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| align="center" style="background:#F5F5F5;" + |PCR viral load
| align="center" style="background:#F5F5F5;" + |PCR viral load
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
*  Increased risk in immunosuppressed kidney transplant patients
*  Increased risk in immunosuppressed [[Kidney transplantation|kidney transplant]] patients
* CMV, EBV, BK virus, adenovirus might be seen
* [[Cytomegalovirus infection|CMV]], [[Epstein Barr virus|EBV]], [[BK virus]], [[Adenoviridae|adenovirus]] might be seen
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Tuberculosis]]<ref name="pmid26123266">{{cite journal |vauthors=Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A |title=Urinary tuberculosis: a cohort of 79 adult cases |journal=Ren Fail |volume=37 |issue=7 |pages=1157–63 |date=August 2015 |pmid=26123266 |doi=10.3109/0886022X.2015.1057460 |url=}}</ref><ref name="pmid27865246">{{cite journal |vauthors=Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A |title=Renal tuberculosis presenting as acute pyelonephritis - A rarity |journal=Indian J Tuberc |volume=63 |issue=3 |pages=210–213 |date=July 2016 |pmid=27865246 |doi=10.1016/j.ijtb.2015.07.010 |url=}}</ref><ref name="pmid23303798">{{cite journal |vauthors=Daher Ede F, da Silva GB, Barros EJ |title=Renal tuberculosis in the modern era |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=1 |pages=54–64 |date=January 2013 |pmid=23303798 |pmc=3541747 |doi=10.4269/ajtmh.2013.12-0413 |url=}}</ref><ref name="pmid28784884">{{cite journal |vauthors=Czapka M, Shukla S, Slosar-Cheah M |title=Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=August 2017 |pmid=28784884 |doi=10.1136/bcr-2017-220440 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Tuberculosis]]<ref name="pmid26123266">{{cite journal |vauthors=Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A |title=Urinary tuberculosis: a cohort of 79 adult cases |journal=Ren Fail |volume=37 |issue=7 |pages=1157–63 |date=August 2015 |pmid=26123266 |doi=10.3109/0886022X.2015.1057460 |url=}}</ref><ref name="pmid27865246">{{cite journal |vauthors=Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A |title=Renal tuberculosis presenting as acute pyelonephritis - A rarity |journal=Indian J Tuberc |volume=63 |issue=3 |pages=210–213 |date=July 2016 |pmid=27865246 |doi=10.1016/j.ijtb.2015.07.010 |url=}}</ref><ref name="pmid23303798">{{cite journal |vauthors=Daher Ede F, da Silva GB, Barros EJ |title=Renal tuberculosis in the modern era |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=1 |pages=54–64 |date=January 2013 |pmid=23303798 |pmc=3541747 |doi=10.4269/ajtmh.2013.12-0413 |url=}}</ref><ref name="pmid28784884">{{cite journal |vauthors=Czapka M, Shukla S, Slosar-Cheah M |title=Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=August 2017 |pmid=28784884 |doi=10.1136/bcr-2017-220440 |url=}}</ref>
Line 168: Line 168:
* Microscopic hematuria +
* Microscopic hematuria +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Pulmonary TB on chest CT
| align="center" style="background:#F5F5F5;" + |[[Tuberculosis|Pulmonary TB]] on chest CT
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Urine mycobacterial PCR
| align="center" style="background:#F5F5F5;" + |Urine mycobacterial [[Polymerase chain reaction|PCR]]
| align="center" style="background:#F5F5F5;" + |Past history of pulmonary TB
| align="center" style="background:#F5F5F5;" + |
* Past history of [[Tuberculosis|pulmonary TB]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fungal]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Fungal]]

Revision as of 19:08, 31 May 2018

Pyuria Differential Diagnosis

Differentiating the diseases that can cause pyuria:[1][2][3][4]

Category Disease Clinical manifestations Para−clinical findings Gold standard for diagnosis Associated findings
Symptoms Physical examination
Lab Findings Imaging
Pain Fever N/V Urinary symptoms BP Edema Other CBC Electrolytes Urinalysis Ultrasound CT scan Other
Dysuria Frequency Urgency Gross hematuria Cell Cast Bacteriuria Culture Other
Infectious diseases UTI[5] Bacterial Asymptomatic bacteriuria[6][7] − − − − − − − Nl − − Nl Nl ± − + − − − − − Urinalysis
  • Increased risk in pregnancy
  • Must be treated prior to an invasive urologic procedure
Cystitis[8] − − − + + + − Nl − − Nl Nl ↑ − + + − − − Urinalysis
Pyelonephritis[9] + + + + + + − Nl − − WBC ↑ Nl ↑ WBC cast + + − − − Clinical manifestation + urinalysis
Viral[10][11] − − + + + + ± Nl − − Nl Nl ↑ − − − − − − − PCR viral load
Tuberculosis[12][13][14][15] − ± − + + + + Nl − − Nl Nl ± − − Positive mycobacterial urine culture
  • Microscopic hematuria +
 − Pulmonary TB on chest CT − Urine mycobacterial PCR
Fungal
STD Chlamydia
Gonococcus
Ureaplasma urealyticum
HSV−2
Herpes zoster
HPV
HIV
Prostatitis
Balanitis
PID
Appendicitis
Category Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Edema Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Ultrasound CT scan Other imaging Gold standard for diagnosis Associated findings
Non−infectious diseases Urinary tract disorders Urinary catheterization
Urinary tract stone
Urinary tract neoplasm
Urinary fistula
Interstitial cystitis
Vesicoureteral reflux
Hydronephrosis
Renal diseases Polycystic kidney disease
Renal vein thrombosis
Interstitial nephritis
Papillary necrosis
IgA nephropathy
Renal transplant rejection
Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Edema Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Ultrasound CT scan Other imaging Gold standard for diagnosis Associated findings
Systemic disease Malignant hypertension
Diabetic nephropathy
Sickle cell disease
Sarcoidosis
Systemic lupus erythematosus
Sjögren’s syndrome
Kawasaki's disease
Graft versus host disease (GVHD)
Medication/toxin Analgesic nephropathy
Contrast−induced nephropathy
Glucocorticoids
Toluene
Lead poisoning
Category Disease Pain Fever N/V Dysuria Frequency Urgency Gross hematuria BP Edema Other PE CBC Electrolytes Cell Cast Bacteriuria Culture Other UA findings Ultrasound CT scan Other imaging Gold standard for diagnosis Associated findings
  1. ↑ Wise, Gilbert J.; Longo, Dan L.; Schlegel, Peter N. (2015). "Sterile Pyuria". New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 0028-4793.
  2. ↑ Stamm, Walter E. (1983). "Measurement of pyuria and its relation to bacteriuria". The American Journal of Medicine. 75 (1): 53–58. doi:10.1016/0002-9343(83)90073-6. ISSN 0002-9343.
  3. ↑ Groah, Suzanne; Perez-Losada, Marcos; Caldovic, Ljubica; Ljungberg, Inger; Sprague, Bruce; Castro-Nallar, Eduardo; Shah, Neel; Hsieh, Michael; Pohl, Hans (2015). "MP20-08 PYURIA AND ASYMPTOMATIC BACTERIURIA IS ASSOCIATED WITH NOVEL AND SPECIFIC URINE MICROBIOMES". The Journal of Urology. 193 (4): e226. doi:10.1016/j.juro.2015.02.980. ISSN 0022-5347.
  4. ↑ Shaikh, N.; Shope, T. R.; Hoberman, A.; Vigliotti, A.; Kurs-Lasky, M.; Martin, J. M. (2016). "Association Between Uropathogen and Pyuria". PEDIATRICS. 138 (1): e20160087–e20160087. doi:10.1542/peds.2016-0087. ISSN 0031-4005.
  5. ↑ Neal DE (February 2008). "Complicated urinary tract infections". Urol. Clin. North Am. 35 (1): 13–22, v. doi:10.1016/j.ucl.2007.09.010. PMID 18061020.
  6. ↑ Nicolle, Lindsay E. (2014). "Asymptomatic bacteriuria". Current Opinion in Infectious Diseases. 27 (1): 90–96. doi:10.1097/QCO.0000000000000019. ISSN 0951-7375.
  7. ↑ Nicolle, Lindsay E. (2015). "Asymptomatic Bacteriuria and Bacterial Interference". Microbiology Spectrum. 3 (5). doi:10.1128/microbiolspec.UTI-0001-2012. ISSN 2165-0497.
  8. ↑ Sabih A, Leslie SW. PMID 28613784. Missing or empty |title= (help)
  9. ↑ Pietrucha-Dilanchian P, Hooton TM (December 2016). "Diagnosis, Treatment, and Prevention of Urinary Tract Infection". Microbiol Spectr. 4 (6). doi:10.1128/microbiolspec.UTI-0021-2015. PMID 28087935.
  10. ↑ Aboumohamed A, Flechner SM, Chiesa-Vottero A, Srinivas TR, Mossad SB (November 2014). "Disseminated adenoviral infection masquerading as lower urinary tract voiding dysfunction in a kidney transplant recipient". Clin. Nephrol. 82 (5): 332–6. doi:10.5414/CN107977. PMID 23816478.
  11. ↑ Santiago-Rodriguez TM, Ly M, Bonilla N, Pride DT (2015). "The human urine virome in association with urinary tract infections". Front Microbiol. 6: 14. doi:10.3389/fmicb.2015.00014. PMC 4304238. PMID 25667584.
  12. ↑ Altiparmak MR, Trabulus S, Balkan II, Yalin SF, Denizli N, Aslan G, Doruk HE, Engin A, Tekin R, Birengel S, Cetin BD, Arslan F, Turhan V, Mert A (August 2015). "Urinary tuberculosis: a cohort of 79 adult cases". Ren Fail. 37 (7): 1157–63. doi:10.3109/0886022X.2015.1057460. PMID 26123266.
  13. ↑ Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A (July 2016). "Renal tuberculosis presenting as acute pyelonephritis - A rarity". Indian J Tuberc. 63 (3): 210–213. doi:10.1016/j.ijtb.2015.07.010. PMID 27865246.
  14. ↑ Daher Ede F, da Silva GB, Barros EJ (January 2013). "Renal tuberculosis in the modern era". Am. J. Trop. Med. Hyg. 88 (1): 54–64. doi:10.4269/ajtmh.2013.12-0413. PMC 3541747. PMID 23303798.
  15. ↑ Czapka M, Shukla S, Slosar-Cheah M (August 2017). "Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome". BMJ Case Rep. 2017. doi:10.1136/bcr-2017-220440. PMID 28784884.
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