Table 1. Some Reported Causes of Sterile Pyuria and the Tests Generally Used to Diagnose Them
Infectious causes
    Perinephric abscessUltrasound; CT
    Renal tuberculosisUrine TB culture and PCR
    Fungal infections of the kidneysGram stain; fungal culture
    Partially treated pyelonephritisHistory; CT
    Fungal infections of the bladderGram stain; fungal culture
    Partially treated cystitisHistory
    Contamination of urine with antisepticRepeat urinalysis
    ProstatitisProstate exam
    UrethritisHistory; urine PCR; chlamydia culture
    CervicitisVaginal exam; cervical culture
    VaginitisVaginal exam; wet prep/KOH
    Appendicitis, diverticulitisUS; CT
    Q feverHistory; serology
Noninfectious causes
    Crystal nephropathy and nephrolithiasisCT, IVP
    Lithium or heavy metal nephropathyHistory; lithium level; heavy metal tests
    Renal papillary necrosis (diabetes, sickle cell disease, analgesic nephropathy)
    Renal sarcoidosisUrinalysis, IVP; US; CT
    Polycystic kidney diseaseRenal biopsy
    Renal transplant rejectionUS; CT
    Interstitial nephritisHistory; renal biopsy
    Genitourinary malignancyUrine eosinophils, renal biopsy
    Interstitial cystitisCT; cystoscopy
    Systemic lupus erythematosis, other autoimmune diseasesCystoscopy
    Kawasaki diseaseESR; 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.