Differential Diagnosis

The patient's presentation suggests a range of potential diagnoses. Here is a categorized list of possible diagnoses:

• Single Most Likely Diagnosis

  • Chronic Kidney Disease (CKD) with Left Kidney Involvement: The history of kidney stones, new onset of microalbuminuria, and slight proteinuria along with leukocytes in urine, points towards a kidney issue. The edema, more pronounced on the left side, could indicate a problem with the left kidney. CKD can lead to anemia, which might cause "air hunger" feelings due to decreased oxygen delivery to tissues.

• Other Likely Diagnoses

  • Pyelonephritis or Kidney Infection: The presence of leukocytes in the urine and a history of kidney stones could suggest an infection of the kidney, especially if the stones are causing an obstruction. This could lead to localized edema and systemic symptoms.
  • Nephrotic Syndrome: Although less likely given the slight proteinuria, nephrotic syndrome could explain the edema and potentially the microalbuminuria if it's an early sign. However, significant proteinuria is typically seen.
  • Left Renal Vein Thrombosis: This could be a complication of the kidney stones or nephrotic syndrome, leading to edema and potentially affecting kidney function.

• Do Not Miss Diagnoses

  • Renal Cell Carcinoma: Although rare, kidney cancer could explain the edema, proteinuria, and hematuria (if present). It's crucial to rule out malignancy, especially with a history of kidney stones.
  • Pulmonary Embolism: The "air hunger" could be indicative of a pulmonary issue. A pulmonary embolism, potentially originating from a deep vein thrombosis (DVT) causing the edema, is a life-threatening condition that must be considered.
  • Sepsis: If the patient has an infection (e.g., pyelonephritis) that is not adequately treated, it could lead to sepsis, a life-threatening condition.

• Rare Diagnoses

  • Alport Syndrome: A genetic disorder affecting the type IV collagen in kidneys, ears, and eyes. It could explain the kidney issues but is less likely without a family history or other systemic symptoms.
  • Amyloidosis: A condition where abnormal proteins (amyloid) accumulate in organs, potentially affecting kidney function. It's rare and would typically present with more systemic symptoms.
  • Membranous Nephropathy: An immune-mediated disease causing nephrotic syndrome. It's less common and would typically present with more significant proteinuria.