Differential Diagnosis for a 5-year-old Kid with Singular Kidney, Abdominal Pain, Elevated Eosinophils, and Abnormal Electrolyte Levels
Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): Given the abdominal pain and singular kidney, kidney stones are a plausible cause. The elevated calcium level could contribute to stone formation. However, the elevated eosinophils are not typically associated with kidney stones, making this diagnosis less straightforward.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): Although UTIs are common in children, the presence of a singular kidney and elevated eosinophils might suggest a more complex infection or an allergic reaction. The elevated potassium could be due to renal impairment.
- Acute Kidney Injury (AKI): The singular kidney and abnormal electrolyte levels (elevated potassium) could indicate AKI, possibly due to an obstructive cause like a kidney stone or a non-obstructive cause such as infection or medication.
- Allergic Interstitial Nephritis: This condition, often caused by medications or infections, can lead to elevated eosinophils and renal dysfunction, manifesting as abdominal pain and electrolyte imbalances.
Do Not Miss Diagnoses
- Hyperparathyroidism: Although rare in children, primary hyperparathyroidism could explain the elevated calcium level. It's crucial to consider this diagnosis due to its potential for significant morbidity if left untreated.
- Sepsis: In the context of abdominal pain and a singular kidney, sepsis of renal origin (e.g., pyelonephritis) must be considered, especially if there are signs of infection or systemic illness. The elevated potassium could indicate renal dysfunction.
- Obstructive Uropathy: Given the singular kidney, any obstruction (e.g., due to a stone) could lead to severe consequences, including loss of the only functioning kidney.
Rare Diagnoses
- Lymphoma: Although rare, lymphoma can cause abdominal pain, renal impairment, and electrolyte disturbances. The elevated eosinophils could be part of a paraneoplastic syndrome.
- Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): This rare autoimmune condition can affect the kidneys and is characterized by elevated eosinophils. However, it is exceedingly rare in children.
- Tubulointerstitial Nephritis and Uveitis Syndrome (TINU): A rare condition that can cause renal dysfunction and is associated with elevated eosinophils, though it is more commonly diagnosed in adolescent females.
Workup
- Imaging: Ultrasound of the abdomen to evaluate the singular kidney for stones, obstruction, or other abnormalities.
- Laboratory Tests: Complete Blood Count (CBC) with differential, blood urea nitrogen (BUN), creatinine, electrolyte panel, urinalysis, and urine culture.
- Eosinophilic Evaluation: Consider testing for parasitic infections or allergic causes of eosinophilia.
- Renal Function Tests: To assess the singular kidney's function and guide further management.
- Parathyroid Hormone (PTH) Level: To evaluate for hyperparathyroidism, especially with elevated calcium levels.