Pyuria

Pyuria typically greater than 10 white blood cells/mm3 urine... 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

Pyuria The presence of white blood cells in the urine, a known marker of inflammatory response to bacterial infection. 

The nitrite test can be used to detect the presence of nitrate-reducing bacteria in the urine (such as E. coli). The leukocyte esterase test is a rapid dipstick test to detect pyuria. 

Renal Urinary tract infection (flurbiprofen, meloxicam) elevated BUN (ketoprofen) hematuria cystitis azotemia nocturia proteinuria polyuria dysuria urinary frequency pyuria oliguria anuria. 

Adverse reactions occurring in 3% or more of patients receiving rifapentine combination therapy include the following Rash pyuria proteinuria hematuria urinary casts neutropenia lymphopenia hyperuricemia and an increase in ALT and AST. 

A randomized, double-blind, placebo-controlled trial suggests that the regular intake of cranberry juice reduces the frequency of bacteriuria and pyuria in elderly women. 

Other than in sensitive individuals, the aromatic nitro compounds are only moderately irritating to the skin, but very toxic to the liver, kidneys and nervous system. The basic mechanism of toxicity is stimulation of oxidative metabolism in cell mitochondria through interference with the normal coupling of carbohydrate oxidation to phosphorylation (ADP to AT ). The increased oxidative metabolism leads to pyrexia, tachycardia, dehydration and the ultimate depletion of fat stores. The most severe toxicity occurs when workers are concurrently exposed to hot, humid environments. Pyrexia and direct action on the brain cause cerebral edema, clinically evidenced by toxic psychosis and, at times, convulsions. Degenerative changes occur in the liver parenchyma, and renal tubules, and clinical signs of renal injury appear (albuminuria, hematuria, pyuria, increased BUN). 

LAP is also seen in the urine with very early glomerular disease (Bedir et al. 1996). The assay substrate is also a substrate for leukocyte esterase and thus increased neutrophils in the urine (pyuria) will cause a false positive result (Vlaskow et al. 2000). 

The presence of pyuria (more than 10 white blood ceUs/mm ) in a symptomatic patient correlates with significant bacteriuria. 

Of 23 indinavir-treated patients with persistent pyuria, four had interstitial nephritis, seven had urothelial inflammation, 10 had both interstitial nephritis and urothelial inflammation, and two had non-specific urinary tract inflammation (26). In all, 21 patients had multinucleated histiocytes identified by cytological testing of urine specimens. Urine abnormalities resolved in all 20 patients who stopped taking indinavir, and pyuria persisted in the other 3. Six patients had raised serum creatinine concentrations, which returned to baseline when indinavir was withdrawn. 

A single case of drug-induced cystitis has been reported. The patient had never taken tranUast, and the symptoms resolved on stopping ketotifen and recurred when the drug was restarted. Aseptic pyuria was found and cystoscopy revealed significant reddening over the urinary bladder (11). 

Allergic interstitial nephritis Penicillins, rifampin, sulfonamides, thiazides, cimetidine.phenytoin, allopurinol, furosemide, NSAIDS, ciprofloxacin, pantoprazole, omeprazole, atazanavir, bevacizumab Rash, fever, eosinophilia, eosinophiluria, pyuria... 

Sarcletti M, Petter A, Romani N, Ehotta K, Konig P, Maier H,and Zangerle R. Pyuria in patients treated with indinavir is associated with renal dysfunction. Clinical Nephrology 54 261-270,2000. 

The classical symptoms of drug-induced hypersensitivity reactions include fever, rashes, arthralgias, eosinophilia, eosinophiluria. Hematuria, sterile pyuria, moderate proteinuria and renal failure are observed in patients with drug-induced immune tubulointerstitial nephritis (discussed in [72]). The interstitial inflammatory cells include eosinophils, lymphocytes, monocytes. 

The decline in kidney function usually occurs within the first few days of therapy, and may be detected after only a few doses or, more rarely, later in the course of treatment [7-17]. Patients may be asymptomatic, but nausea, vomiting, and abdominal, back, or flank pain are common, while oliguria is uncommon. The rise in the serum creatinine concentration is usually modest, and dialysis has only rarely been necessary [18, 19] Most patients recover kidney function within 3 to 14 days of stopping acyclovir therapy, reducing the dose, or increasing hydration [7, 8,10-17, 20]. Chronic renal dysfunction has been only rarely attributed to oral acyclovir use Urinalysis usually shows mild proteinuria, microscopic hematuria, and variable degrees of pyuria. Birefringent needle-shaped crystals may... 

Patients with indinavir crystalluria may be asymptomatic or can develop clinical symptoms such as flank pain, back pain, dysuria, urinary urgency, fever, nausea, and vomiting. Pyuria and hematuria (commonly microscopic) may also be seen [131-133, 135-137, 138]. Indinavir crystals (Figure 1) are variable in their appearance by microscopy, usually with needle-shaped, plate-like, fan-shaped, or starburst-like appearances [131,133]. Ultrasound imaging is emerging as imaging modality of choice and may be more... 

Perazella MA, Kashgarian M, Cooney E. Indinavir nephropathy in an AIDS patient with renal insufficiency and pyuria. Clin Nephrol 1998 50 194-196. 

The presence of leukocyte esterase is indicative of pyuria. The detection of nitrite is indicative of the presence of bacteria that degrade nitrate excreted in the urine. The combination of the two tests is valuable in patients with urinary tract infection. The absence of both constituents is a valuable test to rule out urinary tract infection, thereby reducing the number of samples sent to the laboratory for further tests. The nitrite test may be less helpful in young children in whom the urine remains in the bladder for less time, thereby limiting the time for nitrite production. 

Avorn, J., Monane, M., Gurwit, J., Glynn, R., Choodnovskiy, I., and Lipsitz, L. 1994. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. Journal of the Americal Medical Association 271 751-754. 

Urine RBC - present (hematuria, microhematuria) Urine WBC - present (pyuria)... 

Acute allergic interstitial nephritis is the underlying cause for up to 3% of all cases of acute renal failure. Clinical manifestations of AIN typically present about 14 days after initiation of therapy and include fever, maculopapular rash, eosinophilia, pyuria, hematuria, proteinuria, and oliguria. 

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