Differential Diagnosis for a 7-year-old Girl with Mild Eye Swelling and Cough
Single Most Likely Diagnosis
- Nephrotic Syndrome: This condition is characterized by significant proteinuria (protein in the urine), which is indicated by the UA result showing 1 plus protein. The mild eye swelling could be due to fluid retention, a common symptom in nephrotic syndrome. The cough could be unrelated or a sign of an underlying infection that triggered the nephrotic syndrome.
Other Likely Diagnoses
- Allergic Rhinitis: This could explain the cough (if it's dry and related to postnasal drip) and the mild eye swelling (due to allergic reactions). However, the presence of protein in the urine would need another explanation, possibly a concurrent condition.
- Infectious Causes (e.g., Sinusitis, Pharyngitis): These could explain the cough and potentially the eye swelling if there's significant facial or sinus involvement. The proteinuria might be minimal and related to a transient, non-specific response to infection.
- Acute Poststreptococcal Glomerulonephritis (APSGN): Although less common, APSGN can follow a streptococcal infection (like strep throat) and cause proteinuria, along with other symptoms like hematuria (blood in the urine), which isn't mentioned here.
Do Not Miss Diagnoses
- Systemic Lupus Erythematosus (SLE): Although rare in children, SLE can cause a wide range of symptoms including renal involvement (nephritis), which would explain the proteinuria, and eye symptoms. It's crucial to consider SLE due to its potential severity and the need for early treatment.
- Goodpasture Syndrome: An autoimmune disease that affects the kidneys and lungs, potentially causing cough (due to pulmonary hemorrhage) and renal symptoms like proteinuria. It's rare but critical to diagnose early due to its severity.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This condition can affect various parts of the body, including the kidneys (causing proteinuria) and the respiratory tract (causing cough). It's rare and requires prompt diagnosis and treatment to prevent serious complications.
Rare Diagnoses
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the body, leading to kidney disease (which could explain the proteinuria), hearing loss, and eye abnormalities. It's less likely given the acute presentation but should be considered in the differential for chronic conditions.
- Fabry Disease: A genetic disorder that can lead to renal failure among other symptoms. It's very rare and typically presents with more systemic symptoms, including pain in the extremities and gastrointestinal symptoms, but could be considered in a broad differential for proteinuria.