A 52-year-old patient presents to the GP with a three-day history of urinary frequency and dysuria. Her husband is her only sexual partner. A urine dipstick is performed, showing blood +1 and is positive for leukocyte esterase and nitrites.

What is the most likely diagnosis?

Options:
explanation: Bladder cancer most typically presents as painless haematuria. An acute presentation of dysuria, haematuria and frequency is much more likely to be a urinary tract infection than bladder cancer. However, as there is microscopic haematuria in this woman, she should have a repeat urine dipstick after her symptoms have resolved to check for persistent haematuria. If there is still blood in the urine, alternative diagnoses should be considered, including bladder cancer
name: Bladder cancer
label: c
answer: no
explanation: Nephritic syndrome is a group of conditions characterised by glomerular destruction. The presentation can vary based on the cause, but symptoms can include haematuria, hypertension and symptoms of nephrotic syndrome if protein loss through the kidneys is also high. Urine dipstick findings include proteinuria and haematuria. As this patient has no proteinuria, in addition to frequency and dysuria, which are primarily symptoms of the lower urinary tract, this makes a diagnosis of urinary tract infection more likely
name: Nephritic syndrome
label: d
answer: no
explanation: This is a typical history of a urinary tract infection. It is more common in women than men, as women have a shorter urethra. Typical presenting symptoms include urinary frequency, dysuria and visible or non-visible haematuria. Urinary tract infections are typically positive for nitrite and leukocyte esterase. This because E. coli (the most common cause) produces nitrites, but whether nitrites are positive or not also depends on the bacterial cause. Management for this patient would be with a three day course of antibiotics (first-line antibiotics include nitrofurantoin and trimethoprim). This patient should also be brought back after completing antibiotics for a repeat urine dipstick to ensure the haematuria has resolved
name: Urinary tract infection
label: a
answer: yes
explanation: Chlamydia is the most common bacterial sexually transmitted infection in the UK. It can present similarly; with dysuria, and may have other features, including vaginal discharge. However, the majority of cases are asymptomatic (up to 70% in women). In this case, this woman presents with typical symptoms of a urinary tract infection and has a positive urine dip. Chlamydia infection would not cause an abnormal urinalysis
name: Chlamydia
label: b
answer: no
explanation: Polycystic kidney disease is a genetic condition characterised by the development of multiple cysts on the kidneys, the liver and/or the pancreas. This condition can present with pain and haematuria when a cyst ruptures; however, this is typically back pain. This would also not explain the frequency and dysuria symptoms and the urine dipstick findings of nitrites and leukocyte esterase. This question does not mention any family history of polycystic kidney disease or ballotable kidneys, which can point towards the diagnosis. Therefore urinary tract infection is the most likely diagnosis
name: Polycystic kidney disease
label: e
answer: no

Correct answer: a