Pyuria

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Contents 1 Introduction 2 Differential-diagnosis 3 Notes 4 More General Terms 5 Additional Terms 6 References

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

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

• renal tubulointerstitial disease

• glomerulonephritis
• acute interstitial nephritis ( AIN)
• acute renal transplant rejection

• renal calculi
• bladder tumors
• inflammatory disorders

• cystitis
• prostatitis
• urethritis
• balanitis

• acute urethral syndrome or dysuria-pyuria syndrome in women
• common in patients with indwelling catheter ( foley)

• cannot be used to indicate infection

Notes

• leukocytes are rapidly lysed in hypotonic or alkaline urine; 50% lyse after 2-3 hours of standing at room temperature.

More General Terms

• sign/symptom

Additional Terms

• leukocyte (white blood cell)

References

1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 438
2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 544
3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
4. Dieter RS. Sterile pyuria: a differential diagnosis. Compr Ther. 2000 Fall;26(3):150-2. Review. PMID: [1]

pyuria (leukocytouria)