pyuria
Introduction
Introduction Pyuria refers to a large amount of pus cells in the urine, that is, white blood cells. The pus cells clinically referred to are degenerated white blood cells, so the disease is also called white blood cell urine. Leukocyte system refers to intact cells with no obvious degeneration, and the intracellular structure is clear; pus cells refer to neutrophils that are destroyed during inflammation, irregular in shape, unclear intracellular structure, and filled with particles in the slurry. The nucleus is invisible, and it is easy to aggregate into a group called pus. White blood cells and pus cells appear to have the same clinical significance in the urine.
Cause
Cause
Bacteria are the main cause of pyuria. The most common bacilli are Escherichia coli, which accounts for 60%-80%, followed by E. coli, Proteus, Staphylococcus, Streptococcus faecalis, Alcaligenes, and Aerogenes. Complex pyelonephritis common Pseudomonas aeruginosa. In rare cases, two or more bacteria are simultaneously infected with a mixed infection. In addition to bacteria, mold, protozoa (filaria), Egyptian schistosomiasis, trichomoniasis, hydatid, giant virus (children are prone to occur). The urinary system tuberculosis caused by Mycobacterium tuberculosis is a bacterial infection but has a special clinical manifestation.
Examine
an examination
Related inspection
Shigella bacilli detect urinary sediment epithelial cells urinary sediment white blood cells (WBC, LEU) urinary sediment urine specific gravity
1. Accompanying symptoms
Pyuria with renal colic, suggesting that the lesion is found in the kidney in kidney stones, kidney abscess, polycystic kidney disease. Accompanied by systemic infection symptoms suggest upper urinary tract infection. Should pay attention to low back pain in the medical history, symptoms of bladder dissipation: frequent urination, urgency, dysuria, turbid urine. Children sometimes appear in the form of fever and sputum, which is easily misdiagnosed as fever. Newly married women tend to have a sense of convenience, but the feces are normal whether observed by the naked eye or under the microscope, and the urine can be found abnormal and easily misdiagnosed.
2. Physical examination
Renal tenderness, snoring pain, upper ureteral tenderness point (flat apex of the rectus abdominis) rib waist point tenderness point of the psoas major and 12 ribs) seen in the upper urinary tract infection, polycystic kidney infection or When the upper ureteral obstruction has a large amount of renal effusion, the upper abdomen can touch the swollen deformed kidney.
3. Laboratory inspection
Pyuria urinary is characteristic. Routine examination of urine In addition to the increase in white blood cells and pus cells, attention to leukocyte and pus cell casts. The presence of small round epithelial cells represents upper urinary heel staining. The number of white blood cells and neutrophils increased.
Chronic pyelonephritis: pyuria often appears intermittently, pay attention to repeated urine test; sometimes need to do urine cell count called Eddie count check, white blood cells per hour > 400,000 or 2,000 per 1 ml of urine, or > 4000 per minute Each is listed as an exception. Sometimes an excitation test is required. Intravenous hydrocortisone 100mg, or dexamethasone 5mg, or prednisone 30mg, for 3d, and then urine white blood cell count, is more abnormal than before the test. Urine smear to find the pathogen, can quickly make a diagnosis. Chronic pyelonephritis pays attention to the examination of renal function, and the most persistent damage to renal tubular function.
X-ray venous pyelography is helpful in the diagnosis of chronic pyelonephritis and complex pyelonephritis, but patients should be classified as contraindicated when they are allergic to iodine or have impaired renal function.
Diagnosis
Differential diagnosis
It should be differentiated from the following:
1. White urine: White urine means that the urine discharged from the human body appears white.
2. White mucus-like urine: When white mucus-like urine is often discharged, it may be a symptom of prostatitis, non-gonococcal urethritis or gonorrhea. It should be treated as soon as possible, otherwise it will be transmitted to the spouse, causing inflammation of the reproductive organs. .
