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Clinical investigations from the RACP

The detection and investigation of pyuria

Andrew Jefferys, Michael Suranyi

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Abstract

Pyuria is most commonly associated with urinary tract infection in patients with urinary symptoms. Persistent sterile pyuria, however, may be an indication of underlying renal disease.

Key Points

  • Urine dipstick testing is an important screening tool in general practice.
  • Dipstick findings of urinary leucocytes or nitrite are suggestive of urinary tract infection (UTI).
  • If pyuria on dipstick is persistent but UTI is not confirmed by repeated midstream urine culture, further investigation is warranted, including testing for proteinuria and haematuria, assessing renal function and performing a renal ultrasound.
  • Persistent sterile pyuria also warrants further simple investigation.
  • Patients require referral to a nephrologist if they have any significant, persistent abnormality such as proteinuria, haematuria, sterile pyuria or impaired renal function detected.

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