Differential Diagnosis for a 6-year-old Boy with Bright Red Blood in the Urine
Single most likely diagnosis
- Idiopathic Hypercalciuria: This condition is a common cause of painless, gross hematuria in children, often without any other symptoms or abnormalities on urinalysis or physical examination. The absence of protein, leukocyte esterase, nitrites, and bacteria in the urinalysis, along with the presence of significant hematuria, supports this diagnosis.
Other Likely diagnoses
- Nephrolithiasis (Kidney Stones): Although the patient does not have pain, some children with kidney stones may not experience the typical symptoms of flank pain or dysuria. The presence of gross hematuria and the absence of infection or other urinary abnormalities make this a possible diagnosis.
- Urinary Tract Anomaly: Congenital anomalies of the urinary tract, such as ureteropelvic junction obstruction or vesicoureteral reflux, can cause hematuria. However, these conditions often present with other symptoms or are diagnosed during prenatal ultrasound or after urinary tract infections.
- Glomerulonephritis: Post-streptococcal glomerulonephritis (PSGN) is an immune-mediated condition that can follow a streptococcal infection, but it typically presents with hematuria, proteinuria, and often hypertension and edema. The lack of these additional findings makes PSGN less likely, but it cannot be ruled out without further testing.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Wilms Tumor: A rare but critical diagnosis to consider in any child presenting with a palpable abdominal mass and hematuria. Although the examination is normal, Wilms tumor can sometimes present with isolated hematuria.
- Trauma: Despite the denial of trauma, it is essential to consider non-accidental trauma, especially if there are any inconsistencies in the history or if other signs of abuse are present.
- Sickle Cell Disease or Trait: Sickle cell disease can cause renal complications, including hematuria, due to sickling in the renal medulla. However, this would typically be associated with other symptoms or known diagnosis.
Rare diagnoses
- Alport Syndrome: A genetic disorder characterized by hematuria, progressive kidney disease, and hearing loss. It is rare and typically presents with a family history of kidney disease and hearing loss.
- Nutcracker Phenomenon: A condition where the left renal vein is compressed between the aorta and the superior mesenteric artery, leading to hematuria. It is rare and often associated with left flank pain.
- Vasculitis: Conditions like Henoch-Schönlein purpura can cause hematuria but are typically associated with other systemic symptoms such as rash, joint pain, and gastrointestinal symptoms.