Differential Diagnosis for CVA Tenderness with Kidney Stone

• Single Most Likely Diagnosis
  • Nephrolithiasis (Kidney Stone) with Pyelonephritis: This is the most likely diagnosis because the presence of a kidney stone can cause obstruction and lead to infection, which would explain the CVA (costovertebral angle) tenderness. The stone itself can also cause pain that radiates to the CVA.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): A UTI can cause CVA tenderness, especially if it has ascended to the kidneys (pyelonephritis). The presence of a kidney stone increases the risk of developing a UTI.
  • Nephroptosis: This condition, where the kidney drops down into the pelvis, can cause CVA tenderness and is sometimes associated with kidney stones.
• Do Not Miss Diagnoses
  • Pyonephrosis: An infection of the kidney that results in the formation of pus, often due to an obstructing stone. This condition requires urgent drainage and antibiotic treatment.
  • Sepsis: Any infection, including those related to kidney stones or UTIs, can lead to sepsis, a life-threatening condition that requires immediate medical attention.
  • Renal Cell Carcinoma: Although less common, a tumor in the kidney could cause CVA tenderness and might be associated with a stone or other urinary symptoms.
• Rare Diagnoses
  • Renal Infarction: A blockage of the blood supply to the kidney, which could cause severe pain and CVA tenderness, though it is less commonly associated directly with kidney stones.
  • Retroperitoneal Fibrosis: A rare condition where fibrotic tissue forms in the retroperitoneum and can encase and obstruct structures like the ureters, potentially causing CVA tenderness and kidney stones due to obstruction.