Belo Horizonte, 07 de abril de 2011.

Prezado Bruno,

Conforme solicitado, encaminho parte de algumas citações nas quais são expostas
situações onde a piúria e flora escassa são detectadas. Isoladamente esta situação é
possível, porém ressaltamos que a interpretação do resultado laboratorial deve ser
correlacionada com a clínica.

Acute urethral syndrome: Acute urethral syndrome, which occurs in women, produces dysuria
and pyuria (dysuria-pyuria syndrome) due to bacterial urinary pathogens. Occasionally, it is
caused by N. gonorrhoeae, TB, or fungal disease or by trauma or inflammation of the urethra.
Patients with acute urethral syndrome have dysuria, frequency, and pyuria, but urine culture in
5
these patients shows colony counts that are <10 /mL, which is less than the traditional criterion
for bacterial UTI.

Citado em: http://www.merckmanuals.com/professional/sec17/ch231/ch231b.html

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Indian Journal of Pediatrics

Volume 48, Number 6, 753-756, DOI: 10.1007/BF02758542

ORIGINAL ARTICLES

Urinary tract infection: correlation of pyuria, bacteriuria with urine

culture

A. C. Parija, M. Padhi and S. K. Sen

Abstract

Three hundred cases were analysed to find out value of direct smear examination, pus cell
count and their correlation with culture method for diagnosis of urinary tract infection in children.
Of 132 specimens with significant pyuria in uncentrifuged urine, and 102 specimens with
significant pyuria in centrifuged urine, 54(40.9%) and 42(41%) cases respectively showed
absence of bacteriuria. There was no satisfactory correlation between pyuria and bacterial
colony count. Gram stain smear examination of the centrifuged urine showed high correlation

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with bacterial count in urine cultures. This is a good method in the absence of microbiology
laboratory for the diagnosis of urinary tract infection.

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Pyuria is the presence of white blood cells (leukocytes) in the urine. Pyuria is not a diagnosis. It
is a laboratory finding in many diseases, most commonly urinary tract infections (UTI). Pyuria
usually indicates that bacteria have invaded the upper or lower urinary tract (bacteriuria)
invoking an inflammatory response of the lining of the urinary tract (urothelium) in that location.
Pyuria may also be found in the absence of infection and is frequently asymptomatic. When
pyuria is present without the presence of bacteria, its cause is unclear, although "silent" or
unrecognized kidney infection may be suspected as well as tuberculosis, renal stones, or
cancer. Almost half of chronically incontinent individuals or those with indwelling catheters,
(primarily elderly long-term care patients), exhibit asymptomatic pyuria. However, urinary tract
infection can also be asymptomatic in the elderly. In the absence of infection, asymptomatic
pyuria is not usually treated.

Citado em: http://www.mdguidelines.com/pyuria

Compr Ther. 2000 Fall;26(3):150-2.

Sterile pyuria: a differential diagnosis.

Dieter RS.

Department of Medicine, University of Wisconsin, Madison 53562, USA.

Abstract
Sterile pyuria is not an uncommon laboratory finding. This article explores the major causes of

sterile pyuria, including infectious, systemic, structural and physiologic, and drug-related

causes. It also discusses the differential diagnosis of eosinophiluria and the basic workup of

sterile pyuria.

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N Z Med J. 1999 Oct 22;112(1098):412.

Chlamydia trachomatis as a significant cause of sterile pyuria.

Dowling JR, McCarthy M, Riley D, Morris AJ.

Lupus. 2001;10(6):418-23.

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Significance of isolated hematuria and isolated pyuria in systemic

lupus erythematosus.

Rahman P, Gladman DD, Ibanez D, Urowitz MB.

Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University

Health Network, University of Toronto, Ontario, Canada.

Abstract
Hematuria or sterile pyuria as isolated urinary findings present a clinical dilemma for the treating

physician. Our objective was to determine whether isolated hematuria and isolated sterile pyuria

are associated with active systemic lupus erythematosus (SLE) with respect to renal and non-

renal disease activity. This is a descriptive study from a large SLE cohort followed prospectively

at the University of Toronto Lupus Clinic. All episodes of isolated hematuria and isolated pyuria

between 1970 and 2000 were identified from our database. Isolated hematuria was defined as >

5 red blood cells per high power field; isolated sterile pyuria was defined as > 5 white blood cells

per high power field in the absence of urinary infection and other renal manifestations. Non-

renal disease activity (defined as nrSLEDAI > 1) was determined at first episode of isolated

hematuria and pyuria. Renal disease activity was assessed by scoring renal biopsies within 3

months of detecting isolated hematuria or sterile pyuria. Thirty-four percent (323/946) of our

cohort had at least one episode of isolated hematuria. Seventy-seven percent of these patients

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had concurrent non-renal disease activity. Of the 22 biopsies scored with isolated hematuria,

96% were abnormal (WHO > class I), including 52% with active nephritis. Twenty-three percent

(215/946) had at least one episode of isolated sterile pyuria. Seventy-eight percent of these

patients had concurrent non-renal disease activity. All 12 biopsies scored with isolated pyuria

were abnormal (WHO Class > 1), including 75% with active nephritis. The appearance of

isolated hematuria and isolated pyuria is associated with active renal and non-renal disease

activity. An ongoing debate has emerged regarding the significance of isolated hematuria and

isolated pyuria with respect to SLE disease activity. The results of this study suggest that

isolated hematuria and isolated pyuria is associated with active renal and non-renal disease

activity. Thus isolated hematuria and isolated sterile pyuria should be considered manifestations

of active SLE.

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Pediatr Nephrol. 2004 Mar;19(3):363. Epub 2004 Jan 24.

Sterile pyuria in Kawasaki disease.

Wirojanan J, Sopontammarak S, Vachvanichsanong P.

Atenciosamente,

Assessoria Científica.

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