Differential Diagnosis

The patient's symptoms of large leukocytes, elevated RBC, high WBC, and hazy urine without the presence of nitrites or blood suggest an underlying infection or inflammatory process. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Urinary Tract Infection (UTI): The presence of large leukocytes, elevated RBC, and high WBC in the urine, along with hazy urine, strongly suggests a UTI. The absence of nitrites and blood does not rule out this diagnosis, as not all UTIs present with these findings.
• Other Likely Diagnoses
  • Pyelonephritis: An infection of the kidney, which could explain the elevated WBC and RBC in the urine. The symptoms might be similar to a UTI but could also include flank pain and fever.
  • Prostatitis: Inflammation of the prostate gland, which could cause urinary symptoms similar to a UTI, including elevated WBC and RBC in the urine.
• Do Not Miss Diagnoses
  • Sepsis: Although less likely, if the patient shows signs of systemic infection (fever, hypotension, tachycardia), sepsis should be considered, especially if the UTI or other infection is severe and not responding to treatment.
  • Kidney Stones: While the absence of blood in the urine might make this less likely, some kidney stones can cause inflammation and lead to elevated WBC and RBC without visible blood.
• Rare Diagnoses
  • Tuberculosis (TB) of the Urinary Tract: A rare cause of urinary symptoms, including sterile pyuria (elevated WBC without bacterial growth), which could fit the patient's presentation.
  • Malignancy: Certain cancers, like bladder or kidney cancer, could cause elevated RBC and WBC in the urine, although they would be less common causes of these symptoms compared to infections.