What is the diagnosis for a 59-year-old female with proteinuria (presence of protein in urine), hematuria (presence of Red Blood Cells (RBC) in urine), and chronic abdominal pain, without dysuria (painful urination)?

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Last updated: May 20, 2025 • View editorial policy

Differential Diagnosis for Female Patient with Urinary and Abdominal Symptoms

Single Most Likely Diagnosis

  • Chronic Kidney Disease (CKD): The presence of proteinuria (protein 10 in urine) and hematuria (RBC 4-10) suggests kidney damage or disease. Chronic abdominal pain could be related to various causes, but in the context of renal findings, CKD is a plausible explanation. CKD can cause a range of symptoms including abdominal pain due to various complications.

Other Likely Diagnoses

  • Nephrotic Syndrome: Characterized by heavy proteinuria, which could explain the "protein 10" in the urine. Although abdominal pain is not a primary symptom, it could be related to complications such as ascites or edema.
  • Urinary Tract Infection (UTI) or Pyelonephritis: Despite the absence of dysuria, UTIs can sometimes present with minimal or no typical urinary symptoms, especially in older adults. The presence of RBCs in the urine supports this possibility.
  • Kidney Stones: Could cause chronic abdominal pain and hematuria. However, the absence of typical colicky pain and the presence of significant proteinuria make this less likely.

Do Not Miss Diagnoses

  • Renal Cell Carcinoma: Although less common, it's crucial to consider malignancies, especially given the age of the patient and the presence of hematuria. Abdominal pain and weight loss can be symptoms, but they are non-specific.
  • Vasculitis (e.g., ANCA-associated vasculitis): Can cause renal involvement leading to proteinuria and hematuria, along with systemic symptoms including abdominal pain.
  • Sickle Cell Disease or Sickle Cell Trait: Could lead to hematuria due to sickling in the kidney. Although less common in a 59-year-old presenting for the first time, it's a diagnosis that should not be missed due to its implications.

Rare Diagnoses

  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes. It could present with hematuria and progressive kidney disease but is less likely given the late age of presentation.
  • Lupus Nephritis: Part of Systemic Lupus Erythematosus (SLE), which can cause kidney inflammation leading to proteinuria and hematuria. It's rare but should be considered, especially if there are other systemic symptoms suggestive of SLE.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.