Pyuria (leukocyturia).

Pyuria is one of the indicators of laboratory analysis of urine composition, showing the presence of pus in it. Pyuria is evidence that an acute inflammatory process is developing in the genitourinary system - cystitis, pyelonephritis, prostatitis, pyonephrosis and other diseases. General urine analysis may not reveal moderate pyuria, it is more accurately determined using special studies - Amburge test, Nechiporenko-Almeida test, two-glass and three-glass test.

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Causes 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 correct 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 the urine.

There is an opinion that the intensity of pyuria can be used to judge the degree of expression 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 for the activity of inflammation.

The degree of pyuria (leukocyturia) is assessed and its topical diagnostics are performed using a screening two- or three-glass test, performed according to the same principles as for assessing hematuria. Thorough toilet of the external genitalia is necessary. Males expose the head of the penis, while in women the entrance to the vagina is covered with a cotton swab. Urine is collected naturally. Previously, urine collection with a catheter has been discontinued everywhere due to the bias of the data obtained and the risk of retrograde infection. The patient empties the bladder into two vessels: about 50 ml into the first, and the remainder into the second. An indispensable condition is the continuity of the urine stream. Macro- and microscopic assessment of the latter is performed ex tempore, since its alkaline fermentation begins upon contact with oxygen.

In the urine of healthy people, regardless of age or gender, there is always a certain amount of leukocytes, in laboratory diagnostics such a norm 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 processing the material in a centrifuge, an excess of the normal limits, visible macroscopically is leukocyturia, if leukocytes are visible to the naked eye in the form of cloudy flakes, threads, it is pyuria, in which leukocytes sometimes exceed 3 million in urine collected per day (analysis by the Kakovsky-Addis method).

Thus, pyuria is an important indication of exacerbation of an inflammatory disease of the urinary tract or kidneys.

Pyuria is clinically divided into the following types:

• Initial pyuria, that is, the one that is determined in the first collected portion of urine in a three-glass sample. Initial pyuria indicates inflammatory processes in the lower sections of the excretory tract, for example, in the anterior region of the urethra.
• Terminal pyuria is determined by the third portion 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 is evidence of an inflammatory process in the kidneys and, possibly, in the bladder.

Pyuria has multiple causes, but almost all of them are related to the inflammatory process. Pyuria is not a diagnosis or an independent disease, it is a clear indicator of UTI - urinary tract and kidney infection. The list of diseases that are accompanied by leukocyturia 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).
• Bladder diverticulum.
• Inflammation of the kidney tissue - interstitial nephritis.
• Prostatitis in the acute stage.
• Phimosis.
• Tuberculosis of the kidneys.
• Polycystic kidney disease.
• Renal hypoplasia.
• Hydronephrosis, including congenital.
• Glomerulonephritis.
• Systemic lupus erythematosus.
• General poisoning of the body, intoxication.
• Renal amyloidosis (protein metabolism disorder).
• Chronic renal failure.
• Diabetic glomerulosclerosis.
• Allergosis.
• Acute inflammation of the appendix.
• Presence of stones in the ureter.
• Bacterial sepsis in newborns.
• In kidney transplantation - organ rejection.

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

• 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 – allergy.

Due to the fact that pyuria can have a wide variety of causes and is not a specific symptom, the patient is examined as comprehensively and as thoroughly as possible in order to establish the true cause of the appearance of pus in the urine.

Turbid first portion of urine, presence of urethral threads and leukocytes may indicate an inflammatory process in the urethra distal to the external sphincter of the urethra. 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 pyuria (leukocyturia)

Pyuria has symptoms identical to the underlying disease that causes pus in the urine. Pyuria is almost always combined with bacteriuria (the presence of microorganisms - bacteria in the urine), so a typical symptom of a pathological increase in leukocytes in the urine is painful urination. Frequent urge to urinate, small portions of urine, hyperthermia (increased body temperature), pain and aches in the lumbar region, headache - this is not a complete list of signs of infectious inflammation of the genitourinary system. Pyuria also shows 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, the following can be mentioned:

• Dysuria is a disorder of normal urination, which can be:
  • Frequent - 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.
  • Difficulty urinating – strangury, as a possible sign of stones in the urinary tract, acute stage of prostatitis, polycystic kidney disease, phimosis.
• Pain in the lower abdomen.
• Pain in the lumbar region.
• Change in the color and consistency of urine.
• Burning sensation in the ureter when urinating.
• Pain when urinating.
• Pain in the pubic area (in women).
• Uncharacteristic smell of urine.
• Elevated body temperature.

Pyuria may have symptoms characteristic of kidney disease, among which the following are typical:

Kidney stones:

• Cloudy urine, which may contain pus and blood (a combination of pyuria and hematuria).
• Recurrent pain in the lower back or below the ribs, radiating down to the groin.
• If the stone has moved, there is a bacterial infection and pus, urination is interrupted. Frequent urges to pass small portions of cloudy urine.
• Nausea, even to the point of vomiting.
• Burning in the ureter.
• Feverish condition in acute process and purulent infection.

Pyelonephritis:

• The acute stage is characterized by high fever, pain in the lower back, joints, pain when urinating, cloudy urine with pus, an unusual smell 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, loss of appetite.

Pyuria exhibits symptoms typical of the disease that causes it; pyuria can also develop latently, asymptomatically, and is detected only through laboratory tests of urine.

The three-glass test (Stamey test) more accurately reflects the topical diagnosis in the inflammatory process in the prostate and posterior urethra between the external and internal sphincters. Naturally, this test is applicable only to males. In this case, the first two portions of urine are unchanged, and the last portion, with a volume of 50-70 ml, formed during the final contraction of the detrusor and muscles of the pelvic diaphragm, is cloudy; leukocytes are detected during microscopy of the sediment. The true degree of activity of the inflammatory process in the urinary tract can only be assessed based on the detection of bacteriuria in a diagnostically significant titer.

Treatment pyuria (leukocyturia)

Pyuria treatment involves a comprehensive approach aimed at treating the underlying disease, the symptom of which is the presence of an increased number of leukocytes in the urine. The main objective of pyuria treatment is to sanitize the source of infectious inflammation and eliminate the cause of the pathology.

As a rule, urinary tract infections are treated with antibacterial therapy adequate in sensitivity to the pathogen determined by laboratory testing. Pyuria treatment can be quite short-term if the infectious inflammation has arisen as a result of catheterization (procedures, studies, postoperative catheterization). In such cases, antibacterial therapy lasts 5-7 days, the source of infection, and with it pyuria, are eliminated.

If the disease is chronic and does not have pronounced symptoms, the treatment is as gentle as possible, especially for pregnant women, children and elderly patients. In such cases, immunomodulators and physiotherapeutic procedures are prescribed.

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

Pyuria treatment involves a fairly long period of time, which depends on the timing of eliminating the underlying cause, i.e. the source of inflammation. As a symptom, pyuria can be neutralized within 7-10 days, but if the prescribed course of treatment is not followed, it can recur and become chronic. It is believed that the course of antibacterial therapy for UTI should be at least two weeks.