760357 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1410052
- ↑ 6.0 6.1 6.2 Cheng B et al. Correlation of pyuria and bacteriuria in acute care. Am J Med 2022 Sep; 135:e353. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35580716 https://www.amjmed.com/article/S0002-9343(22)00350-3/fulltext
- ↑ Bilsen MP et al. Current pyuria cutoffs promote inappropriate urinary tract infection diagnosis in older women. Clin Infect Dis 2023 Jun 16; 76:2070 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36806580 PMCID: PMC10273372 Free PMC article https://academic.oup.com/cid/article/76/12/2070/7048393
- ↑ 8.0 8.1 Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019 Oct;16(10):573-598 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31548730 Review.
- ↑ 9.0 9.1 Jacob JT, Nguyen TM, Ray SM. Male genital tuberculosis. Lancet Infect Dis. 2008 May;8(5):335-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18471778