Differential Diagnosis for Worsening High Blood Pressure with Hematuria and Status Post Kidney Stone Removal

Single Most Likely Diagnosis

• Nephrolithiasis with residual stone or fragment: The recent history of kidney stone removal and the presence of hematuria suggest that there might be a residual stone or fragment causing ongoing irritation and potentially worsening hypertension due to renal damage or obstruction.

Other Likely Diagnoses

• Chronic Kidney Disease (CKD): The combination of worsening hypertension and hematuria, especially in the context of a recent kidney stone, could indicate underlying CKD. Kidney stones can cause or exacerbate kidney damage.
• Renal Artery Stenosis: This condition, which involves narrowing of the arteries that carry blood to the kidneys, can cause worsening hypertension and might be associated with hematuria, especially if there's an associated kidney injury or disease.
• Pyelonephritis or other urinary tract infections: Infection can cause hematuria and, if severe, might affect blood pressure. Given the recent surgical intervention, there's a risk of infection.

Do Not Miss Diagnoses

• Renal Cell Carcinoma: Although less likely, it's crucial not to miss a diagnosis of renal cell carcinoma, which can present with hematuria and hypertension. The recent kidney stone and surgical history might obscure the diagnosis.
• Vasculitis (e.g., ANCA-associated vasculitis): This group of diseases can cause kidney damage, leading to hypertension and hematuria. They are less common but critical to diagnose due to their potential for severe outcomes.
• Atherosclerotic Renal Artery Disease: Similar to renal artery stenosis but with a broader cause (atherosclerosis), this condition can lead to worsening hypertension and renal function.

Rare Diagnoses

• Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, leading to kidney disease, hearing loss, and eye abnormalities. It could present with hematuria and progressive kidney disease.
• Sickle Cell Disease or Sickle Cell Trait with Renal Manifestations: Sickle cell disease can cause a variety of renal issues, including sickle cell nephropathy, which might present with hematuria and worsening renal function, potentially affecting blood pressure.
• Tubulointerstitial Nephritis: This condition involves inflammation of the tubules and interstitial tissue of the kidneys and can be caused by various factors, including drugs, infections, and systemic diseases. It might present with hematuria and worsening renal function.