Features:
(1) urinary tract infection with Corynebacterium urealyticum, which produces a urease that splits the urea in the urine
(2) the urine pH becomes alkaline from the release of ammonium and bicarbonate
(3) there is often damage to the urothelium (inflammation, malignancy, instrumentation, etc) or the presence of urinary catheter or stent
(4) there is urothelial deposition of struvite and carbonated apatite, which forms a crust
(5) the crust is associated with chronic inflammation, necrosis and ulceration
Urinary cultures may be reported as negative. A negative urine culture report in the presence of pyuria and clinical UTI should prompt a call to the laboratory:
(1) Corynebacterium urealyticum may be viewed as a commensal organism
(2) a CFU count less than < 100,000 per mL may be significant in some patients
