Brief Answer:
Please find causes and possibilities of sterile pyuria discussed below

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

This is Dr.Vivek, Diagnostic Radiologist and I have been assigned to help you out with your query concerning the presence of sterile pyuria given a history of partial open nephrectomy in 2009 for a stage 1 clear cell renal cell carcinoma and subsequent shut down of the tumor affected kidney.
Please find my observations below.

1. Sterile pyuria is frequently seen without any cause. It has been seen to be self limited and known to even disappear without any treatment. It is possible that you might have such a condition causing sterile pyuria.

2. Among the conditions associated with sterile pyuria, the complete list of causes of sterile pyuria includes the following

Infectious Causes of Sterile Pyuria
• Treated urinary tract infection
• Prostatitis
• Appendicitis
• Chlamydia trachomatis
• Ureaplasma urealyticum
• Mycobacterium tuberculosis
• Fungi
• Viruses

Systemic Causes of Sterile Pyuria
• Malignant hypertension
• Sarcoidosis
• Kawasaki disease
• Cyanotic congenital heart disease
• Acute febrile illness

Structural and Physiologic Causes of Sterile Pyuria
• Polycystic kidney disease
• Vesicourethral reflux
• Nephrocalcinosis/urolithiasis
• Hydronephrosis
• Retained foreign body

Intrinsic Renal Pathology Leading to Sterile Pyuria
Papillary necrosis
• Chronic analgesic nephropathy
• Obstructive uropathy
• Sickle cell disease nephropathy
• Diabetic nephropathy
Tubulointerstitial diseases
• Interstitial nephritis (acute and chronic)
• Lupus nephritis

Drug-related Causes of Sterile Pyuria
• Drug-induced interstitial nephritis
(e.g., nitrofurantoin)
• Chronic analgesic nephropathy
• Papillary necrosis (drug induced)
• Cystitis (e.g., cyclophosphamide)
• Toluene
• Glucocorticoid therapy

3. In the absence of an unexplained sterile pyuria, the causes concerning you might include the following
(i) Presence of an unrecognized urine infection or untreated infection
(ii) Chronic infection like tuberculosis of urinary tract
(iv) Kawasaki disease which is a condition affecting blood vessels
(v) Diabetic nephropathy
(vi) End stage renal disease

4. Since you have been treated with ciprofloxacin and doxycycline, it is true that you do not have an infection due to the conventional bacteria causing urinary infection.

5. It is important to know if you have got any ultrasound scan of your abdomen done in the last 6 months and if yes then were the results normal? It would help to know any details

6. Sterile pyuria has been reported in patients with end-stage renal disease but medical literature shows that it has not been reported in patients with earlier stages of chronic kidney disease. Therefore your thoughts about the end stage renal disease affected right kidney causing sterile pyuria might be a possibility.

7. Making an exact diagnosis requires in your case might require the possibilities to be considered individually and then evaluated for singly. This requires a discussion at the treatment level and probable tests need to be performed, starting from searching for unrecognized infection causing organisms and tuberculosis and proceeding down the list in a step wise manner. This requires various laboratory tests, imaging investigations and clinical examination methods, some of which are too detailed to be discussed and not always required to be done in every patient of sterile pyuria.

8. After going through the text above, it should still be remembered that such sterile pyuria might always appear for no specific reason and also disappear spontaneously without any treatment.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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