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Differential Diagnosis for a 13-year-old Boy with Diffuse Abdominal Pain

Single Most Likely Diagnosis

  • Acute Kidney Injury (AKI) or Acute Glomerulonephritis: Given the presence of hematuria (10-15 RBCs in urine) and elevated creatinine (3), this diagnosis is highly plausible. The abdominal pain could be related to the kidney injury or inflammation.

Other Likely Diagnoses

  • Nephrolithiasis (Kidney Stones): The combination of abdominal pain and hematuria could suggest kidney stones, especially if the pain is severe and colicky.
  • Urinary Tract Infection (UTI): Although less common in boys, a UTI could cause abdominal pain, hematuria, and potentially affect kidney function.
  • Henoch-Schönlein Purpura (HSP): This condition can cause abdominal pain, hematuria, and sometimes kidney dysfunction, especially in children.

Do Not Miss Diagnoses

  • Sepsis: Although the vitals are stable, sepsis can present subtly, especially in the early stages. It's crucial to consider this diagnosis due to its high mortality rate if missed.
  • Appendicitis: While the pain is described as diffuse, appendicitis can sometimes present atypically, especially in children. Missing this diagnosis could lead to severe consequences.
  • Trauma: Even if not immediately apparent, internal trauma could cause abdominal pain and hematuria. It's essential to inquire about any recent accidents or injuries.

Rare Diagnoses

  • Alport Syndrome: A genetic disorder affecting the type IV collagen in kidneys, ears, and eyes, which could explain the hematuria and kidney dysfunction.
  • Vasculitis (e.g., ANCA-associated vasculitis): These conditions are rare but can cause kidney injury, hematuria, and abdominal pain.
  • Tumor (e.g., Wilms Tumor): Although rare, a tumor could cause abdominal pain and affect kidney function, especially if it obstructs the urinary tract or invades the kidney tissue.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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