Differential Diagnosis for Bleeding Kidney with Severe Lower Pelvic Pain

Given the clinical presentation of a bleeding kidney accompanied by severe lower pelvic pain, with bacterial and viral infections ruled out, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Kidney Stone (Nephrolithiasis): This condition is a common cause of severe pain and can lead to bleeding if the stone causes significant trauma to the renal parenchyma or the urinary tract. The pain is often described as severe and can radiate from the flank to the groin.

• Other Likely Diagnoses

  • Renal Trauma: Even if not immediately apparent, any form of trauma to the abdomen or back can cause a bleeding kidney. The severity of the pain and the presence of bleeding support this diagnosis.
  • Renal Vascular Abnormalities: Conditions such as arteriovenous malformations (AVMs) or renal artery aneurysms can cause bleeding and pain.
  • Malignancy: Tumors of the kidney, such as renal cell carcinoma, can cause bleeding and pain, although the pain might be more chronic in nature.

• Do Not Miss Diagnoses

  • Aortic Aneurysm or Dissection: Although less directly related to the kidney, a ruptured abdominal aortic aneurysm or dissection can cause severe back and abdominal pain and can lead to renal ischemia or infarction, which might be perceived as a "bleeding kidney" in the context of severe pain and hemodynamic instability.
  • Ectopic Pregnancy: In women of childbearing age, an ectopic pregnancy can cause severe pelvic pain and, if ruptured, significant internal bleeding. Although not directly a kidney issue, it's a critical diagnosis to consider due to its potential for severe consequences.
  • Ovarian Torsion: Similar to ectopic pregnancy, ovarian torsion can cause severe pelvic pain and might be associated with some degree of bleeding, although it's more of a gynecological emergency.

• Rare Diagnoses

  • Vasculitis: Certain types of vasculitis, such as polyarteritis nodosa, can affect the renal arteries and cause bleeding and pain.
  • Sickle Cell Disease: In patients with sickle cell disease, sickling crises can lead to renal infarction and potentially cause the symptoms described.
  • Renal Infarction: This can be caused by various conditions, including thromboembolism, and might present with severe pain and potentially some degree of bleeding.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic imaging to determine the most appropriate course of action.