Differential Diagnosis
- Single most likely diagnosis
- Pyelonephritis: This diagnosis is most likely due to the presence of many bacteria, WBC 11-20, RBC 11-20, and leukocyte esterase in the urine, along with nonobstructive left nephrolithiasis which can act as a nidus for infection.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): Similar to pyelonephritis, the presence of bacteria and WBCs in the urine supports this diagnosis, but the involvement of the kidney (pyelonephritis) is more likely given the CT findings and the presence of blood and protein in the urine.
- Nephrolithiasis with associated infection or inflammation: The CT shows nonobstructive left nephrolithiasis, and the presence of calcium oxalate and amorphous crystals, along with blood and protein in the urine, supports this diagnosis. The bacteria and WBCs suggest an associated infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although not directly indicated by the provided information, any infection (such as pyelonephritis or UTI) can potentially lead to sepsis, especially in vulnerable populations. It's crucial to monitor for signs of sepsis.
- Obstructive uropathy: Although the CT mentions nonobstructive nephrolithiasis, the presence of stones and infection could potentially lead to obstruction, which would be an emergency.
- Xanthogranulomatous pyrophane (XGP): A rare but serious condition that can mimic other diagnoses and is associated with chronic infection and obstruction.
- Rare diagnoses
- Malacoplusca: A rare condition associated with chronic infection and the formation of calculi.
- Tubulointerstitial nephritis: Could be considered in the presence of renal tubular cells and proteinuria, but the primary findings suggest an infectious or obstructive process rather than an autoimmune or allergic one.