Pyuria (leukocyturia)

Piuria is one of the indicators of laboratory analysis of the composition of urine (urine), showing in it the presence of pus. Piuria is evidence that an acute inflammatory process develops in the organs of the genitourinary system - cystitis, pyelonephritis, prostatitis, pionephrosis and other diseases. The general analysis of urine may not reveal a moderate pyuria, more accurately it is determined with the help of special studies - Amburge samples, Nechiporenko-Almeida test, a two-glassed and three-glassed sample.

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Causes of the pyuria (leukocyturia)

Pyuria is often called leukocyturia, since the urine contains a large number of leukocytes, exceeding the norm. However, such identification is not entirely correct, it is much more competent to talk about pyuria as a significant, acute stage of leukocyturia. In fact, these two terms - leukocyturia and pyuria are differentiated by the number of leukocytes in urine.

There is an opinion that the intensity of pyuria can be used to judge the severity of the inflammatory process in the urinary tract. Recently, it has been established that neither active leukocytes nor Sternheimer-Malbin cells can be considered a criterion of inflammation activity.

The degree and topical diagnosis of pyuria (leukocyturia) is carried out using a screening two- or three-glass sample, performed on the same principles as for assessing hematuria. A thorough toilet is required for the external genitalia. Male faces expose the head of the penis, women enter the vagina with a cotton swab. Collection of urine is carried out naturally. Previously practiced urine catheter fences are now universally discontinued due to biased data and the risk of retrograde infection. The patient empties the bladder into two vessels: the first - about 50 ml, in the second - the remainder. An indispensable condition is the continuity of the urine stream. Macro- and microscopic evaluation of the latter is carried out ex tempore, since contact with oxygen begins its alkaline fermentation.

In the urine of healthy people, regardless of age or sex, there is always a certain amount of white blood cells, in laboratory diagnostics such a rule is defined as 0-3 for men and 0-6 for women and children. A slight excess of the norm is most often observed in women due to contamination of urine and vaginal discharge. The presence of leukocytes in urine is determined by the settled layer of urine after treatment of the material in the centrifuge, exceeding the norm limits, visible macroscopically - it is leukocyturia, if white blood cells are visible to the naked eye in the form of cloudy flakes, filaments, is pyuria, in which leukocytes sometimes exceed 3 million in urine , collected per day (Kakowski-Addis analysis).

Thus, pyuria is an important evidence of an exacerbation of the inflammatory disease of the urinary tract or kidney.

Pyuria is clinically divided into the following types: 

• An initial pyuria, that is, one that is determined in the first collected portion of urine with a three-glassed sample. Initial pyuria is evidence of inflammatory processes in the lower parts of the outflow tract, for example, in the anterior region of the urethra. 
• The terminal pyuria is determined by the third dose of urine and indicates inflammation in deeper tissues and organs, for example, in the prostate gland. 
• Total pyuria is the presence of purulent discharge in all three portions of urine and evidence of an inflammatory process in the kidneys and, possibly, in the bladder.

Piuria causes multiple causes, but almost all of them are associated with an inflammatory process. Pyuria is not a diagnosis or an independent disease, it is a clear indicator of UTI - urinary tract infection and kidney infection. The list of diseases that are accompanied by leucocyturia and pyuria is quite large, among the most frequently diagnosed are the following: 

• Inflammation of the bladder and urethra (cystitis, urethritis). 
• Inflammation of the renal pelvis (pyelitis, pyelonephritis, purulent pyelonephritis). 
• Diverticulum of the bladder. 
• Inflammation of the kidneys - interstitial nephritis. 
• Prostatitis in the acute stage. 
• Phimosis. 
• Tuberculosis of the kidneys. 
• Polycystic kidney disease. 
• Hypoplasia of the kidneys. 
• Hydronephrosis, including congenital. 
• Glomerulonephritis. 
• Systemic lupus erythematosus. 
• General poisoning of the body, intoxication. 
• Amyloidosis of the kidneys (violation of protein metabolism). 
• Chronic renal failure. 
• Glomerulosclerosis is diabetic. 
• Allergosis. 
• Acute inflammation of the appendix. 
• Presence of stones in the ureter. 
• Sepsis of bacterial etiology in newborns. 
• When kidney transplantation - organ rejection.

The type of leukocytes detected can also serve as indirect indications of the cause of pyuria: 

• A neutrophilic urogram indicates infection, possible tuberculosis, pyelonephritis. 
• Mononuclear urogram - interstitial nephritis or glomerulonephritis. 
• Lymphocytic type of urogram - systemic pathologies, such as systemic lupus erythematosus. 
• Eosinophilic urogram - allergosis.

Due to the fact that the cause of pyuria can be very diverse, and is not a specific symptom, the patient is examined as complexly and comprehensively as possible in order to establish the true cause of pus in the urine.

The cloudy first portion of urine, the presence of urethral strands and leukocytes may indicate an inflammatory process in the urethra distal to the external urethral sphincter. Turbid urine and leukocytes in the second portion indicate inflammation, the level of localization of which is located proximal to the internal sphincter.

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Symptoms of the pyuria (leukocyturia)

Pyuria symptoms are identical to the underlying disease, which also provokes the appearance of pus in the urine. Pyuria is almost always combined with bacteriuria (the presence of microorganisms - bacteria in urine), so a typical symptom of the abnormal increase in white blood cells in the urine is painful urination. Frequent urges to urinate, small portions of urine, hyperthermia (fever), pain and aches in the lumbar region, headache - this is far from a complete list of signs of infectious inflammation of the genito-urinary tract. Pyuria also exhibits obvious symptoms - urine becomes cloudy and purulent inclusions are clearly visible in it.

Among the typical signs that are characteristic of UTI - urinary tract infection, we can name the following: 

• Dysuria is a violation of normal urination, which can be as follows:
  • Rapid - pollakiuria, frequent urge to urinate as a sign of possible diabetes, cystitis, prostatic hyperplasia (mainly at night), urethritis and other inflammatory processes of the lower urinary tract.
  • Difficult urination - stranguras, as a possible sign of concrements in the urinary tract, acute stage of prostatitis, polycystic kidney disease, phimosis. 
• Pain in lower abdomen. 
• Pain in the lumbar region. 
• Change in color and consistency of urine. 
• Burning in the ureter when urinating. 
• Pain when urinating. 
• Pain in the pubic area (in women). 
• Uncharacteristic smell of urine. 
• Increased body temperature.

Pyuria symptoms can have, characteristic for kidney disease, among them typical are the following: 

Stones in the kidneys: 

• Muddy urine, in which there may be pus and blood spots (combination of pyuria with hematuria). 
• Periodic pain in the lower back or below the ribs, irradiating downward, in the groin. 
• If the stone has moved, there is a bacterial infection and pus, urination is interrupted. Frequent desires and small portions of cloudy urine. 
• Nausea, right up to vomiting. 
• Burning in the ureter. 
• A feverish condition with an acute process and a purulent infection. 

Pyelonephritis: 

• The acute stage is characterized by high fever, pain in the lower back, joints, pain during urination, turbid urine with pus, uncharacteristic odor of urine, high body temperature, nausea, vomiting. 
• Chronic pyelonephritis (latent) - pyuria as the main symptom, transient dull pain in the lower back, transient dysuria, weakness, possible anemia, decreased appetite.

Pyuria symptoms are typical for the disease, its causing, and pyuria can develop secretly, asymptomatically and is detected only by laboratory tests of urine.

A three-glassed sample (Stamey test) more accurately reflects the topical diagnosis in the inflammatory process in the prostate and the posterior urethra between the external and internal sphincters. Naturally, this sample is applicable only to males. Thus, the first two portions of urine are not changed, and the last portion, with a volume of 50-70 ml, formed during the final contraction of the detrusor and the muscles of the pelvic diaphragm, turns out to be turbid; when microscopic sediment is detected leukocytes. The true degree of activity of the inflammatory process in the urinary tract can be assessed only on the basis of detection of bacteriuria in a diagnostically significant titer.

Treatment of the pyuria (leukocyturia)

Piuria treatment involves a comprehensive, directed at the treatment of the underlying disease, the symptom of which is the presence of an increased number of white blood cells in the urine. The main task of treating pyuria is to sanitize the focus of infectious inflammation and eliminate the cause of pathology.

As a rule, urinary tract infections are treated with antibiotic therapy, adequate for sensitivity to a specific laboratory pathogen. Piuria treatment can be quite short-term if infectious inflammation arose as a result of catheterization (procedures, studies, post-operative catheterization). In such cases, antibacterial therapy lasts 5-7 days, the focus of infection, and with it and pyuria are eliminated.

If the disease occurs in a chronic form and does not have a pronounced symptomatology, treatment is carried out as sparing as possible, especially in pregnant women, children and elderly patients. In such cases, immunomodulators are prescribed, physiotherapeutic procedures.

Acute urinary tract infections are usually treated with fluoroquinolones, cephalosporin group (new generation) drugs. Along with these drugs, the appointment of antibiotics - carbalenems - bactericidal inhibitors of cell wall synthesis of microorganisms is shown. Classical penicillins in combination with fluoroquinolones can also be used.

Piuria treatment involves a rather long one, which depends on the timing of elimination of the underlying cause, that is, the focus of inflammation. As a symptom of pyuria can be neutralized within 7-10 days, however, if the prescribed course of treatment is not followed, recur and go into chronic form. It is believed that the course of antibiotic therapy in UTI should be at least two weeks.