Thursday, April 15, 2010

April 15th - LBJ - Sterile Pyuria

Today at LBJ the Renal Service presented patient with HIV that had with multple systemic complaints.  They were consults for AKI (baseline Cr 0.9 - now 5.4) and on the Urinalysis the patient had sterile Pyuria.  Here is a quick review are the causes of sterile pyuria (Significant WBCs - meaning at least 5-8 per hpf on Urinalysis with few/no bacteria and negative Gm Stain).

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

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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