Differential Diagnosis for Acute Hypertension with Hematuria and Status Post Kidney Stone Removal

Single Most Likely Diagnosis

• Renal Artery Stenosis or Thrombosis: This condition could be a complication following kidney stone removal, especially if the procedure caused injury to the renal artery. The stenosis or thrombosis could lead to acute hypertension due to decreased renal perfusion, triggering the renin-angiotensin-aldosterone system. Hematuria could be present due to the underlying vascular issue affecting the kidney.

Other Likely Diagnoses

• Kidney Injury or Infarction: Post-procedural complications from the kidney stone removal could include direct injury to the kidney tissue, leading to infarction. This would cause acute hypertension and hematuria.
• Nephrotic Syndrome: Although less common as an immediate post-procedural complication, nephrotic syndrome could be considered if the patient has significant proteinuria in addition to hematuria, potentially leading to hypertension.
• Pyelonephritis or Sepsis: Infection following the procedure could lead to sepsis, causing hypertension and potentially hematuria if the infection involves the kidneys.

Do Not Miss Diagnoses

• Aortic Dissection: Although rare, aortic dissection is a life-threatening condition that could present with acute hypertension and, if the dissection involves the renal arteries, could cause hematuria. It's crucial to consider this diagnosis, especially if the patient has a history of hypertension or aortic disease.
• Pheochromocytoma: A rare tumor of the adrenal gland that could cause episodic or sustained hypertension. Hematuria might not be a direct symptom but could be present if the tumor affects renal function or causes renal vascular issues.
• Vasculitis (e.g., ANCA-associated vasculitis): Systemic vasculitis could affect renal vessels, leading to hypertension and hematuria. It's essential to consider this diagnosis to initiate appropriate treatment.

Rare Diagnoses

• Renal Vein Thrombosis: More common in patients with nephrotic syndrome or other hypercoagulable states, renal vein thrombosis could cause acute hypertension and hematuria, especially if it occurs post-procedure.
• Page Kidney: A rare condition where there is external compression of the kidney, potentially from a subcapsular hematoma post-procedure, leading to hypertension due to activation of the renin-angiotensin system.