Differential Diagnosis for 72 YRS FEMALE RT RENAL ANGLE PAIN
- Single most likely diagnosis
- Pyelonephritis or renal infection: The patient's symptoms of right renal angle pain radiating to the right lumbar region, along with tenderness in the right renal angle upon deep palpation, are classic signs of a renal infection. The absence of lower urinary tract symptoms (LUTS) does not rule out pyelonephritis, especially in older adults who may present atypically.
- Other Likely diagnoses
- Nephrolithiasis (kidney stones): Although the patient does not have LUTS, kidney stones can cause severe pain (renal colic) that radiates from the flank to the groin and can be associated with tenderness in the renal angle.
- Musculoskeletal pain: Given the location of the pain and the presence of tenderness upon palpation, musculoskeletal issues such as a strain or inflammation in the muscles of the back could be considered, especially if the pain is exacerbated by movement or position.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Renal cell carcinoma or other renal tumors: Although less common, these conditions can present with flank pain and a palpable mass. Given the potential severity of these conditions, they should not be overlooked.
- Polycystic kidney disease (PKD): This genetic disorder can lead to cysts filled with fluid in the kidneys, which can cause pain, especially if the cysts rupture or become infected.
- Aortic aneurysm or dissection: While the pain pattern might not perfectly align, aortic pathology can sometimes present with back or flank pain and is a medical emergency.
- Rare diagnoses
- Retroperitoneal fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum, which can encase and obstruct structures such as the ureters, leading to pain and potentially renal failure.
- Renal infarction: This is a rare condition where the blood supply to the kidney is interrupted, leading to tissue death. It can present with acute flank pain and might be considered in the appropriate clinical context, such as in patients with atrial fibrillation or other hypercoagulable states.