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 urinary tract infection or minimal change disease.
- Urinary Tract Infection (UTI): Although UTIs are more common in girls, the symptoms provided (cough and eye swelling) are not typical for a UTI. The proteinuria could be seen in a UTI, especially if it involves the kidneys (pyelonephritis).
- Post-Streptococcal Glomerulonephritis (PSGN): This condition follows a streptococcal infection (like strep throat) and can cause proteinuria and hematuria (blood in the urine). The eye swelling could be due to fluid retention. The cough could be a residual symptom from the initial infection.
Do Not Miss Diagnoses
- Systemic Lupus Erythematosus (SLE): Although rare in children, SLE can present with a wide range of symptoms including renal involvement (proteinuria), eye symptoms, and systemic symptoms like cough. Missing this diagnosis could lead to significant morbidity.
- Goodpasture Syndrome: An autoimmune disease that affects the kidneys and lungs, presenting with hemoptysis (coughing up blood) and renal failure. The eye swelling could be secondary to fluid retention. This is a rare condition but critical to diagnose early.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This is a form of vasculitis that affects small- and medium-size vessels and can present with a variety of symptoms including cough, renal involvement, and eye symptoms. It's rare but potentially life-threatening if not treated promptly.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by glomerulonephritis, end-stage kidney disease, and hearing loss. Eye abnormalities are also common. It's a rare condition and would be considered if there's a family history or other specific findings like hearing loss.
- Fabry Disease: A genetic disorder that results from the buildup of a particular type of fat in the body's cells, affecting many parts of the body including the kidneys, heart, and skin. It could potentially explain the proteinuria and eye swelling but is very rare and would require specific diagnostic tests.