Make sure the specimen is obtained appropriately (i.e. clean catch) before making the call of sterile pyuria!!!
Infectious Causes
1) Tuberculosis of the GU Tract (work up with Urinary AFB)
2) Gonnorrhea/Chlyamydia infection (Can send G/C Probe to w/up) or UTI with "other" fastidious organisms (i.e. ureaplasma)
3) Fungal Infections of the Urinary Tract
3) Reports of some Viral Infections of GU tract causing sterile pyuria
4) Recently treated UTI (of any cause) in the last 2 weeks
Inflammatory Causes
1) Prostatitis (without active infection)
2) Appendicitis or Diverticulitis (when adjacent to bladder)
Systemic Diseases
1) Lymphoma of the Bladder
2) Amyloidosis, Leukemia and Myeloma (via causing a chronic interstitial nephritis)
2) Sarcoidosis
3) Malignant hypertension (usually with concurrent hematuria)
4) Kawasaki Disease
Renal Causes
1) Renal Vein Thrombosis (Consider in a patient with nephrotic syndrome + flank pain)
2) Intersititial Nephritis (and it's various causes - Analgesic/Antibiotic/other drug induced, lupus nephritis, Sjogren's, vasculitis, treated pyelonephritis, heavy metals)
3) Renal Papillary Necrosis (can be from NSAID use, Sickle Cell Disease or even obstruction)
4) Nephrocalcinosis (suspect with RTA Type I) and chronic/recurrent nephrolithiasis
5) Cholesterol Emboli Syndrome (Consider with concurrent glomerulonephritis and recent vascular intervention)
6) Polycystic Kidney Disease
7) Interstitial cystitis
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References:
Dieter, R. Sterile Pyria: A Differential Diagnosis. COMP THER. 2000;26(3)
Massry et al. Textbook of Nephrology
Fausi et al. Harrison's Principles of Internal Medicine 16th ed
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