Differential Diagnosis for Urinary Tract Infection
Given the laboratory results of leukocytes 15, nitrite 0, Protein 15, blood positive, and specific gravity (sg) 1.015, we can categorize the differential diagnosis as follows:
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): The presence of leukocytes (indicating an inflammatory response), proteinuria, and hematuria (blood in the urine) strongly suggests a UTI. The absence of nitrite does not rule out a UTI, as not all bacteria that cause UTIs produce nitrate reductase, the enzyme responsible for converting nitrate to nitrite.
Other Likely Diagnoses
- Kidney Stone: The presence of blood in the urine (hematuria) and proteinuria could also be indicative of a kidney stone, especially if the patient is experiencing pain.
- Glomerulonephritis: An inflammatory condition of the glomeruli, which could explain the hematuria and proteinuria. However, the presence of leukocytes might be less pronounced compared to a UTI.
Do Not Miss Diagnoses
- Pyelonephritis: An infection of the kidney itself, which can present similarly to a UTI but may have more severe consequences if not promptly treated. The presence of leukocytes and other abnormalities in the urine could indicate pyelonephritis.
- Severe Sepsis or Septic Shock from a UTI: Although less common, a UTI can lead to severe sepsis or septic shock, especially in vulnerable populations. Early recognition and treatment are crucial.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by glomerulonephritis, end-stage kidney disease, and hearing loss. It could present with hematuria and proteinuria but is much less common than other causes.
- Goodpasture Syndrome: An autoimmune disease that can cause glomerulonephritis and pulmonary hemorrhage. It is rare and typically presents with more systemic symptoms in addition to renal findings.