Differential Diagnosis for Kidney Pain
The patient presents with flank pain, feverish feelings, and a history of previous kidney infection. The following differential diagnosis is organized into categories:
- Single Most Likely Diagnosis
- Pyelonephritis: The patient's symptoms of flank pain, feverish feelings, and history of previous kidney infection on the left side are consistent with pyelonephritis. Although the urinalysis is not strongly positive (LEU- NEG, NIT- NEG), the presence of protein (+15) and a slightly acidic pH (6.0) may indicate an underlying infection.
- Other Likely Diagnoses
- Nephrolithiasis (Kidney Stones): The patient's flank pain, especially if it worsens at night, could be indicative of kidney stones. The absence of painful urination or blood in the urine does not rule out this diagnosis, as not all kidney stones cause these symptoms.
- Musculoskeletal Pain: The patient's flank pain could be referred from musculoskeletal structures, such as the back or abdominal muscles. However, the patient's history of a previous kidney infection and the presence of some abnormal urinalysis results make this less likely.
- Do Not Miss Diagnoses
- Sepsis: Although the patient does not present with typical sepsis symptoms such as hypotension or organ dysfunction, any infection, including pyelonephritis, can potentially lead to sepsis if not properly treated. It is crucial to monitor the patient's condition closely.
- Perinephric Abscess: A complication of pyelonephritis, a perinephric abscess can present with similar symptoms and requires prompt diagnosis and treatment to avoid severe consequences.
- Rare Diagnoses
- Renal Cell Carcinoma: Although rare, renal cell carcinoma can cause flank pain and other symptoms similar to those presented by the patient. However, this diagnosis would typically be considered after other more common causes have been ruled out.
- Renal Infarction: This is a rare condition where the blood supply to the kidney is interrupted, leading to tissue death. It can present with acute flank pain and might be considered if other diagnoses are excluded, especially in the context of risk factors such as atrial fibrillation or other thromboembolic conditions.