Differential Diagnosis
- Single most likely diagnosis
- Pyelonephritis: The presence of moderate blood, protein, and RBCs in the urine, along with moderate bacteria, suggests an upper urinary tract infection. The elevated CRP (41.2) and the abnormal CBC results (bands absolute 1.2, lymphocytes absolute 0.6) also support a systemic infection, making pyelonephritis the most likely diagnosis.
- Other Likely diagnoses
- Sepsis: The elevated CRP and abnormal CBC results could indicate a systemic infection, and the presence of bacteria in the urine suggests a possible source of sepsis.
- Kidney stones: The presence of blood and protein in the urine could be indicative of kidney stones, which could also be causing an infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic shock: Although less likely, septic shock is a life-threatening condition that requires immediate attention. The elevated CRP and abnormal CBC results could be indicative of septic shock, especially if the patient is showing signs of hypotension or organ dysfunction.
- Emphysematous pyelonephritis: This is a rare but life-threatening condition that occurs when an upper urinary tract infection causes gas to form in the kidney tissue. Although less likely, it is essential to consider this diagnosis, especially if the patient has diabetes or is immunocompromised.
- Rare diagnoses
- Glomerulonephritis: The presence of protein and blood in the urine could be indicative of glomerulonephritis, an inflammation of the kidney's filtering units. However, this diagnosis is less likely given the presence of bacteria in the urine and the systemic infection suggested by the CBC and CRP results.
- Tubulointerstitial nephritis: This is a rare condition that causes inflammation of the kidney's tubules and interstitial tissue. Although possible, it is less likely given the presence of bacteria in the urine and the systemic infection suggested by the CBC and CRP results.