Sterile pyuria: a practical management guide.

e225 British Journal of General Practice, March 2016 INTRODUCTION Sterile pyuria (SP) is not an uncommon finding in clinical practice. Nine per cent of patients presenting to their GP with lower urinary symptoms, and who are suspected of having urinary tract infections (UTIs), are found to have SP.1 It continues to pose a diagnostic conundrum to physicians, as well as to allied healthcare professionals (HCPs), because there are no guidelines on its management. Currently no agreed definition for SP exists. It is simply the presence of white blood cells within the urine, in the absence of infection. Typically, the presence of more than 5–8 leucocytes per high-power field on microscopy, in the absence of positive urine cultures, would be classified as an SP. It can also be associated with haematuria, proteinuria, and casts, complicating the diagnosis. Broadly speaking, SP may be classified as infectious or non-infectious. This article reviews the many causes of SP (Figure 1), and aims to create a clear pathway in the management of these patients.