Differential Diagnosis for Hematuria and Leukocyturia

Given a dipstick urinalysis (UA) showing large amounts of blood and leukocytes, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI): This is the most common cause of both hematuria (blood in the urine) and leukocyturia (white blood cells in the urine). The presence of leukocytes indicates an inflammatory response, which is consistent with a bacterial infection.

• Other Likely Diagnoses

  • Kidney Stones: Stones can cause irritation and injury to the urinary tract, leading to both bleeding and inflammation. The pain associated with kidney stones can be severe and is often accompanied by other symptoms like nausea and vomiting.
  • Bladder Cancer: Although less common, bladder cancer can present with painless hematuria. The presence of leukocytes might indicate a secondary infection, but the primary concern would be the malignancy.
  • Prostatitis: In men, prostatitis (inflammation of the prostate) can cause both hematuria and leukocyturia due to the proximity of the prostate to the urinary tract and the potential for bacterial infection.

• Do Not Miss Diagnoses

  • Sepsis from a Urinary Source: While not the most common diagnosis, sepsis originating from a urinary tract infection is a medical emergency. The presence of leukocytes and possibly blood in the urine, combined with systemic symptoms like fever, tachycardia, and hypotension, would indicate sepsis.
  • Pyelonephritis: An infection of the kidney itself, pyelonephritis can present with similar findings to a lower UTI but may have additional symptoms like flank pain and fever. It requires prompt treatment to prevent complications.

• Rare Diagnoses

  • Goodpasture Syndrome: A rare autoimmune disease that can cause both renal and pulmonary manifestations, including hematuria. It is characterized by the presence of anti-GBM antibodies.
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes. It can cause hematuria but is less likely to present with significant leukocyturia.
  • Tubulointerstitial Nephritis: An inflammation of the spaces between the renal tubules, which can be caused by drugs, infections, or immune system disorders. It might present with hematuria and leukocyturia, among other symptoms.

Each of these diagnoses requires careful consideration of the patient's symptoms, medical history, and additional diagnostic tests to determine the underlying cause of the hematuria and leukocyturia.