Pyuria is a urinary condition that is characterized by high number of white blood cells in the urine.
Doctors define a high number as at least 10 white blood cells per cubic millimeter (mm3) of centrifuged urine. The urine may appear cloudy or as if it contains pus, indicating pyuria.
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Sterile pyuria occurs without a detected presence of bacteria. In these cases, it may be related to non-detected bacteria, a virus or other germ type, or some other causal medical condition.
Causes of Pyuria
Pyuria can be caused by different conditions. However, it is most commonly caused by a UTI, which is an infection in any area of the urinary system, including the kidneys, ureters, urethra, or bladder.
Sterile pyuria is most often caused by sexually transmitted infections (STIs), such as gonorrhea or viral infections.
Some causes of sterile pyuria include:
- bacteremia with sepsis
- urinary tract stones
- interstitial cystitis
- tumors in the urinary tract
- kidney disease
- autoimmune diseases, such as SLE or Kawasaki’s disease
- polycystic kidney disease
Pyuria can also be a reaction to taking certain types of medications such as:
- proton pump inhibitors, such as omeprazole
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin
- penicillin antibiotics
Symptoms of Pyuria
Pyuria can cause cloudy urine and urine with pus that may not be linked by any other symptoms. The change in color or texture is as a result of the increased number of white blood cells. If a UTI is present, symptoms may also include:
- pelvic pain
- foul-smelling urine
- blood in urine
- frequent urges to urinate
- a burning sensation when urinating
Other symptoms that may occur if another underlying condition causes pyuria includes:
To diagnose pyuria, a doctor will perform a urinalysis by taking a urine sample, which is then analyzed in the lab, based on its appearance, concentration, and content.
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Cloudy urine with an abnormal white blood cell count may indicate pyuria.
The urinalysis might also point to other abnormalities. For instance, the presence of nitrite or leukocyte esterase can indicate a UTI, while raised protein levels might indicate kidney disease.
Treatment of Pyuria
Treatment for pyuria depends on the primary cause. Usually, a UTI causes pyuria and treatment will involve a short course of antibiotic therapy, such as oral trimethoprim-sulfamethoxazole or nitrofurantoin.
Antibiotics can also treat bacterial STIs and tuberculosis. If there is no improvement after taking a full course of antibiotics, a more serious underlying condition may be present.
In some cases, stopping the medications that are causing the increase in urine white blood cells may treat pyuria. However, it is essential to consult a doctor before stopping any medications.
Pyuria during pregnancy
Pyuria and UTIs often occur during pregnancy as a result of the anatomical and hormonal changes that allows bacteria to enter the urinary tract and grow. Anyone experiencing pyuria during pregnancy should speak to a doctor to determine the underlying cause.