Differential Diagnosis for Negative Proteinuria, Haemoglobinuria, Leukocyturia

Given the symptoms of negative proteinuria, haemoglobinuria, and leukocyturia with negative tests for nitrite, Candida, and bacteria, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Nephrolithiasis (Kidney Stones): This condition can cause hematuria (blood in urine) and leukocyturia (white blood cells in urine) due to the irritation and inflammation caused by the stones. The absence of infection markers (nitrite, bacteria) and the presence of blood and white cells in the urine support this diagnosis.
• Other Likely Diagnoses
  • Glomerulonephritis: An inflammation of the glomeruli, the filtering units of the kidneys, which can cause hematuria. Some forms may not present with significant proteinuria initially.
  • Tubulointerstitial Nephritis: Inflammation of the tubules and interstitial tissue of the kidneys, which can be caused by drugs, infections, or other diseases, leading to leukocyturia and sometimes hematuria.
  • Vasculitis: Inflammation of the blood vessels, which can affect the kidneys and cause hematuria and leukocyturia.
• Do Not Miss Diagnoses
  • Malignancy (e.g., Bladder or Kidney Cancer): Although less common, these conditions can present with hematuria and should always be considered to avoid delayed diagnosis.
  • Sickle Cell Disease or Trait: Can cause hematuria due to sickling in the kidney.
  • Goodpasture Syndrome: A rare autoimmune disease that can cause glomerulonephritis and pulmonary hemorrhage, presenting with hematuria.
• Rare Diagnoses
  • Alport Syndrome: A genetic disorder characterized by glomerulonephritis, end-stage kidney disease, and hearing loss, which can present with hematuria.
  • Loin Pain-Hematuria Syndrome: A rare condition characterized by recurrent episodes of severe flank pain and hematuria, often without an identifiable cause.
  • Renal Trauma: Although usually associated with a clear history of trauma, minor injuries might not always be recalled or recognized, leading to hematuria and leukocyturia.

Each of these diagnoses has a different set of implications for patient management and outcome, emphasizing the importance of a thorough diagnostic workup.