Differential Diagnosis
- Single most likely diagnosis
- Urinary Tract Infection (UTI) with ureteral obstruction due to a stone: The presence of many bacteria, WBCs, and RBCs in the urine, along with leukocyte esterase and a 3 mm stone at or near the ureterovesical junction (UVJ), supports this diagnosis. The mild left hydroureteronephrosis and urinary bladder wall thickening also correlate with a UTI and possible obstruction.
- Other Likely diagnoses
- Pyelonephritis: The WBC count of 14.8 and the presence of WBCs and RBCs in the urine could indicate an upper urinary tract infection, which is pyelonephritis.
- Cystitis: The urinary bladder wall thickening and the presence of many bacteria, WBCs, and RBCs in the urine support this diagnosis.
- Ureteral obstruction without infection: Although less likely given the presence of bacteria, the 3 mm stone could still cause obstruction without an active infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although the patient's WBC count is elevated, indicating a possible infection, sepsis is a life-threatening condition that requires immediate attention. The presence of a UTI and possible obstruction increases the risk of sepsis.
- Emphysematous pyelonephritis: A rare but life-threatening condition that occurs when a UTI leads to gas formation in the kidney. Although less likely, it is crucial to consider in patients with diabetes or immunocompromised states.
- Urosepsis: Similar to sepsis, urosepsis is a life-threatening condition that occurs when a UTI leads to a systemic infection.
- Rare diagnoses
- Xanthogranulomatous pyelonephritis: A rare form of chronic pyelonephritis that can cause obstructive uropathy and renal damage.
- Malakoplakia: A rare inflammatory condition that can affect the urinary tract and cause obstructive symptoms.
- Tuberculosis of the urinary tract: A rare condition that can cause chronic infection and obstructive uropathy.