Differential Diagnosis for a 73-year-old Female with Dysuria, Trace Blood, Leukocytes, and Protein on Urinalysis
- Single most likely diagnosis:
- Urinary Tract Infection (UTI): This is the most common cause of dysuria, especially in elderly females. The presence of leukocytes and protein on urinalysis supports this diagnosis, as it indicates an inflammatory response and possible kidney involvement.
- Other Likely diagnoses:
- Bacterial Cystitis: Similar to UTI, but more specifically involving the bladder. Symptoms and urinalysis results align with this condition.
- Interstitial Cystitis: A condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms could fit, although it's less likely than an infection.
- Kidney Stones: Although not directly indicated by the urinalysis, the presence of blood could suggest a stone. However, stones typically cause more severe pain and possibly radiating pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sepsis from a UTI: Especially in the elderly, a UTI can quickly progress to sepsis, a life-threatening condition.
- Pyelonephritis: An infection of the kidney, which can be severe and requires prompt treatment. The presence of protein and leukocytes could indicate an upper urinary tract infection.
- Malignancy (e.g., bladder or kidney cancer): Although less likely, the presence of blood in the urine (hematuria) is a red flag symptom that warrants further investigation to rule out cancer.
- Rare diagnoses:
- Tubulointerstitial Nephritis: An inflammation of the tubules and surrounding tissue in the kidneys, which could explain the proteinuria and hematuria.
- Vasculitis affecting the kidneys: Conditions like ANCA-associated vasculitis could present with renal involvement, including proteinuria and hematuria, but are much less common.
- Foreign body in the urinary tract: Although rare, it could cause irritation and infection, leading to the symptoms described.