Differential Diagnosis for 18-year-old Female with Bilateral Flank Pain and Foul Urine Odor
- Single most likely diagnosis
- Urinary Tract Infection (UTI): The patient's symptoms of bilateral flank pain and foul urine odor are classic for a UTI, particularly pyelonephritis, which affects the kidneys. The absence of fever, nausea, or vomiting does not rule out this diagnosis, as not all patients with UTIs present with systemic symptoms.
- Other Likely diagnoses
- Kidney Stones: The presence of bilateral flank pain could suggest kidney stones, although the absence of nausea and vomiting is less typical. However, some patients with kidney stones may not exhibit these symptoms.
- Interstitial Cystitis: This condition can cause chronic pain in the bladder and pelvic area, which might be perceived as flank pain, along with foul-smelling urine due to possible associated infections or changes in urine composition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis from a UTI: Although the patient denies fever, it's crucial to consider the possibility of sepsis, especially if the UTI is not promptly treated. Sepsis can lead to severe consequences, including organ failure and death.
- Pyelonephritis with complications (e.g., abscess): Complicated pyelonephritis, such as an abscess, requires immediate medical attention and could be life-threatening if not properly managed.
- Rare diagnoses
- Polycystic Kidney Disease (PKD): This genetic disorder can cause cysts to form on the kidneys, leading to flank pain. However, it's less likely in an 18-year-old without a known family history.
- Tubulointerstitial Nephritis: An inflammation of the tubules and surrounding tissue in the kidneys, which could be caused by various factors, including infections, drugs, or systemic diseases. It's a rare condition but could explain the patient's symptoms.