A 35-year-old female presents with fever, right-sided flank pain, and nausea. She has a history of kidney stones. Her blood pressure is 90/60 mmHg and her heart rate is 110 bpm. Her laboratory results show leukocytosis and elevated creatinine. What are the potential diagnoses and next steps?
This patient's presentation suggests a urinary tract infection, likely pyelonephritis, complicated by a kidney stone and sepsis, given her fever, leukocytosis, flank pain, and evidence of organ dysfunction (elevated creatinine). This is a medical emergency. Immediate steps include obtaining blood and urine cultures, initiating broad-spectrum antibiotics, and providing intravenous fluid resuscitation. Urgent urological consultation is necessary for potential decompression of the obstructed kidney, typically through a ureteral stent or a percutaneous nephrostomy.