Differential Diagnosis
- Single most likely diagnosis
- Pyelonephritis: The presence of many bacteria, WBC 11-20, RBC 11-20, and leukocyte esterase in the urine, along with the CT abdomen showing nonobstructive left nephrolithiasis, points towards an infection of the kidney, which is consistent with pyelonephritis. The presence of blood and protein in the urine further supports this diagnosis.
- Other Likely diagnoses
- Urinary Tract Infection (UTI): While pyelonephritis is a specific type of UTI affecting the kidneys, a broader diagnosis of UTI could also be considered given the presence of bacteria and leukocyte esterase in the urine.
- Nephrolithiasis with infection: The CT finding of nonobstructive left nephrolithiasis, combined with signs of infection (bacteria, elevated WBC, and RBC in urine), suggests that the kidney stone could be a nidus for infection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although less likely given the information, the presence of a significant infection (as suggested by many bacteria and elevated WBC) could potentially lead to sepsis, especially if not promptly treated. Sepsis is a life-threatening condition that requires immediate attention.
- Emphysematous Pyelonephritis: This is a severe infection of the kidney that involves gas formation and is more common in diabetic patients. It's a life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses
- Xanthogranulomatous Pyelonephritis: A rare form of chronic pyelonephritis that involves the destruction of renal tissue and the presence of granulomatous tissue. It's often associated with long-standing urinary tract obstruction and infection.
- Malakoplakia: A rare inflammatory condition that affects the genitourinary tract, characterized by the formation of distinctive plaques. It's associated with chronic infection, often with E. coli.