Differential Diagnosis for Polyuria, Urgency, Right Kidney Pain, and Glucose in Urine in a 75-Year-Old Female

Single Most Likely Diagnosis

• Diabetes Mellitus: The presence of glucose in the urine, along with symptoms of polyuria (frequent urination) and urgency, strongly suggests diabetes mellitus, especially in an elderly patient. Diabetes can lead to nephropathy, which might cause kidney pain.

Other Likely Diagnoses

• Urinary Tract Infection (UTI): UTIs are common in elderly females and can cause dysuria (painful urination), urgency, and frequent urination. The presence of glucose in the urine could be due to diabetes, but UTIs can also cause glycosuria if the infection is severe enough to impair renal function temporarily.
• Kidney Stones: While more common in younger populations, kidney stones can occur in the elderly and cause severe pain (renal colic), often accompanied by urgency and frequency of urination. The glucose in the urine might not be directly related but could indicate an underlying metabolic issue.
• Chronic Kidney Disease (CKD): CKD can lead to polyuria, and advanced stages might result in glucose appearing in the urine due to impaired renal function. However, CKD typically has a more gradual onset.

Do Not Miss Diagnoses

• Pyelonephritis: An infection of the kidney, which can present with flank pain, fever, and symptoms of a lower UTI like urgency and frequency. It's crucial to diagnose and treat promptly to avoid sepsis, especially in the elderly.
• Obstructive Uropathy: Any obstruction in the urinary tract (e.g., due to stones, tumors) can cause severe pain and urinary symptoms. In elderly females, obstructive causes might be less common than in males but should not be overlooked.
• Sepsis: While not a primary diagnosis for the symptoms, sepsis can result from untreated infections (like pyelonephritis or severe UTIs) and is a medical emergency, especially in the elderly.

Rare Diagnoses

• Diabetic Ketoacidosis (DKA): Although more common in type 1 diabetes, DKA can occur in type 2 diabetes, especially in the context of infection or other stressors. It presents with hyperglycemia, metabolic acidosis, and ketosis.
• Renal Cell Carcinoma: While kidney cancer can cause pain and hematuria (blood in the urine), it less commonly presents with the combination of polyuria, urgency, and glucose in the urine. However, it's a consideration in the differential diagnosis of flank pain in an elderly patient.