Differential Diagnosis for 74-year-old with Hematuria and Lower Back Pain
Single Most Likely Diagnosis
- Kidney Stone: The presence of blood in the urine (hematuria) and lower back pain are classic symptoms of a kidney stone. Although the patient reports no pain with urination, the absence of dysuria does not rule out this diagnosis, especially if the stone is not currently obstructing the ureter.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): While the patient denies pain with urination, UTIs can sometimes present with hematuria and back pain, especially in older adults.
- Benign Prostatic Hyperplasia (BPH): In men, BPH can cause hematuria due to prostate enlargement affecting the bladder or urethra.
- Bladder Cancer: Hematuria is a common presenting symptom of bladder cancer, and the patient's age increases the risk.
Do Not Miss Diagnoses
- Renal Cell Carcinoma: This is a potentially life-threatening condition that can present with hematuria and back pain. Early detection is crucial for treatment.
- Aortic Aneurysm or Aortic Dissection: Although less common, these conditions can cause back pain and, if ruptured, could lead to hematuria due to retroperitoneal bleeding. The patient's history of hypertension and use of anticoagulants (Xarelto) increases the risk.
- Pyelonephritis: An infection of the kidney, which can present with back pain and hematuria, especially if severe.
Rare Diagnoses
- Sickle Cell Disease or Sickle Cell Trait: Could lead to hematuria due to sickling in the kidney, though this would be less likely in a 74-year-old without a known history.
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidney, leading to hematuria, but typically presents earlier in life.
- Vasculitis (e.g., ANCA-associated vasculitis): Can cause renal involvement leading to hematuria and back pain, but is less common and usually accompanied by other systemic symptoms.