Differential Diagnosis for 47 YOF with Sudden Onset Right Flank Pain and Hematuria
- Single Most Likely Diagnosis
- Urolithiasis: The sudden onset of severe flank pain, often described as colicky, along with the presence of blood in the urine (hematuria), strongly suggests a kidney stone (urolithiasis). The pain typically radiates from the flank to the groin and can be accompanied by nausea, vomiting, and frequent urination. The presence of nitrate in the urine could be a secondary finding due to a urinary tract infection (UTI) complicating the stone, but the primary presentation points towards urolithiasis.
- Other Likely Diagnoses
- Pyelonephritis: Although less likely given the acute onset of flank pain and hematuria, pyelonephritis (an infection of the kidney) could present with similar symptoms, including flank pain and hematuria. The presence of nitrate in the urine supports a bacterial infection, which is consistent with pyelonephritis. However, the sudden onset and severity of pain are more characteristic of urolithiasis.
- Do Not Miss Diagnoses
- Renal Infarction: This is a less common but critical diagnosis that must be considered. Renal infarction can present with acute flank pain and hematuria. It is often associated with conditions that predispose to thromboembolism, such as atrial fibrillation. Missing this diagnosis could lead to significant morbidity or mortality.
- Sepsis (from a complicated UTI or pyelonephritis): While the primary presentation may suggest urolithiasis or pyelonephritis, the possibility of sepsis, especially in the context of a UTI or pyelonephritis, must be considered. Sepsis can rapidly progress and is life-threatening if not promptly recognized and treated.
- Rare Diagnoses
- Renal Cell Carcinoma: Although rare, renal cell carcinoma can present with hematuria and flank pain. However, the sudden onset of symptoms is less typical for cancer, which usually has a more insidious onset.
- Renal Artery Aneurysm or Arteriovenous Malformation (AVM): These vascular abnormalities can cause hematuria and flank pain but are much less common than urolithiasis or pyelonephritis. They might be considered if initial evaluations for more common causes are negative.