PYURIA

Ask the Following Questions:

1. Are there significant RBCs in the urine? If so, one should consider glomerulonephritis, collagen disease, tuberculosis, neoplasm, trauma, renal calculus, and polycystic kidney disease. If not, the most likely etiology is a UTI.
2. Are there WBC casts in the urine? This would make pyelonephritis or interstitial nephritis more likely.
3. Are there RBC casts in the urine? This would help differentiate glomerulonephritis and collagen diseases from the other conditions associated with hematuria.

DIAGNOSTIC WORKUP

First, look at the urinary sediment under a microscope. Further workup should include a urine culture and colony count, AFB smear and culture, CBC, sedimentation rate, ANA test, chemistry panel, serum protein electrophoresis, IVP, and a urology consultation. A urologist may do cystoscopy and retrograde pyelography. He may order a CT scan of the abdomen to rule out renal carcinomas and other kidney disease. A nephrologist may need to be consulted in difficult cases. A urologist should be consulted in all cases of recurrent or persistent pyuria.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Urine odor: Introduction (review 6 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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