Wbc

Pyuria is best diagnosed by microscopic examination of centri-fuged urine sediment. Normal urine may contain up to 2 WBC per HPF in men, and up to 5 WBC per HPF in women. Significant pyuria requires >10 WBC per HPF.

• Fresh leucocytes (larger and rounder) are more suggestive of pathology, while old leucocytes (small and wrinkled) are usually seen in urine contaminated with vaginal secretions

• Large numbers of WBCs per HPF is highly specific for UTIs (especially if associated with hematuria), but various factors can affect the numbers of WBCs detected, including the intensity of the inflammatory response; hydration status of the patient; urine collection technique; and centrifugation and sampling technique

• Other causes of significant pyuria include almost any non-infective urinary tract pathology and results must be interpreted appropriately. Persistent abacterial pyuria should instigate investigations to exclude—

■ Urinary stones

■ Urinary tuberculosis

■ Glomerulonephritis

The absence of pyuria, in conjunction with either a negative bacterial culture or with a growth of mixed organisms, is likely to be secondary to contamination. Moreover, even with isolation of a single urinary pathogen, the absence of pyuria would suggest a contamination/sampling error in over 85% of patients.

TABLE 1.4. Origin of hematuria in glomerular and non-glomerular causes

Non-glomerular

TABLE 1.4. Origin of hematuria in glomerular and non-glomerular causes

Non-glomerular

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