Differentials

Acute pyelonephritis

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Acute infections may be superimposed on underlying chronic pyelonephritis.

Presents with anorexia; fevers or chills; nausea and vomiting; constant, usually dull, back pain; and hematuria.

INVESTIGATIONS

The blood leukocyte count may be elevated.

Urinalysis should show leukocytes and blood, and urine cultures will be positive.

Acute pyelonephritis

Renal calculi

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Renal stones usually cause intermittent, sharp, often radiating pain.

INVESTIGATIONS

Spiral CT scan of the abdomen is the test of choice.

Ultrasound of the kidneys may also demonstrate renal or bladder calculi but may miss ureteral calculi due to overlying gas in the intestines.

Nephrolithiasis

Renal cancer

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

There are no differentiating symptoms or signs.

INVESTIGATIONS

Difficult to differentiate xanthogranulomatous pyelonephritis from renal cancer on imaging; diagnosis often not made until following nephrectomy.[33][35]

Renal cell carcinoma

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