Differential Diagnosis
- Single most likely diagnosis
- Diabetic nephropathy or diabetic kidney disease: The patient's diabetes, presence of glucose in the urine, and abnormal urinalysis results (moderate blood, WBC, and RBC in urine) suggest kidney damage due to diabetes. The BUN/creatinine ratio is also elevated, which can be seen in diabetic nephropathy.
- Other Likely diagnoses
- Urinary tract infection (UTI): Although the CT scan did not show any acute inflammatory pathology, the urinalysis results (moderate blood, WBC, and RBC in urine, and few bacteria) could indicate a UTI, especially in a diabetic patient who is more prone to infections.
- Non-alcoholic fatty liver disease (NAFLD): The CT scan shows an enlarged, fatty liver, which is consistent with NAFLD, a common condition in diabetic patients.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pyelonephritis or sepsis: Although the CT scan did not show any acute inflammatory pathology, the presence of bacteria, WBC, and RBC in the urine could indicate a more severe infection like pyelonephritis, which can lead to sepsis if not treated promptly.
- Obstructive uropathy: The absence of urinary tract stones on the CT scan does not entirely rule out obstructive uropathy, which could be caused by other factors like blood clots or tumors. This condition can lead to acute kidney injury if not addressed.
- Rare diagnoses
- Renal vein thrombosis: This is a rare condition that can occur in diabetic patients, especially those with nephrotic syndrome. Although the CT scan did not show any signs of thrombosis, it is essential to consider this diagnosis in the presence of hematuria and proteinuria.
- Papillary necrosis: This is a rare condition that can occur in diabetic patients, characterized by necrosis of the renal papillae. It can present with hematuria, proteinuria, and flank pain, but it is not commonly diagnosed without specific imaging findings or biopsy.