What is the likely diagnosis for a 62-year-old patient with nephrotic syndrome, painful purpura, and impaired renal function with ultrasonographic findings of enlarged kidneys, increased echogenicity, and decreased corticomedullary differentiation?

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Diferencial de diagnóstico para un paciente de 62 años con síndrome nefrótico, lesiones violáceas dolorosas y riñones aumentados de tamaño con mayor ecogenicidad y menor diferenciación corticomedular

  • Diagnóstico más probable:
    • Amyloidosis: La presencia de síndrome nefrótico, lesiones violáceas dolorosas (posiblemente petequias o purpuras) y cambios en la ecografía renal sugieren una posible amyloidosis, que es una condición en la que se depositan proteínas anormales en los órganos, incluyendo los riñones.
  • Otros diagnósticos probables:
    • Glomerulonefritis: La inflamación de los glomérulos renales puede causar síndrome nefrótico y cambios en la ecografía renal.
    • Nefropatía diabética: Aunque no se menciona la diabetes, es una causa común de síndrome nefrótico y cambios renales en adultos mayores.
    • Nefropatía por IgA: Una causa común de glomerulonefritis que puede presentarse con síndrome nefrótico y hematuria.
  • No debes perder (diagnósticos que no son tan probables, pero que serían mortales si se pierden):
    • Síndrome de Goodpasture: Una enfermedad autoinmune que puede causar glomerulonefritis y síndrome nefrótico, y que requiere un tratamiento urgente.
    • Vasculitis: Como la granulomatosis con poliangiitis o la poliarteritis nodosa, que pueden causar síndrome nefrótico y cambios renales.
  • Diagnósticos raros:
    • Nefropatía por depósito de cadenas ligeras: Una condición en la que se depositan proteínas anormales en los riñones, similar a la amyloidosis.
    • Nefropatía por fibrilas finas: Una condición en la que se depositan fibrilas finas en los riñones, que puede causar síndrome nefrótico y cambios renales.

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