Differential Diagnosis for a 16yo Female Athlete with Protein and Ketones in Urine

• Single most likely diagnosis:
  • Dehydration: This is a common condition in athletes, especially during intense training or competition. Dehydration can cause a temporary increase in protein and ketones in the urine due to concentrated urine and the body's stress response.
• Other Likely diagnoses:
  • Overexertion or intense exercise: Prolonged or intense physical activity can lead to the presence of protein and ketones in the urine due to muscle breakdown and increased fat metabolism.
  • Dietary factors: A diet low in carbohydrates and high in protein, or recent consumption of a high-fat meal, can cause the presence of ketones in the urine.
  • Menstrual-related changes: Hormonal fluctuations during the menstrual cycle can affect kidney function and lead to changes in urine composition, including the presence of protein and ketones.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Diabetic ketoacidosis (DKA): Although less common in athletes, DKA is a life-threatening condition that requires immediate attention. The presence of ketones in the urine, along with other symptoms like hyperglycemia, can indicate DKA.
  • Kidney disease or damage: Underlying kidney issues, such as nephrotic syndrome or acute kidney injury, can cause proteinuria (protein in the urine) and may be accompanied by ketonuria (ketones in the urine).
• Rare diagnoses:
  • Pregnancy-related conditions: Although rare in a 16-year-old athlete, pregnancy can cause changes in urine composition, including the presence of protein and ketones.
  • Genetic disorders: Certain genetic conditions, such as maple syrup urine disease or ketone body utilization disorders, can affect metabolism and lead to the presence of ketones in the urine.