Differential Diagnosis for 58-year-old Male Veteran with Left Flank Pain
Single Most Likely Diagnosis
- Pyelonephritis or Urinary Tract Infection (UTI): Given the patient's symptoms of left flank pain, presence of leukocytes, rare urine bacteria, white blood cells, and red blood cells on urinalysis, a UTI or pyelonephritis is the most likely diagnosis. The history of kidney stones also increases the risk for UTIs.
Other Likely Diagnoses
- Nephrolithiasis (Kidney Stones): The patient's history of kidney stones and current presentation of flank pain and hematuria (red blood cells in urine) make kidney stones a likely consideration.
- Acute Interstitial Nephritis: This condition can cause flank pain and is often associated with an allergic reaction, infection, or certain medications. The presence of white blood cells in the urine could suggest an inflammatory process.
Do Not Miss Diagnoses
- Sepsis: Although less likely given the information, sepsis is a life-threatening condition that can arise from untreated infections, including UTIs or pyelonephritis. The presence of bacteria in the urine and leukocytes warrants careful consideration of sepsis, especially in a veteran population that may have underlying health conditions.
- Renal Cell Carcinoma or Other Malignancies: While rare, flank pain and hematuria can be symptoms of renal cell carcinoma or other malignancies affecting the urinary tract. Given the patient's age, this is a critical diagnosis not to miss.
- Renal Infarction: This is a rare but potentially life-threatening condition that could present with acute flank pain and might be considered, especially if there's a history of cardiovascular disease or hypercoagulable states.
Rare Diagnoses
- Malacoplakia: A rare inflammatory condition that can affect the urinary tract and present with symptoms similar to a UTI, including flank pain and hematuria.
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that can cause flank pain, often associated with long-standing urinary tract obstruction, such as by kidney stones.
- Tuberculosis of the Urinary Tract: Although rare in many parts of the world, urinary tract tuberculosis can cause chronic flank pain, hematuria, and other urinary symptoms, and should be considered, especially in high-risk populations or those with exposure history.