Differential Diagnosis for Recurrent Kidney Stones
Single most likely diagnosis
- Hyperoxaluria and hypocitraturia: The patient's history of Crohn's disease with persistent watery diarrhea increases the risk of hyperoxaluria due to increased oxalate absorption in the gut. Additionally, the diarrhea can lead to hypocitraturia, as citrate is lost in the stool, further increasing the risk of stone formation.
Other Likely diagnoses
- Hyperoxaluria and hypercalciuria: Although less likely than hypocitraturia, hypercalciuria can occur in patients with Crohn's disease due to increased calcium absorption in the gut, which can contribute to stone formation.
- Hyperoxaluria and hyperuricosuria: The patient's history of Crohn's disease and UTIs may increase the risk of hyperuricosuria, which can contribute to uric acid stone formation.
Do Not Miss
- Enteric hyperoxaluria with normal urine oxalate: In some cases, patients with Crohn's disease may have normal urine oxalate levels despite having enteric hyperoxaluria. This can occur if the increased oxalate absorption is balanced by increased oxalate excretion in the stool.
- Primary hyperparathyroidism: Although less likely, primary hyperparathyroidism can cause hypercalciuria and increase the risk of stone formation. This diagnosis should not be missed, as it requires specific treatment.
Rare diagnoses
- Hyperoxaluria and hypermagnesuria: This combination is less common and typically occurs in patients with specific genetic disorders, such as primary hyperoxaluria.
- Distal renal tubular acidosis (RTA): Although rare, distal RTA can cause alkaline urine and increase the risk of stone formation. However, this diagnosis is less likely in the absence of other symptoms, such as hypokalemia or metabolic acidosis.