Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with obstructing ureteral stone: The presence of many bacteria, WBCs, and RBCs in the urine, along with a 3 mm stone at or near the ureterovesical junction (UVJ) and hydroureteronephrosis, strongly suggests a UTI complicated by an obstructing stone.
- Other Likely diagnoses
- Pyelonephritis: The combination of WBCs and bacteria in the urine, along with the finding of hydroureteronephrosis, could indicate an upper urinary tract infection.
- Cystitis: The urinary bladder wall thickening and the presence of WBCs, RBCs, and bacteria in the urine support this diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient's CBC shows an elevated WBC count, which could be indicative of infection, it's crucial to consider sepsis, especially if the patient shows signs of systemic illness, as untreated sepsis can be fatal.
- Emphysematous Pyelonephritis: This is a severe infection of the kidney that can occur in diabetic patients or those with urinary tract obstruction. It's a life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that can occur in the setting of long-standing urinary tract obstruction, often associated with a urinary tract infection.
- Malakoplakia: A rare inflammatory condition that can affect the urinary tract, often associated with chronic infection and can mimic other conditions like cancer.