Wednesday, May 13, 2009

Sterile Pyuria [updated]

Patient came in yesterday with a three month history of frequent UTIs. These UTIs were diagnosed when the patient presented to her doctor with back/flank pain and the U/A was positive for leukocyte esterase and white cells but was always nitrate negative and the cultures never revealed more than low colony counts of skin flora.

The patient's pain repeatedly responded to a few days of quinolone therapy.

Differential for sterile pyuria:
  • Renal TB: patient's husband had a history of active TB
  • Interstitial nephritis: patient was taking a significant amount of NSAIDs and ASA for the back pain
  • Nephrolithiasis: patient had calcifications in the kidney on the U/S
  • Urogenital cancer
  • Vaginal contamination
  • Glomerulonephritis
  • Chlamydia, mycoplasma, ureaplasma (thanks Jim)
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