Differential Diagnosis for Hematuria with Delirium or Acute Psychosis-like Picture

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI) with Sepsis: This is a common condition, especially in the elderly, where a UTI can lead to sepsis, causing delirium and acute kidney injury, which may result in hematuria. The combination of infection and potential renal involvement makes it a plausible cause for both symptoms.

Other Likely Diagnoses

• Kidney Stones: Severe pain and possible infection associated with kidney stones can lead to delirium, especially if the patient is elderly or has a history of psychiatric issues. Hematuria is a common finding in patients with kidney stones.
• Acute Kidney Injury (AKI): Various causes of AKI, such as medications, toxins, or ischemia, can lead to a buildup of toxins, resulting in delirium. Hematuria may be present depending on the underlying cause of AKI.
• Pyelonephritis: An infection of the kidney, which can cause severe illness, including delirium, especially in vulnerable populations. Hematuria can occur due to the inflammatory process affecting the kidneys.

Do Not Miss Diagnoses

• Sepsis from Any Source: Sepsis, regardless of its origin, can cause delirium and organ dysfunction, including acute kidney injury leading to hematuria. Early recognition and treatment are crucial.
• Anticholinergic Toxicity: Certain medications or substances can cause anticholinergic syndrome, leading to delirium. If these substances are excreted in the urine, they might cause hematuria or be associated with urinary retention, which can lead to UTIs and subsequent hematuria.
• Porphyria: A group of disorders that can cause abdominal pain, neurological symptoms, and psychiatric disturbances, including delirium. Some forms of porphyria can lead to hematuria due to the disease's effect on the kidneys.

Rare Diagnoses

• Thrombotic Thrombocytopenic Purpura (TTP): A rare blood disorder that can cause kidney injury, leading to hematuria, and neurological symptoms, including delirium, due to the formation of blood clots in small blood vessels throughout the body.
• Hemolytic-Uremic Syndrome (HUS): Similar to TTP, HUS can cause kidney failure, hematuria, and neurological symptoms, including delirium, although it is more commonly associated with diarrhea caused by E. coli O157:H7.
• Vasculitis: Certain types of vasculitis, such as ANCA-associated vasculitis, can affect the kidneys and cause hematuria, and also lead to neurological symptoms, including delirium, due to the inflammation of blood vessels.