Article Figures & Data
Tables
- Table 1. Some Reported Causes of Sterile Pyuria and the Tests Generally Used to Diagnose Them
Cause Evaluation Infectious causes Perinephric abscess Ultrasound; CT Renal tuberculosis Urine TB culture and PCR Fungal infections of the kidneys Gram stain; fungal culture Partially treated pyelonephritis History; CT Fungal infections of the bladder Gram stain; fungal culture Partially treated cystitis History Contamination of urine with antiseptic Repeat urinalysis Prostatitis Prostate exam Urethritis History; urine PCR; chlamydia culture Cervicitis Vaginal exam; cervical culture Vaginitis Vaginal exam; wet prep/KOH Appendicitis, diverticulitis US; CT Q fever History; serology Noninfectious causes Crystal nephropathy and nephrolithiasis CT, IVP Lithium or heavy metal nephropathy History; lithium level; heavy metal tests Renal papillary necrosis (diabetes, sickle cell disease, analgesic nephropathy) Renal sarcoidosis Urinalysis, IVP; US; CT Polycystic kidney disease Renal biopsy Renal transplant rejection US; CT Interstitial nephritis History; renal biopsy Genitourinary malignancy Urine eosinophils, renal biopsy Interstitial cystitis CT; cystoscopy Systemic lupus erythematosis, other autoimmune diseases Cystoscopy Kawasaki disease ESR; ANA, anti-DNA History; physical exam ANA, antinuclear antibodies; CT, computed tomography; ESR, erythrocyte sedimentation rate; KOH, potassium hydroxide; IVP, intravenous pyelogram; PCR, polymerase chain reaction; TB, tuberculosis; US, ultrasound.
Population Characteristics No. (%) Age (years) <18 66 (31.4) ≥18 144 (68.6) Sex Female 116 (55.2) Male 94 (44.8) Race White 165 (78.6) Black 29 (13.8) American Indian 10 (4.8) Other/unknown 6 (2.9) Primary health insurance Medicare 54 (25.8) Medicaid 63 (30.1) Commercial 50 (23.9) Uninsured 42 (20.1) Setting before admission Home 171 (81.4) Nursing home 9 (4.3) Inpatient facility 26 (12.4) Unknown 4 (1.9) Primary discharge diagnosis Pneumonia 45 (19.5) Intra-abdominal infection 88 (41.9) Female genital infection 10 (4.8) Enteritis 41 (19.5) Septicemia, bacterial 26 (12.4) Pyuria >5 WBCs/HPF No 148 (70.5) Yes 62 (29.5) >10 WBCs/HPF No 179 (85.2) Yes 31 (14.8) Urine culture result (if urine cultured) Negative 31 (70.5) Positive 13 (29.5) At least 1 possible urinary tract symptom No 30 (14.3) Yes 180 (85.7) Urinary tract infection No 198 (94.3) Yes 12 (5.7) HPF, high-powered field; WBC, white blood cells.
Characteristics Pyuria P Culture Positive* P All Patients 62/210 (29.5) 13/44 (29.5) Age group .87 .09 Children 19/66 (28.8) 2/18 (11.1) Adults 43/144 (29.9) 11/26 (42.3) Sex <.001 .69 Female 50/116 (43.1) 10/36 (27.8) Male 12/94 (12.8) 3/8 (37.5) Weight (lb) .61 .26 <100 13/45 (28.9) 1/13 (7.7) 100–200 37/111 (33.3) 8/23 (34.8) >200 9/36 (25) 3/6 (50) Primary diagnosis Pneumonia 4/45 (8.9) <.001 0/3 (0) .54 Septicemia 28/88 (31.8) .54 3/17 (17.6) .20 Intra-abdominal infect. 12/41 (29.3) 1.00 1/10 (10) .24 Enteritis 3/10 (33) 1.00 2/2 (100) .08 Female genital infection 15/26 (57.7) .001 7/12 (58.3) .02 Signs and symptoms Fever 26/93 (28) .76 5/23 (21.7) .33 Abdominal pain 43/126 (34.1) .09 9/30 (30) 1.00 Flank pain 1/6 (16.7) .67 0/1 (0) 1.00 Abdominal tenderness 29/86 (33.7) .28 3/21 (14.3) .05 CVA tenderness 1/3 (33) 1.00 0/1 (0) 1.00 Laboratory tests Urine nitrite 14/19 (73.7) <.001 7/11 (63.6) .008 Urine bacteria (≥mod.) 30/44 (68.2) <.001 11/23 (47.8) .008 eGFR by CG <60 16/48 (33.3) .56 3/13 (23.1) .23 ↵* Values are n/numbers of patients with pyuria who had a urine culture performed (%).
All P values were obtained using Fisher's exact test.
CG, Cockroff-Gault; CVA, costovertebral angle; eGFR, estimated glomerular filtration rate.
