Presenting Complaints

The patient presents with a chief complaint of blood in her urine for the past 2 days.

History of Presenting Complaint

The patient, a 38-year-old female, reports that she has been noticing bright red blood in her urine for the past 2 days. She describes the blood as being present throughout her urination, with no clots. She also reports experiencing a burning sensation when urinating and a frequent urge to urinate, but denies any flank pain or fever. The patient states that this is the first time she has experienced this issue.

Significant Positives & Negatives For Differentials

Urinary Tract Infection (UTI)

Positives:

• Presence of hematuria (blood in urine)
• Presence of dysuria (burning with urination)
• Presence of frequent urination
• History of recurrent UTIs

Negatives:

• Lack of pyuria (white blood cells in urine) on urinalysis
• Lack of positive urine culture
• Persistence of symptoms despite antibiotic treatment

Kidney Stones

Positives:

• Hematuria
• History of recurrent UTIs (can be associated with kidney stones)

Negatives:

• Lack of flank pain or colicky abdominal pain
• No history of passing stones
• No evidence of obstruction on imaging

Bladder Cancer

Positives:

• Hematuria
• Age of the patient (38 years old)

Negatives:

• Lack of risk factors (e.g., smoking, occupational exposures)
• Sudden onset of symptoms (rather than gradual)
• No other urinary symptoms (e.g., irritative voiding symptoms)

Interstitial Cystitis

Positives:

• Hematuria
• Dysuria
• Frequent urination

Negatives:

• Lack of chronic pelvic pain or discomfort
• No history of chronic bladder inflammation or irritation

Glomerulonephritis

Positives:

• Hematuria

Negatives:

• Lack of proteinuria or other signs of glomerular disease
• No systemic symptoms (e.g., edema, hypertension)
• No history of autoimmune or connective tissue disorders

Past Medical History

The patient has a history of recurrent urinary tract infections (UTIs) in the past, with the last episode occurring about 6 months ago. She was treated with antibiotics and the infection resolved. She has no other significant past medical history.

Drug/Medication History

The patient takes an oral contraceptive pill for birth control. She denies any other regular medication use.

Social History

The patient is married and works as an office administrator. She denies any history of smoking, alcohol, or recreational drug use.

Family History

The patient's mother has a history of kidney stones, but the patient is unaware of any other significant family history of genitourinary or kidney disorders.

Systems Review

The patient denies any other symptoms, such as abdominal pain, back pain, nausea, vomiting, or weight changes.

Ideas, Concerns & Expectations

The patient is concerned that the blood in her urine may be a sign of a serious underlying condition, such as kidney cancer or bladder cancer. She is hoping the doctor can determine the cause and provide appropriate treatment.

Case Presentation

Based on the patient's presentation and the significant positives and negatives for the differential diagnoses, the most likely diagnosis is a urinary tract infection (UTI). The patient's symptoms of hematuria, dysuria, and frequent urination, along with her history of recurrent UTIs, strongly suggest a UTI as the primary cause. While other diagnoses like kidney stones or bladder cancer should be considered, the lack of specific symptoms and risk factors for these conditions make a UTI the most likely explanation for the patient's current presentation.

To confirm the diagnosis and rule out other potential causes, the next steps should include:

• Urinalysis to assess for hematuria, pyuria, and other signs of infection
• Urine culture to identify the causative organism and guide antibiotic treatment
• Imaging studies, such as a renal ultrasound or CT scan, to evaluate for kidney stones or other structural abnormalities
• Referral to a urologist for further evaluation, if the initial workup is inconclusive or the patient does not respond to treatment