Pyuria

Notes
  • This is the presence in urine of elevated numbers of white cells, mainly neutrophil (>10 white cells/mm3).
  • It is a symptom/sign of an underlying disease or condition.
  • Pyuria may be sterile or non-sterile
  • When pyuria is associated with hematuria and proteinuria, it is normally a sign of parenchymal renal disease
  • Any cause of inflammation in the urinary system can lead to pyuria (due to the infiltration of WBC in the inflamed area)

##Causes of pyuria:

  • TB (sterile)
  • Tumor (sterile)
  • Use of indwelling catheter (sterile and asymptomatic)
  • Chronic urinary incontinence (sterile and asymptomatic)
  • UTIs (are the most common cause of pyuria [98-99%] and infections can bacterial, viral and parasitic)
  • Bacterial infections including STDs e.g. gonorrhea
  • Viral infections e.g. Herpes simplex and Human papilloma virus (HPV)
  • Parasites such as Schistosoma haematobium, Entamoeba histolytica, trichomonas vaginalis and Giardia lamblia
  • Pregnancy
  • Mechanical trauma
  • Inflammatory lesions of the kidneys such as lupus nephritis, polyarteritis nodosa, analgesic nephropathy, glomerulonephritis, lead nephropathy and secondary s yphilis.
  • Stones in the bladder, ureter and kidney
  • Reiter's syndrome
  • Soaps and other chemicals
  • Post-menopausal atrophic vaginitis
  • Prostitis
  • Non-urological infections such as pneumonia
  • Appendicitis
  • Diverticulitis
  • Balanitis
  • Kawasaki disease

##Risk factors for pyuria:

  • UTIs
  • Women are more likely to have pyuria /UTIs than men (due their short urethra as well as short anal-vaginal distance)
Symptoms
  • The presence in urine of elevated numbers of white cells, mainly neutrophil (>10 white cells/mm3).
Diagnosis
  • Clinical review
  • Urinalysis
  • Culture and sensitivity
  • Ultrasound of urinary system
  • Urine for AAFB and culture for TB in case of persistent sterile pyuria
Differential
  • Not applicable
Prevention
  • Prevention of underlying causes such as UTIs
  • Good personal hygiene
  • Wiping the vaginal and anal areas from front to back
  • Drinking a lot of water to help clear bacteria out of the urinary system
  • Wash or shower before and after sexual intercourse
Management
  • Management of underlying causes especially UTIs
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