Differential Diagnosis
- Single most likely diagnosis
- Nephrolithiasis with obstructive uropathy: The patient's presentation of severe right lower back pain, hematuria, and the CT scan finding of a 7 mm right distal ureteral stone strongly supports this diagnosis. The stone is likely causing obstruction, leading to the patient's symptoms.
- Other Likely diagnoses
- Pyelonephritis: Although the patient does not have fever or other signs of infection, the presence of a ureteral stone increases the risk of infection. The patient's symptoms of flank pain, nausea, and fatigue could be consistent with pyelonephritis.
- Hyperparathyroidism: The patient's elevated calcium level (12) could be related to hyperparathyroidism, which is a known cause of nephrolithiasis. However, this would require further evaluation to confirm.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Renal cell carcinoma or other malignancy: Although less likely, it is essential to consider the possibility of a malignancy, especially given the patient's age and symptoms. A thorough evaluation, including imaging and potentially a biopsy, would be necessary to rule out this diagnosis.
- Sepsis: If the patient's condition worsens or if he develops signs of infection, sepsis should be considered. Prompt recognition and treatment of sepsis are crucial to prevent serious complications.
- Rare diagnoses
- Multiple myeloma: The patient's elevated calcium level and renal symptoms could be related to multiple myeloma, although this is a less common diagnosis. Further evaluation, including serum protein electrophoresis and bone marrow biopsy, would be necessary to confirm.
- Medullary sponge kidney: This is a rare condition that can cause nephrolithiasis and obstructive uropathy. However, it is less likely given the patient's presentation and would require further evaluation to confirm.