Differential Diagnosis for Urinary Pain with Gross Hematuria
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI) or Kidney Stone: The initial presentation of gross hematuria followed by microscopic hematuria, along with urinary pain, is highly suggestive of a UTI or a kidney stone. These conditions are common and can cause both pain and bleeding due to infection or the passage of a stone through the urinary tract.
Other Likely Diagnoses
- Bladder Cancer: Although less common than UTIs or kidney stones, bladder cancer can present with painless gross hematuria. However, in some cases, it may cause urinary pain, especially if there is associated infection or if the tumor obstructs urine flow.
- Prostatitis: In men, prostatitis (inflammation of the prostate) can cause urinary pain and hematuria. The condition can be acute or chronic and may be due to bacterial infection.
- Kidney Infection (Pyelonephritis): An infection of the kidney can cause severe pain, fever, and hematuria. It is a possible diagnosis, especially if the patient has a history of UTIs or underlying urinary tract abnormalities.
Do Not Miss Diagnoses
- Trauma: Although the history may not suggest trauma, it is crucial to consider the possibility, especially if the patient is not forthcoming about their history. Trauma to the urinary tract can cause hematuria and pain.
- Sickle Cell Disease or Trait: Patients with sickle cell disease or trait can experience sickling in the low-oxygen environment of the kidney, leading to ischemia, pain, and hematuria.
- Bleeding Disorders: Conditions like hemophilia or von Willebrand disease can predispose to bleeding, including in the urinary tract. Although rare, these conditions can have significant implications if not recognized.
Rare Diagnoses
- Arteriovenous Malformation (AVM) or Arteriovenous Fistula (AVF): These vascular anomalies can cause hematuria due to abnormal connections between arteries and veins in the kidney or bladder.
- Goodpasture Syndrome: A rare autoimmune disease that can cause glomerulonephritis and pulmonary hemorrhage, presenting with hematuria among other symptoms.
- Tuberculosis (TB) of the Urinary Tract: Although rare in many parts of the world, TB can infect the urinary tract, causing chronic pain, hematuria, and other systemic symptoms.
- Schistosomiasis: In endemic areas, this parasitic infection can cause urinary tract symptoms, including hematuria, due to the eggs of the parasite lodged in the bladder wall.