Leukocyturia in sterile urine R82.8

Sterile leukocyturia is a special form of leukocyturia in which a high leukocyte count is detected, but the bacteriological findings are consistently negative (Antwerpes 2025).

• Urogenital tuberculosis: In cases of sterile leukocyturia, urogenital tuberculosis should always be ruled out (Staubach 2008).
• Atypical pathogens such as fungi, parasites, and mycoplasmas (Burger 2024)
• Interstitial nephritis
• Urogenital tumors (Pschyrembel)
• Acute coronary syndrome
• Analgesic nephropathy (Frank 2021)
• Treated cystitis ( Antwerpes 2025)

Since pathogens that are difficult to culture are not uncommon in cases of sterile leukocyturia, specialized diagnostic tests, including PCR, should be performed. In women, it is also recommended to rule out concomitant intra-abdominal infections such as appendicitis, adnexitis, and diverticulitis ( Frank 2021).

If acid-fast bacilli cannot be detected microscopically in cases of sterile leukocyturia, a tuberculosis culture is required by examining the first morning urine on three consecutive days. In addition, an animal test is generally performed, as it has the highest sensitivity. However, it can take up to 8 weeks (Staubach 2008).

Patients with sterile leukocyturia should always be referred to a nephrologist (Kempinski 2021).

• Sterile leukocyturia plus microhematuria:

If microhematuria is also detected in addition to sterile leukocyturia, the following should be ruled out as a priority:

• Analgesic nephropathy
• Papillary necrosis
• Diverticula
• Behcet’s disease (mucosal ulcerations)
• Adnexitis
• Malignant tumors, such as urothelial carcinoma
• Stenoses of the urinary tract
• Pararheumatic diseases, including collagenoses and vasculitides (Frank 2021)

• Renal Tuberculosis
• Interstitial nephritis
• Tumor in the urinary tract (Antwerp 2025)
• Pregnancy
• Gonorrhea
• Reiter's syndrome
• Non-gonococcal urethritis
• Post-gonococcal urethritis (Herold 2025)
• Mycoplasmas (Kempinski 2021)
• Adenovirus cystitis (Hofmann 2014)

Depending on the underlying condition (Roth 1993).

1. Antwerpes U et al. (2025) Leukocyturia. Doc Check Flexikon. https://flexikon.doccheck.com/de/Leukozyturie
2. Burger R, Stein R, Miethke T, Younsi N (2024) Sterile Leukocyturia—Sometimes It’s Not What You Think! 64th Annual Meeting of the Southwest German Society for Urology e.V. https://www.egms.de/static/de/meetings/swdgu2024/24swdgu33.shtml
3. Frank H et al. (2021) Interdisciplinary S2k Guideline “Rational Laboratory Diagnostics for the Evaluation of Acute Kidney Injury and Progressive Kidney Disease 2021”; AWMF Register No. 115/001
4. Herold G et al. (2025) Internal Medicine. Herold Verlag 599
5. Hofmann W, Aufenanger J, Hofmann G (2014) Clinical Handbook of Laboratory Diagnostic Pathways: Introduction, Screening, and Staged Diagnostics. Walter de Gruyter GmbH Berlin / Boston 143–145
6. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison’s Principles of Internal Medicine. McGraw-Hill Education
7. Kempinski S (2021) Accurately Diagnosing Kidney Damage Using Blood and Urine Tests. Medical Tribune https://www.medical-tribune.de/medizin/urologie/nierenschaeden-ueber-blut-und-urin-richtig-diagnostizieren
8. Pschyrembel Online. Sterile Leukocyturia. https://www.pschyrembel.de/Sterile%20Leukozyturie/B0BRJ
9. Roth S, Semjonow A, Rathert P (1993) Clinical Urology: From Diagnosis to Treatment. Springer Verlag Heidelberg / Berlin / New York / Tokyo / Hong Kong / Barcelona / London / Paris / Budapest 35
10. Staubach K. H., Straub L., Kreutzig T., Guzek B., Limberger A. (2008) Concise Textbook: Four-Subject Group—Minor Surgical Specialties: Urology, Ophthalmology, ENT, Orthopedics. Elsevier Urban & Fischer Verlag, Munich / Jena 17