Significance of Pyuria in Urinary Sediment

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Abstract
Microscopic examination of the urinary sediment to determine the degree of pyuria is an accepted method to screen for urinary tract infection. The significance of pyuria in relation to the method of specimen acquisition, number of white blood cells and isolation of pathogens on culture was investigaged. Only 36% of the patients with > 10 white blood cells/high power field on examination of the 1st random specimen had > 10 white blood cells/high power field when a repeat clean catch midstream specimen was examined and only 20% of the patients > than 105 pathogens [bacteria]/ml on culture. The finding of > 10 white blood cells/high power field on a clean catch midstream specimen indicated > 105 pathogens/ml in 40% of the cases. The use of a higher threshold for significant pyuria (more than 20 white blood cell/high power field) on examination of a random specimen increased the incidence of more than 105 bacteriuria found in specimens with initial pyuria by 43% and represents the additional detection of 8.7% of the total population studied. When screening for pyuria and infection one should obtain a clean catch midstream specimen for examination of urinary sediment or increase the threshold for significant pyuria on a random specimen.

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