Dysuria in Elderly Male with Advanced CKD

Primary Non-Infectious Etiologies to Consider

• Advanced CKD (Stage 4 with eGFR 23) causes impaired salt and water homeostasis, leading to uremic toxicity that can directly irritate bladder mucosa, as reported by the American College of Physicians and the Clinical Nutrition society 1, 2

Diagnostic Approach

• Verify urinalysis was performed correctly with microscopic examination, not just dipstick, as pyuria can be absent in non-infectious causes, according to the Infectious Diseases Society of America 3

Management Strategy

• Consider nephrology referral given eGFR <30 mL/min/1.73 m² per standard CKD guidelines, as this patient requires evaluation for progression and potential need for renal replacement therapy planning, as recommended by the National Kidney Foundation and the American Diabetes Association 4, 5

Critical Pitfalls to Avoid

• Do not empirically treat with antibiotics given negative culture and absence of pyuria, as this is inappropriate and contributes to resistance, as stated by the Infectious Diseases Society of America 3
• Do not assume asymptomatic bacteriuria requires treatment in this population—pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment, according to the Infectious Diseases Society of America 3