Differential Diagnosis for 74-year-old Male with Hematuria and Flank Pain
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI) with Pyelonephritis: The presence of nitrites, large leukocytes, and blood in the urine, along with flank pain, strongly suggests a UTI that has ascended to the kidneys, causing pyelonephritis. The patient's age and symptoms align with this diagnosis.
Other Likely Diagnoses
- Nephrolithiasis (Kidney Stones): The patient's flank pain and hematuria could be indicative of kidney stones, which are common in older adults and can cause significant pain and bleeding.
- Bladder Cancer: Given the patient's age and symptoms of hematuria, bladder cancer is a consideration, although less likely than a UTI or kidney stones without additional risk factors or symptoms.
Do Not Miss Diagnoses
- Sepsis: Although less likely given the information, sepsis from a urinary source is a potentially life-threatening condition that must be considered, especially in an older adult with symptoms of infection and flank pain.
- Renal Infarction: This is a rare but potentially deadly condition that could present with flank pain and hematuria, especially in a patient with atrial fibrillation on anticoagulation, where the risk of thromboembolic events is higher.
Rare Diagnoses
- Renal Cell Carcinoma: While possible, this diagnosis is less likely without additional symptoms such as a palpable mass or significant weight loss.
- Vasculitis or Glomerulonephritis: These conditions could present with hematuria and proteinuria but are less common and would typically have additional systemic symptoms or specific findings on the CMP or UA that are not mentioned.