Pyuria N39.0

Pyuria is the presence of pus in the urine. This pus is macroscopically visible, the urine shows a distinct cloudiness and occasionally has a putrid smell.

In the case of pyuria there are 10 or > 10 leucocytes per ml of urine or

> 100 leukocytes per visual field during laboratory diagnostic clarification.

A distinction is made between a:

• sterile pyuria (without bacterial detection) and a
• bacterial pyuria.

Normally the urine is sterile. Only when > 10 bacteria / ml urine are detected, we speak of bacteriuria. Values of < 104 are a questionable contamination, values between > 10 4 to 105 indicate a borderline finding (only in the case of catheter urine does the number indicate a bacterial infection). However, if the number of bacteria increases > 10 5, a significant bacteriuria is present.

Pyuria is a frequently occurring symptom. It is found in 13.9% of women, whereas only 2.6% of men are affected. The reason for the gender difference is the anatomical conditions that cause women to develop infections in the pelvic and bladder area more often.

Sterile pyuria is found in:

• urogenital tuberculosis (Mycobacterium tuberculosis; in 90% of cases there is pathological urine with pyuria and simultaneous haematuria)
• Chlamydia
• Ureaplasma
• Neisseria gonorrhoeae
• genital herpes
• advanced HPV infection
• Trichomoniasis
• Mycoplasma
• Nephrolithiasis
• Urolithiasis
• Fungal infections
• chronic interstitial nephritis
• uroepithelial tumor
• chronic prostatitis
• chronic urethritis
• schistosomiasis after a stay in the tropics
• Kawasaki syndrome (very rare, mostly affects children; high fever; exanthema etc.)
• previous antibiosis
• contamination of the urine sample with disinfectant
• et al.

Pyuria with concomitant leukocyturia is particularly common in:

• acute cystitis
• acute prostatitis
• acute pyelonephritis
• and others.

Pyuria in itself is not a sign of a urinary tract infection and should not be treated as such.

It is important to diagnose pyuria and then to treat the underlying disease accordingly.

Patients with oliguria or anuria almost always have pyuria. Here too, antibiotic treatment should only be given if the uricult test is positive.

1. Gerok W et al (2007) Internal medicine - reference work for the medical specialist. Schattauer Publishing House
2. Herold G et al (2017) Internal Medicine. Herold Publisher S 603
3. Huhnstock K et al. (1974) Diagnosis and Therapy in Practice Springer Verlag SS 651, 657
4. Kasper DL et al (2015) Harrison's Principles of Internal Medicine Mc Graw Hill Education
5. Kasper DL et al (2015) Harrison's Internal Medicine. Thieme Publishing House SS 1355, 2259
6. Keller C K et al (2010) Practice of nephrology. Springer publishing house. SS 20 - 22, 61, 63, 287
7. Sökeland J et al (2004) Urology Thieme Publishing House. S 63
8. Wise G J et al (2015) Sterile Pyuria. New Engl J Med 372: 1048-1054