Differential Diagnosis for Persistent Mild Left-Sided Hydronephrosis
Single Most Likely Diagnosis
- Chronic Pelvic Floor Dysfunction or Mild Ureteral Stricture: This could be due to a variety of causes including previous surgeries, infections, or congenital conditions. The fact that the hydronephrosis is mild and stable suggests a chronic, possibly low-grade obstruction.
Other Likely Diagnoses
- Nephrolithiasis (Kidney Stones): Even if not currently causing an obstruction, a stone could have caused intermittent obstruction leading to hydronephrosis. The absence of current symptoms does not rule out the presence of stones.
- Ureteropelvic Junction (UPJ) Obstruction: This is a condition where blockage occurs at the junction where the ureter attaches to the renal pelvis. It can be congenital or acquired and may cause intermittent or persistent hydronephrosis.
- Vesicoureteral Reflux: Although more common in children, it can also occur in adults, especially if there's a history of urinary tract infections or other urinary abnormalities.
Do Not Miss Diagnoses
- Ureteral Tumor or Cancer: Although less common, any obstruction in the ureter could potentially be due to a tumor. Early detection is crucial for treatment outcomes.
- Retroperitoneal Fibrosis: A rare condition characterized by the proliferation of fibrous tissue in the retroperitoneum that can encase and obstruct structures such as the ureters.
- Lymphoma or Other Malignancies: These can cause external compression of the ureters leading to hydronephrosis. Given the potential severity of these conditions, they must be considered.
Rare Diagnoses
- Prune Belly Syndrome: A rare congenital disorder characterized by the absence or severe weakness of the abdominal muscles, undescended testes, and urinary tract anomalies, which could include hydronephrosis.
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. It could potentially lead to urinary tract abnormalities, including hydronephrosis, due to tissue fragility and poor healing.
- Sickle Cell Disease: Can cause a variety of renal complications, including hydronephrosis, due to sickling of red blood cells within the kidney or ureters.