Single most likely diagnosis
- Nephrolithiasis: This is the most common cause of gross hematuria in patients with horseshoe kidney, as the abnormal anatomy can predispose to stone formation due to urinary stasis.
Other Likely diagnoses
- Urinary tract infection (UTI): The abnormal anatomy of a horseshoe kidney can also increase the risk of UTIs, which can cause hematuria.
- Trauma: Although less common, trauma to the abdomen can cause injury to the horseshoe kidney, leading to hematuria.
- Renal cell carcinoma: Although rare, renal cell carcinoma can occur in horseshoe kidneys and present with hematuria.
Do Not Miss diagnoses
- Ureteropelvic junction (UPJ) obstruction: This condition can cause recurrent infections, stones, and hematuria, and is more common in horseshoe kidneys due to the abnormal anatomy.
- Vascular anomalies: Horseshoe kidneys can be associated with vascular anomalies, such as aneurysms or arteriovenous malformations, which can cause hematuria and are potentially life-threatening if missed.
Rare diagnoses
- Tuberculosis: Although rare in developed countries, tuberculosis can infect the kidneys and cause hematuria, and should be considered in patients with risk factors or exposure history.
- Angiomyolipoma: This is a rare benign tumor that can occur in the kidneys and cause hematuria, and is more common in patients with tuberous sclerosis complex.