Peer Reviewed
Feature Article Urology

The detection and investigation of pyuria

Andrew Jefferys, Michael Suranyi
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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