Pyuria

Pyuria is defined as the presence of white blood cells in the urine. This condition is commonly caused by urinary tract infection, asymptomatic bacteriuria, or vaginal contamination of the urine specimen.

Differential Diagnosis

• Urinary tract infection
• Asymptomatic bacteriuria
  –Relatively common in school-age girls
  –Urine cultures are repeatedly positive
  –Patients remain asymptomatic
• Sexually transmitted disease (STD)
  –Gonorrhea, Chlamydia, Trichomonas
  –Bacterial vaginitis (can be nonsexually transmitted)
• Other causes of vaginal discharge/perineal irritation (e.g., candidal vaginitis)
• Acute interstitial nephritis
  –“Allergic” tubulointerstitial process
  –Occurs 7–14 days after exposure to inciting agent (e.g., antibiotics or NSAIDs)
  –May have polyuria, fever, and rash, and elevated serum creatinine of unclear etiology
  –Urinalysis is otherwise unremarkable
• Inherited cystic diseases
  –PKD: Occurs in both autosomal dominant and autosomal recessive forms
  –Juvenile nephronophthisis: Rare cause of inherited chronic tubulointerstitial nephritis, steady progression to kidney failure in the first two decades of life, autosomal recessive inheritance
  • Appendicitis
    –May present with symptoms suggestive of acute pyelonephritis (fever, flank or abdominal pain)
    –Urine culture is negative
    –Symptoms are progressive
  • Renal tuberculosis
    –Routine urine culture negative
  • Gastroenteritis (typically viral)
  • Lupus nephritis
  • Alport syndrome
  • Nail-patella syndrome
  • Urethritis
  • Kawasaki disease
    –Most common vasculitis of childhood
    –Characterized by high fever, irritability, mucous membrane changes, edema of the hands and feet, lymphadenopathy
    –Coronary vasculitis and aneurysms may result
    –Treated with aspirin and IVIG

Workup and Diagnosis

• History
  –Previous UTI or positive urine culture
  –Unprotected sexual activity, previous STD
  –Recent antibiotic or other medication exposure
  –Poor growth (seen in chronic kidney disease)
  –Dysuria, urgency, frequency, fever, flank pain
  –Polyuria, polydipsia
  –Abdominal pain (particularly right lower quadrant)
  –Family history of polycystic kidney disease or other inherited kidney disease
• Physical exam
  –Temperature, BP, height, and weight
  –Rashes
  –Pelvic exam (if patient sexually active)
  –Exam of the external genitalia
  –Abdominal masses
  –Costovertebral angle tenderness
• Labs
• Urinalysis (including microscopy), urine culture
  –STD screen if sexually active: GC culture, Chlamydia DNA probe or ligase chain test, wet prep for Trichomonas
  –Chemistry panel to screen for renal disease
  • Additional studies depend on the clinical situation
    –Abdominal CT scan or ultrasound for appendicitis
    –Renal ultrasound if inherited cystic diseases are suspected

Treatment

• Suspected UTI: Empiric oral antibiotics after culture (e.g., co-trimoxazole); if acutely ill, consider intravenous antibiotics
• Asymptomatic bacteriuria: Should not be treated unless patient develops symptoms or has a previous history of symptomatic UTI, because treatment of asymptomatic patients promotes antibiotic resistance
• STDs
  –Simple cervicitis, treat with IM ceftriaxone and PO azithromycin; add metronidazole for Trichomonas
  –Ill patients or PID: Consider hospital admission, IV cefoxitin and oral doxycycline
• Suspected acute interstitial nephritis
  –Discontinue any potential causative agents
  –Ensure adequate hydration
  –Monitor serum creatinine and electrolytes daily
  –Treat sequelae of acute renal failure (hyperkalemia)

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Urine odor

Read excerpts from these other book chapters related to Urine odor:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Urine odor

• Back to symptom: Urine odor: Introduction (review 6 causes)
• Next Book Extract About Urine odor: URINE COLOR CHANGES (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Urine odor

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: URINE COLOR CHANGES (Differential Diagnosis in Primary Care)

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• HALITOSIS AND OTHER BREATH ODORS (Differential Diagnosis in Primary Care)

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