Differential Diagnosis for a Bleeding Kidney

The following is a list of possible reasons a kidney would be bleeding, categorized by likelihood and potential impact.

• Single most likely diagnosis

  • Trauma: This is the most likely cause of a bleeding kidney, as any form of injury to the abdominal or back area can cause damage to the kidney, leading to bleeding. The severity of the trauma can range from minor to severe, and the bleeding can be either immediate or delayed.

• Other Likely diagnoses

  • Kidney stones: Stones in the kidney can cause bleeding due to the irritation and damage they cause to the kidney tissue and urinary tract.
  • Infection or Pyelonephritis: Severe infections of the kidney can lead to inflammation and bleeding.
  • Cancer: Both benign and malignant tumors of the kidney can cause bleeding, either due to the tumor itself or as a result of tumor rupture.
  • Vascular issues: Conditions such as arteriovenous malformations (AVMs) or aneurysms in the kidney can lead to bleeding.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Sickle cell disease: Patients with sickle cell disease are at an increased risk of bleeding in various organs, including the kidneys, due to the sickling of red blood cells causing vascular occlusion.
  • Bleeding disorders: Conditions such as hemophilia or other coagulopathies can increase the risk of spontaneous bleeding in the kidney.
  • Vasculitis: Inflammation of the blood vessels (vasculitis) can affect the kidneys and lead to bleeding.

• Rare diagnoses

  • Renal cyst rupture: Rupture of a renal cyst, which can be congenital or acquired, can lead to bleeding.
  • Angiomyolipoma rupture: These are rare, benign tumors of the kidney that can rupture and cause bleeding.
  • Renal artery or vein thrombosis: Although more commonly associated with acute kidney injury, these conditions can also lead to bleeding, especially if there is associated infarction of the kidney tissue.