Pyuria Research Articles

Urogenital Tuberculosis: A Narrative Review and recommendations for diagnosis and treatment.

to review the more relevant aspects of urogenital tuberculosis (UGT) and make recommendations about the diagnosis and treatment. a literature review was conducted in the Pubmed, Embase and Scielo databases in search of studies on UGT in the past 60 years. A narrative review was performed concerning six topics of UGT diagnosis and treatment. Recommendations were made supported on degrees of evidence according to the modified GRADE system. UGT suspicion occurs in persistent hematuria or pollakiuria with sterile pyuria; stenosis and/or thickening of the urinary tract; or chronic prostatitis or epididymitis. Urinary bacteriological tests have low sensitivity, and a negative test does not rule out UGT diagnosis. In ureteral stenosis, a double-J catheter or nephrostomy should be used early (up to 1 month) during pharmacological treatment and in single less than 2 cm stenosis endoscopic treatment may be attempted. Bladder augmentation with ileum, sigmoid or ileocecal segments should be performed when the contracted bladder capacity is less than 100 mL. Spontaneous voiding occurs in most patients after bladder augmentation. The diagnosis of UGT depends on a high degree of suspicion based on non-specific symptoms and radiological findings. Urinary bacteriological tests have low sensitivity, but even in the absence of diagnostic confirmation, treatment can be carried out through a combination of drugs for a period of six months. In the presence of ureteral stenosis or contracted bladder, complex but well stablished reconstruction procedures are necessary.

Scrotal and penile edema in a patient with incomplete kawasaki disease: a case report and brief literature review

BackgroundKawasaki disease (KD) is a medium artery vasculitis that predominantly affects children under age 5. Prompt diagnosis and treatment with IVIG and moderate dose aspirin is required to prevent the formation of coronary artery aneurysms. While scrotal edema and erythema have been seen in KD, here we present a distinctive case of incomplete Kawasaki with these features as well as penile edema.Case presentationA 2-year-old, unvaccinated, African American male presented with 4 days of fever, bilateral limbic sparing conjunctivitis, a papular rash, unilateral shotty cervical lymphadenopathy, mild right-hand edema, and scrotal and penile edema and erythema. His labs were significant for sterile pyuria, elevated ALT, anemia for age, and hypoalbuminemia. He was diagnosed with incomplete Kawasaki disease and was treated with IVIG and moderate dose aspirin. Echocardiogram was negative for coronary aneurysms. His symptoms resolved and he was discharged home with low dose aspirin. At his 2-week follow up, he remained well-appearing with no refractory Kawasaki symptoms.ConclusionThis is a unique case of penile edema in KD which to our knowledge has not been previously reported in literature. An understanding of genitourinary symptoms in Kawasaki disease can help timely diagnosis and treatment of the disease.

Kawasaki disease with shock as the primary manifestation: How to distinguish from toxic shock syndrome?: A case report and literature review.

Kawasaki disease (KD) is a vasculitis syndrome of small to medium-sized arteries that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. Cardiac manifestations, including coronary artery aneurysms, myocarditis, myocardial infarction, and sudden cardiac death, are the most serious complications observed in KD. On rare occasions, it may accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). KDSS is a serious complication that can be presented to the emergency department as an initial feature when typical clinical symptoms of KD have not be detected. We report the case of a 12-year-old boy admitted with prolonged fever, bilateral non-purulent conjunctivitis, and signs of shock such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers, hypoalbuminemia, and sterile pyuria. He was initially treated with intravenous cefotaxime and vancomycin considering the possible diagnosis of toxic shock syndrome, while the treatment was not effective. Subsequent chest computerized tomography and ultrasound identified pulmonary consolidation and polyserous effusion. Echocardiography revealed mild biatrial dilatation and mild valvular regurgitation with preserved left ventricular function. After a multidisciplinary consultation, a diagnosis of KDSS was made. To prevent coronary artery lesions and other severe complications, the patient immediately received immunoglobulin, corticoid, and acetylsalicylic acid. Soon afterwards, he showed significant improvement, with the temperature dropped to normal and hypotension corrected about 24 hours post-intravenous immunoglobulin therapy. Polyserous effusions also disappeared before discharge. Follow-up echocardiography revealed normal results. Clinicians should maintain a high index of suspicion for KD and consider pulmonary involvement and polyserous effusions as potential complications. For children with KD, any symptoms pointing to infection should be carefully considered. When there is no etiologic evidence, antibiotics should be used with caution. Our case also highlights the importance of considering KDSS as a differential diagnosis in children presenting with prolonged fever and shock. Early recognition, timely treatment, and close monitoring are key to preventing severe complications and ensuring favorable outcomes in patients with KDSS.

Pyuria in hospitalized general medical patients without urinary tract infection.

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm 3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63-75.8) % sensitive and 80.6(75.1-86.2) % specific. The positive and negative predictive values were 44.6 (37.7- 51.6) % and 92.1 (88.4 - 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

Pyuria in hospitalized general medical patients without urinary tract infection

Urine microscopy for detecting pus cells is a common investigation ordered in hospitalized general medical patients as part of routine care. A few previous studies have shown that sterile pyuria is not uncommon in this population. We studied the prevalence of pyuria among patients hospitalized with non-urinary tract infection (UTI) diagnosis in the medical wards. We excluded patients with asymptomatic bacteriuria (ASB). Pyuria was quantified in uncentrifuged urine using the chamber counting method, and ≥ 10 pus cells per mm3 was considered significant. We also compared this method with the commonly used but less accurate method of counting pus cells/high power field using centrifuged urine (routine method). We studied 196 patients; 113 (57.7%) were males. Most (175[89.3%]) patients were hospitalized for an infection. We found that 18.4% of the study group had sterile pyuria, and it was strongly associated with the presence of concomitant microscopic hematuria (unadjusted odds ratio, 3.74 [1.65 to 8.50]; P=0.002). We found no association of pyuria with female gender, diabetes, acute kidney injury, or current antibiotic use. By routine method, 56 (28.6 %) patients had significant pyuria. In comparison to the chamber counting method, the routine method was 69.4(63—75.8) % sensitive and 80.6(75.1—86.2) % specific. The positive and negative predictive values were 44.6 (37.7— 51.6) % and 92.1 (88.4 — 95.9) %. We concluded that sterile pyuria and microscopic hematuria could be present in a proportion of hospitalized general medical patients without UTI or ASB. Clinical judgment is essential in interpreting the significance of abnormal urinalysis reports.

Isolated Renal Mucormycosis by Apophysomyces in an Immunocompetent Adult

ABSTRACT Isolated renal mucormycosis (IRM) in an apparently healthy immunocompetent adult is a rare entity with most cases reported from India and China. Fever not responding to antibiotics, sterile pyuria, and characteristic imaging findings are strong pointers toward renal mucormycosis. We report a rare case of IRM due to Apophysomyces elegans in an apparently healthy young adult who underwent bilateral nephrectomy and ultimately succumbed to sepsis. Clinical indicators such as fever not responding to antibiotics, severe flank tenderness, sterile pyuria, and characteristic computed tomography findings (diffuse or patchy areas of absent contrast enhancement, perinephric fat stranding, and thickened Gerota’s fascia) are strong pointers toward renal mucormycosis. Aggressive surgical debridement and timely antifungal is imperative for favorable patient outcome in this aggressive infection.

Proportion of Urinary Tract Infection in Children between 6 Months to 5 Years of Age Presenting with Fever

Abstract Purpose: Fever serves as the most frequent cause of visits to emergency/outpatient pediatric departments among children under the age of five. Very frequently, the youngster is given antibiotics on an arbitrary basis without receiving the proper examination for a urinary tract infection (UTI). This study’s goals were to assess the prevalence of UTIs in febrile children between 6 months and 5 years of age. To study the proportion of UTIs in children between 6 months and 5 years presenting with fever. To study the association of various risk factors with UTI. Methodology: This Cross-sectional Descriptive observational research was done in the Pediatric department of tertiary care hospital from August 2020 to December 2022, in febrile kids between 6 months and 5 years age group using different variables. Association between two qualitative variables was seen by using Chi-square/Fischer’s exact test. A P < 0.05 was considered statistically significant whereas a P < 0.001 was considered highly significant. Results: Among the total study population, it was found that 5.58% of the patients with fever without focus had a UTI, while the majority of patients, 94.42% did not have a UTI but had fever without a specific focus. In UTI cases, urine culture growth patterns showed the presence of different isolates, including Escherichia coli (30.43%), Klebsiella (56.52%), Pseudomonas aeruginosa (8.7%), and Candida (4.34%). Conclusion: In the present research, the overall occurrence of UTI in children <5 years with fever without focus was 5.58%. Patients with significant pyuria and positive urine culture (UTI) were 43.75% and with significant pyuria but the sterile culture was 56.25%. So, it is concluded that significant pyuria can be sterile pyuria and cannot be labeled as UTI without confirmation on the urine culture report.

The prevalence of urogenital tuberculosis in people living with HIV

The prevalence of urogenital tuberculosis (UGT) is not well known, especially in people living with HIV, therefore, our aim was to identify the prevalence of urogenital tuberculosis in HIV-infected individuals and characterize the clinical and laboratory risk factors associated with UGT. A cross sectional study was conducted to characterize the prevalence of UGT in people living with HIV. PCR tests and specific culture were performed on samples from 181 patients living with HIV, divided into two groups: A) patients with suggestive UGT symptoms and b) hospitalized patients without any suggestive UGT symptoms. Only one case of UGT was diagnosed, with a positive PCR but negative specific culture, resulting in a prevalence of 0.55%. The patient had disseminated tuberculosis (miliary pulmonary, intestinal, and urogenital with bilateral nephromegaly) with acute febrile syndrome, no urogenital symptoms, but with microscopic hematuria and sterile pyuria. This patient had poorly controlled HIV infection with positive viral load and CD4 count below 200 cells/mm³. The prevalence of UGT in patients living with HIV is very low. However, patients with poorly controlled disease may present disseminated tuberculosis associated with UGT. Urine screening for UGT may be relevant for diagnosing disseminated tuberculosis in patients living with HIV with acute infectious syndrome.

A patient with Tuberculous para-valvular leak and tuberculous hepatic abscesses treated conservatively with anti-tuberculous medication without the need for surgical intervention. “Case report”

Introduction: We report a case of a young lady with rheumatic heart disease who underwent mechanical prosthetic mitral valve replacement and tricuspid valve repair. The case was complicated after one year by multi system tuberculous abscesses, para-valvular leak and hemolytic anemia. Case summary: The case started one year following mechanical prosthetic mitral valve replacement, and after contact with a tuberculous patient. The lady developed, sterile pyuria, two tuberculous hepatic abscesses, and a big pelvic tuberculous abscess. She first needed percutaneous drainage for the pelvic abscess followed by laparotomy and surgical drainage after recurrence. The case was complicated by Para-valvular leak in the prosthetic mitral valve detected by Transoesophageal echocardiography as well as refractory hemolytic anemia needing multiple transfusions. She required six months of anti-tuberculous therapy for the hemolysis to stop. Treatment continued for a total of one year of anti-tuberculous therapy. The patient restored normal valve dynamics and hematological parameters without the need for surgical intervention for the para-valvular leak. Conclusion: We report this case to show that small tuberculous para-valvular leak and hemolytic anemia as well as tuberculous hepatic abscesses can be treated medically as an alternative option to the well-known and recommended surgical indication. We also confirm delayed healing of the abdominal surgical wound due to tuberculosis.

Comparing the adverse effects of ketamine and esketamine between genders using FAERS data.

Ketamine was developed as an anesthetic. Esketamine is the isolated S-enantiomer of racemic ketamine. They provide new avenues for the treatment of depression, especially treatment-resistant depression. Considering differences in the pharmacokinetics and hormonal status of ketamine in patients of different genders, sex-based differences in esketamine adverse drug events (ADE) may also be observed. This study presents data mining and safety analysis of adverse events of ketamine and esketamine between genders, promoting the individualization of clinical practice. Adverse drug reactions to ketamine and esketamine reported between the first quarter of 2004 and the second quarter of 2023 in the U.S. Food and Drug Administration on Adverse Event Reporting System (FAERS) were extracted. Thereafter, the reporting odds ratio (ROR) with 95% confidence interval (CI) was calculated. A total of 2907 female reports and 1634 male reports on esketamine were included in the analysis. ROR mining showed that completed suicide, decreased therapeutic product effects, urinary retention, and hypertension were common in men. Additionally, 552 female and 653 male ketamine reports were recorded. ROR mining revealed that toxicity to various agents, bradycardia, cystitis and agitation, were more likely to occur in men, whereas women were more likely to develop suicidal ideation, increased transaminase levels, sclerosing cholangitis, and sterile pyuria. The adverse events of esketamine and ketamine differ across genders, which should be considered in clinical practice to provide individualized treatment.

Poncet’s disease, an uncommon manifestation of a common disease: a case report

Poncet’s disease is a form of reactive arthritis caused by active extra-articular tuberculosis. Limited data available on this rare disease has hindered a complete understanding of it. Even though its prevalence was previously disputed, the incidence has recently been increasing, prompting the need for improved knowledge. Polyarthritis can be the only initial symptom preceding overt manifestation, and it can cause disabling pain, leading to restricted mobility and function. However, even in the context of active tuberculosis, polyarthritis of Poncet’s disease can be misinterpreted as another rheumatological disease that presents similarly.We report a 47-year-old woman, who presented with inflammatory polyarthritis in the background of recurrent sterile pyuria with obstructive uropathy which was due to active genitourinary tuberculosis. She showed a dramatic resolution of symptoms following the initiation of anti-tuberculous treatment.We suggest that tuberculosis should be considered as a differential diagnosis for patients presenting with atypical joint pain, particularly in regions where tuberculosis is endemic.

Bacterial Etiology And Their Antibiograms in Community Acquired Urinary Tract Infections with Special Consideration on Sterile Pyuria

Bacterial Etiology And Their Antibiograms in Community Acquired Urinary Tract Infections with Special Consideration on Sterile Pyuria

#3652 ACUTE KIDNEY INJURY (AKI) IN CANCER PATIENTS TREATED WITH COMBO THERAPIES: CHEMOTHERAPY, OR IMMUNOTHERAPY, THAT IS THE QUESTION

Abstract Background and Aims Lung cancer is the second most common malignancy in men and the third in women and approximately 85% of all cases are constituted by non-small cell carcinoma (NSCLC). In recent years, the introduction of immune checkpoint inhibitors and molecular targeted therapies, as monotherapy or in association with chemotherapy, has revolutionized the treatment of NSCLS. Pembrolizumab in association with pemetrexed and carboplatin, for instance, has been approved as first-line treatment for non-squamous NSCLC. Nephrotoxic side effects of both old and new therapies continue to be a substantial adverse event (AE) and could preclude effective oncological treatment. When a patient in combined oncological therapy develops AKI it is not always easy to establish which drug is responsible of the AE. The objective of our study was to develop a diagnostic algorithm to help the clinician to diagnose and manage AKI in patient treated with pembrolizumab + pemetrexed +/- carboplatin. Method We performed a retrospective multicentric data collection. We analyzed data about all the patient referred to the onconephrology outpatient clinic due to AKI (Stage 2 or higher) during oncological treatment with pembrolizumab + pemetrexed +/- carboplatin, from 2020 to 2022. AKI stages were identified according to KDIGO guidelines and CTCAE 5.0. We focused on the following data: chemical-physical urinalysis, urinary electrolytes, serum electrolytes, kidney function (AKI progression and trend of renal function after oncological drug discontinuation). Results A cohort of 89 patients was analyzed: 54 males (61%) and 35 females (39%), with an average age of 69 years (51-76). The main comorbidities were hypertension (76%), diabetes mellitus (36%), CKD (64%) and cardiovascular diseases (26%). Overall, 11 patients (12%) had a non drug-related AKI, 90% of which due to pre-renal causes. 43 patients developed immune-related AKI; among these 23 pts had sterile pyuria and/or WBC casts, 35 pts had other organ IrAEs, 32 pts had AKI progression upon discontinuation of oncological therapy, and 37 pts had an increase in serum creatinine ≥1 mg/dl between two consecutive pretherapy blood tests. Chemotherapy-induced nephrotoxicity occurred in 35 patients and had the following features: hypo K or hypo Mg in 9 pts, increased urinary electrolytes in 16 pts, stable renal function after oncological drugs discontinuation in 32 pts and an increase in serum creatinine ≤0,5 mg/dl between two consecutive pretherapy blood tests in 27 pts. Characteristics of drug-related AKI are summarized in Table 1. Conclusion One of the main challenges with patients on multiple cancer therapies who develop AKI is to identify the possible drug responsible for the nephrotoxicity to avoid unnecessary suspension of one or more oncological drugs. Although the most frequently suggested approach is the execution of the renal biopsy, it is not always possible to perform it in a short time due to difficulties in organizing the diagnostic procedure and the time necessary for the histological analysis. Furthermore, Oncological Guideline recommend starting steroid therapy as soon as the Grade ≥2 immune related AEs develop. The above retrospective results shed light on the main characteristic of AKI due to immunotherapy or chemotherapy; the information obtained helped us to develop a diagnostic algorithm that addresses the clinician in identifying with reasonable certainty the cause of AKI without the need to perform a renal biopsy (Figure 1).

#5781 DRUG-INDUCED ACUTE INTERSTITIAL NEPHRITIS (D-AIN): HOW TO IDENTIFY THE RESPONSIBLE DRUG?

Abstract Background and Aims The mainstay of D-AIN treatment is the removal of the responsible drug. However, it is not always easy to identify the culprit drug as this entity mainly affects elderly patients on multiple medications, they rarely associate systemic symptoms (rash, fever), and the timeline regarding the diagnosis and the associated drug is not always clear. Therefore, the diagnosis and treatment are delayed, making full renal function recovery less likely. The lymphocyte transformation test (LTT) has demonstrated to be useful in the identification of the involved drug in other hypersensitivity-mediated lymphocyte T diseases such as Stevens-Johnson Syndrome or Dress Syndrome. For this reason, we wonder if this test could be relevant in identifying the responsible drug in D-AIN. The aim of this study is to test LTT in patients with clinical and histological diagnosis of D-AIN. Method We have conducted a retrospective observational study in which we have collected data from 2019 to 2022 from our electronic databases. Results: We have registered 9 cases of D-AIN diagnosed with histological confirmation in whom the LTT had been performed. 22.2% of these patients were men. The mean age was 48.1 years (standard deviation of 15.8). None of them had previous chronic kidney disease (CKD). Mean peak creatinine at diagnosis was 4.66 mg/dl (standard deviation of 1.95). Regarding the typical symptoms of the D-AIN, three patients (33%) presented with fever and none of them suffered from rash. 6 patients had sterile pyuria (66%). All of them received steroid treatment. Concerning the LTT results, 7 cases were positive for one of the drugs the patient was taking, and 2 were negative. Among the positive cases, the identified drugs were 1 case of beta lactams (piperacillin), 1 case of PPIs (omeprazole), 1 case of metamizole, 1 case of paracetamol, 1 case of eslicarbazepine and 2 cases of NSAIDs (dexketoprofen), while the negative cases have not been suspected of taking any culprit drug. Conclusion LTT may be a useful test to identify the responsible drug for D-AIN, especially in patients taking multiple medications in which may be included some of great importance like immunotherapy (typical cause of D-AIN) in oncological treatments. In negative cases, it could be expected that the patient had taken medications difficult to be identified in the clinical history or, in some situations, the drug hapten responsible for kidney damage might be a drug metabolite and not the drug itself, which cannot be detected by the test.

Kawasaki disease in Malaysia: Biochemical profile, characterization, diagnosis and treatment.

Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the East Asian countries. Nevertheless, to date, the data on KD in Malaysia are limited. This study aimed to evaluate the epidemiology, clinical features, treatment, and outcomes of KD among the pediatric patients admitted to Hospital Canselor Tunku Muhriz (HCTM), Kuala Lumpur, Malaysia. A retrospective cohort study of 66,500 pediatric patients presented at HCTM from the year 2004 to 2021 was conducted. 62 KD cases out of 66,500 pediatric admissions were reported, with a male-to-female ratio of 1.58 to 1. Majority of KD patients (95.0%) were younger than 5 years old. Prior infection was reported in 5 KD patients (8.1%). Apart from the classical features, manifestations of various organ systems including cardiovascular (16.1%), gastrointestinal (43.5%), neurological (1.61%), musculoskeletal (1.61%), and genitourinary (17.7%) systems were observed. There was a significant association between sterile pyuria and coronary artery aneurysm (CAA) (p < 0.05). Interestingly, abnormal liver parameters (p < 0.05) and incomplete KD (p < 0.05) were significantly related to IVIG resistance. The presence of family history, immunological disorder, and previous infection in our KD patients suggested that there is a possibility of genetic, immunological, and infectious roles in the pathophysiology of KD. IVIG resistance is more likely to occur in KD patients with hepatic dysfunction or incomplete KD presentation. These findings highlighted the significant contribution of laboratory parameters to the prognosis of KD, prompting more in-depth research on the KD scoring systems and their relevance in this country.

Detection of urogenital pathogens in sterile pyuria samples by polymerase chain reaction

BackgroundPatients with sterile pyuria may be infected with sexually transmitted diseases or have renal tuberculosis. This study investigated the possibility of detecting sexually transmitted diseases and Mycobacterialtuberculosis in sterile pyuria samples with polymerase chain reaction.MethodsForty-four day-3 negative urine culture samples were investigated for the presence of sexually transmitted diseases and Mycobacterialtuberculosis.ResultsAmong the 44 samples, 61.4% were positive by polymerase chain reaction (PCR) for bacterial DNA (either sexually transmitted diseases or Mycobacteria). Among the 27 positive samples, 37% were positive for Ureaplasmaurealyticum, 26% were positive for Chlamydiatrachomatis, 14.8% were positive for Neisseriagonorrhoeae, 11.1% were positive for Mycoplasmagenitalium, 7.4% were positive for Mycoplasmahominis, and only one sample (3.7%) was positive for Mycobacterialtuberculosis. No significant associations were found between PCR-positive urine samples and patient characteristics.ConclusionsIt was concluded that Ureaplasmaurealyticum was predominant in sterile pyuria followed by Chlamydiatrachomatis. There were no significant associations between PCR-positive samples and sex, symptomatic patients, or antibiotic use. PCR is an instant diagnostic tool for sexually transmitted diseases in sterile pyuria; hence, it is advised to be performed on negative culture samples as a routine laboratory screening test whenever possible.

Sterile Pyuria in Kawasaki Disease: A Large Prospective Cohort Study

BackgroundKawasaki disease (KD) is an acute systemic vasculitis and is becoming the leading cause of acquired cardiac disease in Children. Sterile pyuria is a known complication of KD. However, its associations with the inflammatory reaction severity, IVIG resistance as well as coronary artery lesions (CALs) in KD remain elusive.AimsWe aimed to analyze the clinical profiles of sterile pyuria in KD, to determine whether sterile pyuria is an indicator of the disease severity in patients with KD, and to assess the associations between sterile pyuria and IVIG resistance as well as CALs.MethodsWe prospectively collected data from 702 patients with KD between January 2015 and June 2020. Profiles of patients with sterile pyuria (group A, n = 63) were compared to those of patients without sterile pyuria (group B, n = 639). The associations between sterile pyuria and IVIG resistance as well as CALs in KD were further determined by univariate and/or multivariate logistic regression analysis.ResultsSterile pyuria was observed in 9.0% of patients with KD, without predominance in age spectrum and gender. The levels of neutrophil percentages, alanine transaminase, total bilirubin, blood urea nitrogen, creatinine, the incidence of initial IVIG resistance, and rate of moderate/giant coronary artery aneurysms (CAAs) were significantly higher in group A than that in group B. Sterile pyuria was identified as an independent risk factor for initial IVIG resistance, yielding high specificity (92.7%) and low sensitivity (18.5%). However, sterile pyuria was not associated with repeated IVIG resistance and persistence of CALs in KD.ConclusionThe incidence of sterile pyuria is relatively low in KD patients. Patients with sterile pyuria in KD exhibited a more severe inflammatory burden and were more likely to develop the initial IVIG resistance and moderate/giant CAAs. The overall prognosis of KD patients with sterile pyuria was satisfactory.

Diagnostic Value of Urine Ribonuclease 7 (RNase 7) to Creatinine Ratio for Detecting Urinary Tract Infection in Children with Pyuria

Abstract Objective Ribonuclease 7 (RNase 7) is one of the members of the antimicrobial peptides playing a role in maintaining urinary tract sterility. We aimed to investigate the predictive value of the urine RNase 7 levels in children with pyuria and associations between RNase 7 and vesicoureteral reflux (VUR) and renal scarring. Methods This study included 109 children with pyuria (46 febrile urinary tract infections [UTIs], 38 nonfebrile UTIs, and 25 sterile pyuria) whose RNase 7 levels were measured by enzyme-linked immunoassay. The results for urine RNase 7 concentrations were expressed as micrograms per milligrams creatinine. Results RNase 7/Cr levels were higher in patients with both febrile and nonfebrile UTIs than the patients with sterile pyuria (p = 0.001). RNase 7/Cr had predictive values of diagnosis of febrile and nonfebrile UTIs (cut-off value: 2.92 µg/mg, p = 0.003; cut-off value: 3.67 µg/mg, p &lt; 0.001, respectively). RNase 7/Cr had higher levels in the patients with VUR than without VUR (cut-off value: 4.28 µg/mg, p = 0.037). The patients with renal scarring had higher urine RNase 7/Cr than those without scarring (cut-off value: 4.54 µg/mg, p = 0.041). Conclusion The evaluation of RNase 7/Cr may help prevent unnecessary and/or inappropriate antibiotic use in children with pyuria. The higher RNase 7 levels in patients with VUR and renal scarring may reflect long-term inflammation or greater inflammatory response during acute infection.

The diagnostic utility of cystoscopy in assessing patients with persistent microscopic abnormalities of urinalysis

BackgroundMicroscopic abnormalities are common findings on routine urinalysis performed for various clinical reasons. As a small proportion of these may indicate an underlying malignancy, a large number of patients with these abnormalities are referred for further investigations, which includes a cystoscopy. We aim to investigate the diagnostic utility of cystoscopy in detecting malignancy in this group of patients.MethodsA retrospective review of patients who underwent standard diagnostic workup for microscopic abnormalities of urinalysis (microscopic haematuria, sterile pyuria and bacteriuria) between January 2013 and December 2018 was performed. Patients with macroscopic haematuria, concurrent UTI, recent kidney stone passage, dysmorphic red cells, proteinuria and casts on urinalysis were excluded. Demographic information, age at diagnosis, smoking status and final diagnosis were extracted.ResultsIn total, 552 patients identified. 58% of the patients are males (319 patients). The mean age was 61 years with 35% patients having a history of smoking. 94% of the patients underwent pre-cystoscopy imaging. Twelve (2%) patients had a final diagnosis of genitourinary malignancy. Out of the 12 patients diagnosed with malignancy, pre-cystoscopy imaging detected a bladder lesion in 11 (92%) patients.ConclusionsThe incidence of genitourinary malignancy in patients with persistent microscopic abnormalities of urinalysis is low at 2%. In our cohort, flexible cystoscopy demonstrated little additional diagnostic value with only 1 malignancy (0.2%) detected by flexible cystoscopy alone. Hence, we may have to reconsider our current threshold in investigating this group of patients.

Acute interstitial nephritis: clinical presentation and diagnosis

Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute interstitial nephritis typically presents with acute renal failure, alone or with fever, eosinophilia, hematuria, sterile pyuria and small range proteinuria. An early diagnosis is crucial to prevent the morbidity and mortality associated with renal function decline. The most frequent etiology of this disease is drug-induced. A kidney biopsy is not systematically required to establish the diagnosis. It should be considered in the absence of renal function improvement 5 to 7 days after withdrawal of the causal agent. Although the benefits of glucocorticoid treatment have not been proven to date, its use may be associated with a better kidney function recovery.