Differential Diagnosis
The patient's laboratory results and medical history suggest a range of potential diagnoses. The following categories outline the differential diagnosis:
- Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): The presence of a potential 6.5 x 2 mm calculus within the distal left ureter, as indicated by the X-ray findings, strongly suggests nephrolithiasis. The patient's elevated creatinine level and mildly decreased e-GFR also support this diagnosis, indicating possible kidney damage or obstruction.
- Other Likely Diagnoses
- Dehydration: The patient's elevated BUN and creatinine levels could be indicative of dehydration, which may be contributing to the development of kidney stones.
- Infection: The patient's elevated WBC count and high percentage of polys could suggest an underlying infection, potentially related to the kidney stones.
- Chronic Kidney Disease (CKD): The patient's mildly decreased e-GFR and elevated creatinine level may indicate early stages of CKD, which could be contributing to the development of kidney stones.
- Do Not Miss Diagnoses
- Sepsis: Although the patient's laboratory results do not strongly suggest sepsis, it is a potentially life-threatening condition that can occur in the context of kidney stones or infection. The patient's elevated WBC count and high percentage of polys warrant careful consideration of this diagnosis.
- Obstructive Uropathy: The presence of a kidney stone could be causing obstructive uropathy, which is a serious condition that requires prompt treatment to prevent long-term kidney damage.
- Rare Diagnoses
- Multiple Myeloma: The patient's elevated globulin level and low iron level could be suggestive of multiple myeloma, although this diagnosis is less likely given the patient's overall clinical presentation.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): The patient's elevated RDW and low iron level could be indicative of PNH, although this diagnosis is rare and would require further testing to confirm.