Differential Diagnosis for 47 YOF with Sudden Onset Right Flank Pain and Hematuria
- Single most likely diagnosis
- Nephrolithiasis (Kidney Stones): The sudden onset of flank pain and hematuria, along with the presence of nitrate, blood, and glucose in the urine, points towards a kidney stone. The pain is often severe and can be accompanied by nausea, vomiting, and frequent urination. The presence of blood in the urine (hematuria) is a common finding in patients with kidney stones.
- Other Likely diagnoses
- Pyelonephritis: An infection of the kidney, which can cause flank pain, hematuria, and the presence of nitrate and glucose in the urine due to the infection. The patient's symptoms and urine findings could be consistent with an upper urinary tract infection.
- Urinary Tract Infection (UTI): While the presence of glucose in the urine might initially suggest diabetes, given the patient is non-diabetic, it could indicate an infection that is causing an imbalance in urine composition. UTIs can cause hematuria and flank pain, especially if the infection has moved up the urinary tract.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Renal Infarction: Although less common, a renal infarction (a blockage of the blood flow to the kidney) can present with sudden flank pain and hematuria. It is crucial to consider this diagnosis due to its severe consequences if not promptly treated.
- Sepsis from a urinary source: If the patient's infection (if present) has led to sepsis, it would be a life-threatening condition requiring immediate intervention. The presence of systemic symptoms such as fever, tachycardia, and hypotension would raise suspicion for sepsis.
- Rare diagnoses
- Renal Cell Carcinoma: Although rare, it could present with hematuria. However, the sudden onset of symptoms would be less typical for a malignancy, which usually has a more insidious onset.
- Vasculitis (e.g., ANCA-associated vasculitis): This could cause renal inflammation leading to hematuria and flank pain, but it would be less common and might be accompanied by other systemic symptoms or findings suggestive of an autoimmune process.