Differential Diagnosis

• Single most likely diagnosis
  • Urinary Tract Infection (UTI): The presence of hematuria (blood in urine) and proteinuria (protein in urine) with a moderate increase in leukocytes on dipstick testing strongly suggests a UTI, especially in an elderly male. The absence of abdominal pain does not rule out this diagnosis, as UTIs can be asymptomatic or present with minimal symptoms in older adults.
• Other Likely diagnoses
  • Prostatitis: Although the prostate is described as normal, prostatitis can sometimes present without significant prostate abnormalities on examination. The presence of hematuria and proteinuria could be related to an inflammatory process involving the prostate.
  • Kidney Stones: While there's no mention of pain, which is a common symptom of kidney stones, it's possible for stones to cause hematuria and proteinuria without significant pain, especially if they are small and not obstructing.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bladder Cancer: Hematuria is a key symptom of bladder cancer. Although less likely than a UTI, missing a diagnosis of bladder cancer could have severe consequences, making it crucial to consider, especially in an older adult.
  • Kidney Cancer: Similar to bladder cancer, kidney cancer can present with hematuria. It's less common but critical to rule out due to its potential severity.
• Rare diagnoses
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the body, leading to kidney disease, hearing loss, and eye abnormalities. It's rare and typically presents earlier in life but could be considered in the differential for unexplained hematuria and proteinuria.
  • Goodpasture Syndrome: An autoimmune disease that can cause kidney inflammation and bleeding in the lungs. It's rare and usually presents with more systemic symptoms, but the renal involvement could mimic the presentation seen here.