Pyuria

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Pyuria
Pyuria.JPG
White blood cells seen under a microscope from a urine sample.
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Pyuria is the condition of urine containing white blood cells or pus. Defined as the presence of 6-10 or more neutrophils per high power field of unspun, voided mid-stream urine, it can be a sign of a bacterial urinary tract infection. Pyuria may be present in people with sepsis, or in older people with pneumonia. Others additionally require discoloration, clouding or change in the smell of urine for a pyuria to be present. Without these additional features, there is said to be leukocyturia.

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Sterile pyuria [1] is urine which contains white blood cells while appearing sterile by standard culturing techniques. It is often caused by sexually transmitted infections, such as gonorrhea, or viruses which will not grow in bacterial cultures. Sterile pyuria is listed as a side effect from some medications such as paracetamol (acetaminophen). Its occurrence is also associated with certain disease processes, such as Kawasaki disease and genitourinary tuberculosis. [2] However, there are many known causes, including systemic or infectious disease, structural and physiological reasons, intrinsic kidney pathology, or drugs. [2]

Leukocyturia

Under normal conditions, fewer than two million leukocytes are expelled in urine per day. A number greater than two million is called leucocyturia and can be determined when determining the Addis count. [3]

However, this method requires a 24-hour urine collection, so it is not practical. Currently, the number of leukocytes is estimated under the microscope for which morning urine is taken. It has been arbitrarily assumed that a number of over 4-5 leukocytes in the field of vision of the microscope indicates leukocyturia. [4]

At the moment, there are also quick test strips available, allowing after wetting a special diagnostic bar, the detection of granulocytes in the urine, as evidenced by the color change of the test strip. [5] The principle of their operation is based on the detection of granulocytes esterases, including leukocytes. This method, however, is burdened with a large number of false positive results (use of antibiotics, such as imipenem, meropenem, clavulanic acid, which is sometimes combined with penicillin derivatives) or false negative (gentamicin, cefalexin, glycosuria, proteinuria).[ citation needed ]

Leukocyturia is a laboratory symptom of many diseases like glomerulonephritis or pyelonephritis. It may occur in the case of diseases of the urinary tract, reproductive system and diseases of the abdominal organs. [6] Leukocyturia is mostly a sign of urinary tract infection, especially if significant bacteriuria is found (for most people, the number of bacteria in a culture is > 10^5) and other symptoms associated with passing urine. [7] The presence of leukocyturia does not indicate the need for antimicrobial therapy yet.[ citation needed ]

Additional images

Pyuria in a person with urosepsis Pyuria2011.JPG
Pyuria in a person with urosepsis

See also

Related Research Articles

<span class="mw-page-title-main">Urinary tract infection</span> Infection that affects part of the urinary tract

A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. Lower urinary tract infections may involve the bladder (cystitis) or urethra (urethritis) while upper urinary tract infections affect the kidney (pyelonephritis). Symptoms from a lower urinary tract infection include suprapubic pain, painful urination (dysuria), frequency and urgency of urination despite having an empty bladder. Symptoms of a kidney infection, on the other hand, are more systemic and include fever or flank pain usually in addition to the symptoms of a lower UTI. Rarely, the urine may appear bloody. Symptoms may be vague or non-specific at the extremities of age.

<span class="mw-page-title-main">Cystoscopy</span> Medical procedure; endoscopy of the urinary bladder via the urethra

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.

<span class="mw-page-title-main">Urinalysis</span> Array of tests performed on urine

Urinalysis, a portmanteau of the words urine and analysis, is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic examination targets parameters such as color, clarity, odor, and specific gravity; urine test strips measure chemical properties such as pH, glucose concentration, and protein levels; and microscopy is performed to identify elements such as cells, urinary casts, crystals, and organisms.

<span class="mw-page-title-main">Hematuria</span> Presence of blood in urine

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

Dysuria refers to painful or uncomfortable urination.

<span class="mw-page-title-main">Urine test</span> Medical test of urine

A urine test is any medical test performed on a urine specimen. The analysis of urine is a valuable diagnostic tool because its composition reflects the functioning of many body systems, particularly the kidneys and urinary system, and specimens are easy to obtain. Common urine tests include the routine urinalysis, which examines the physical, chemical, and microscopic properties of the urine; urine drug screening; and urine pregnancy testing.

Mycoplasma pneumonia is a form of bacterial pneumonia caused by the bacterium Mycoplasma pneumoniae.

<span class="mw-page-title-main">Blood culture</span> Test to detect bloodstream infections

A blood culture is a medical laboratory test used to detect bacteria or fungi in a person's blood. Under normal conditions, the blood does not contain microorganisms: their presence can indicate a bloodstream infection such as bacteremia or fungemia, which in severe cases may result in sepsis. By culturing the blood, microbes can be identified and tested for resistance to antimicrobial drugs, which allows clinicians to provide an effective treatment.

<span class="mw-page-title-main">Pyelonephritis</span> Inflammation of the kidney

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.

Urethral syndrome is defined as symptoms suggestive of a lower urinary tract infection but in the absence of significant bacteriuria with a conventional pathogen. It is a diagnosis of exclusion in patients with dysuria and frequency without demonstrable infection. In women, vaginitis should also be ruled out.

<i>Staphylococcus saprophyticus</i> Species of bacterium

Staphylococcus saprophyticus is a Gram-positive coccus belonging to the genus Staphylococcus. S. saprophyticus is a common cause of community-acquired urinary tract infections.

<span class="mw-page-title-main">Antibiotic sensitivity testing</span> Microbiology test used in medicine

Antibiotic sensitivity testing or antibiotic susceptibility testing is the measurement of the susceptibility of bacteria to antibiotics. It is used because bacteria may have resistance to some antibiotics. Sensitivity testing results can allow a clinician to change the choice of antibiotics from empiric therapy, which is when an antibiotic is selected based on clinical suspicion about the site of an infection and common causative bacteria, to directed therapy, in which the choice of antibiotic is based on knowledge of the organism and its sensitivities.

Leukocyte esterase (LE) is an esterase produced by leukocytes. A leukocyte esterase test is a urine test for the presence of white blood cells and other abnormalities associated with infection.

A nitrite test is a chemical test used to determine the presence of nitrite ion in solution.

<span class="mw-page-title-main">Bacteriuria</span> Presence of bacteria in urine

Bacteriuria is the presence of bacteria in urine. Bacteriuria accompanied by symptoms is a urinary tract infection while that without is known as asymptomatic bacteriuria. Diagnosis is by urinalysis or urine culture. Escherichia coli is the most common bacterium found. People without symptoms should generally not be tested for the condition. Differential diagnosis include contamination.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

<span class="mw-page-title-main">Urine test strip</span> Diagnostic tool used in urinalysis

A urine test strip or dipstick is a basic diagnostic tool used to determine pathological changes in a patient's urine in standard urinalysis.

<span class="mw-page-title-main">Abnormal urine color</span> Medical condition

Normally, human urine color is straw-yellow. Urine color other than straw-yellow sometimes reflects an abnormality—an underlying pathological condition—in human beings.

Urinary cell-free DNA (ucfDNA) refers to DNA fragments in urine released by urogenital and non-urogenital cells. Shed cells on urogenital tract release high- or low-molecular-weight DNA fragments via apoptosis and necrosis, while circulating cell-free DNA (cfDNA) that passes through glomerular pores contributes to low-molecular-weight DNA. Most of the ucfDNA is low-molecular-weight DNA in the size of 150-250 base pairs. The detection of ucfDNA composition allows the quantification of cfDNA, circulating tumour DNA, and cell-free fetal DNA components. Many commercial kits and devices have been developed for ucfDNA isolation, quantification, and quality assessment.

References

  1. Gilbert J. Wise & Peter N. Schlegel (March 12, 2015). "Sterile Pyuria". N Engl J Med. 372 (11): 1048–1054. doi: 10.1056/NEJMra1410052 . PMID   25760357.
  2. 1 2 Dieter RS (2000). "Sterile pyuria: a differential diagnosis". Compr Ther. 26 (3): 150–2. doi:10.1007/s12019-000-0001-1. PMID   10984817. S2CID   11629600.
  3. Vasan, R.S. (1998). Textbook of Medicine. Orient Blackswan. p. 939. ISBN   9788125012665.
  4. Bagga (2009). Urinary Tract Infections And Anomalies. Elsevier Health Sciences. p. 4. ISBN   9788131223710.
  5. Hofmann, Walter; Aufenanger, Johannes; Hoffmann, Georg (2016). Laboratory Diagnostic Pathways: Clinical Manual of Screening Methods and ... Walter de Gruyter GmbH & Co KG. p. 142. ISBN   9783110455083.
  6. Von Forstner, Manfred Schmidl (1986). Laboratory testing in veterinary medicine diagnosis and clinical monitoring. Boehringer Mannheim. p. 20.
  7. Archives of Medical Research, Volume 31. Instituto Mexicano del Seguro Social. 2000. p. 214.