Differential Diagnosis for Patient with Midline to Right Lower Flank Pain
Single Most Likely Diagnosis
- Chronic Kidney Stone or Nephrolithiasis: Given the history of right open nephrectomy and the current presentation of midline to right lower flank pain, which has been increasing over the past month, along with symptoms of polyuria, polydipsia, and dribbling, a chronic kidney stone or nephrolithiasis in the remaining kidney is a plausible cause. The pain could be due to a stone causing obstruction, and the polyuria and polydipsia could be indicative of an underlying issue affecting the kidney's ability to concentrate urine.
Other Likely Diagnoses
- Urinary Tract Infection (UTI) or Pyelonephritis: The symptoms of flank pain, polyuria, polydipsia, and dribbling could also suggest a UTI or pyelonephritis, especially if the patient has a history of urinary tract issues post-nephrectomy.
- Obstruction of the Ureter or Renal Pelvis: An obstruction in the ureter or renal pelvis of the remaining kidney could cause flank pain and affect urinary function, leading to symptoms like polyuria and dribbling.
- Kidney Cyst or Mass: A cyst or mass in the remaining kidney could cause chronic pain and affect kidney function, potentially leading to the symptoms described.
Do Not Miss Diagnoses
- Ureteral Stricture or Stenosis: This is a potentially serious condition that could lead to severe consequences if not addressed, including loss of the remaining kidney function. It could be a complication of the previous surgery.
- Renal Cell Carcinoma in the Remaining Kidney: Although less likely, given the recent history of nephrectomy, it's crucial not to miss a new primary malignancy in the remaining kidney, which could present with similar symptoms.
- Sepsis due to Urinary Tract Infection: Sepsis is a life-threatening condition that requires immediate attention. A UTI in a patient with a history of nephrectomy could potentially lead to sepsis if not promptly treated.
Rare Diagnoses
- Amyloidosis: A rare condition that could affect the kidney and cause chronic pain and dysfunction, although it would be less likely without other systemic symptoms.
- Renal Tubular Acidosis (RTA): A rare condition affecting the kidney's ability to regulate acid levels, which could lead to symptoms like polyuria and polydipsia, but would typically have other distinguishing features.
- Vascular Issues (e.g., Renal Artery Stenosis): Rare vascular issues could affect kidney function and cause pain, but these would typically have other specific signs and risk factors.