What is the most likely additional finding in a 42-year-old man with hematuria, fatigue, and nasal congestion, who has impaired renal function, proteinuria, and a renal biopsy showing crescents in most glomeruli, with a pauci-immune pattern?

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Diagnóstico Diferencial

  • Diagnóstico más probable:
  • Granulomatosis con poliangitis (GPA): La presencia de semilunas en la biopsia renal, sin depósitos en inmunofluorescencia, y la congestión nasal sugieren una vasculitis asociada a ANCA, como la GPA.
  • Otros diagnósticos probables:
  • Vasculitis microscópica poliangiítica: También es una vasculitis asociada a ANCA, que puede presentar con glomerulonefritis y afectación de otras partes del cuerpo.
  • Enfermedad de Wegener: Es una forma de vasculitis que puede afectar los riñones, las vías respiratorias y otros órganos, y también se asocia con ANCA.
  • No te pierdas (diagnósticos que no son tan probables, pero que serían mortales si se pasan por alto):
  • Glomerulonefritis postinfecciosa: Aunque no hay hallazgos sugestivos de infección, es importante considerar esta posibilidad, ya que puede ser mortal si no se trata adecuadamente.
  • Enfermedad de Goodpasture: Aunque no hay anticuerpos anti-MBG, es importante considerar esta posibilidad, ya que puede ser mortal si no se trata adecuadamente.
  • Diagnósticos raros:
  • Vasculitis eosinofílica con poliangitis (Churg-Strauss): Es una forma de vasculitis que puede presentar con glomerulonefritis y afectación de otras partes del cuerpo, pero es menos común que las otras opciones.
  • Enfermedad de Behçet: Es una forma de vasculitis que puede afectar los riñones, las vías respiratorias y otros órganos, pero es menos común que las otras opciones.

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