Differential Diagnosis for Proteinuric Chronic Kidney Disease
Single Most Likely Diagnosis
- A Focal segmental glomerulosclerosis (FSGS): This is the most likely diagnosis given the patient's African descent, family history of end-stage kidney disease, and presentation with nephrotic syndrome (generalized anasarca, low albumin, high cholesterol, and significant proteinuria). FSGS is a common cause of nephrotic syndrome in adults, especially in those of African ancestry.
Other Likely Diagnoses
- C Membranous nephropathy: This is another possible cause of nephrotic syndrome, characterized by the presence of immune complexes on the glomerular basement membrane. While it's less likely than FSGS given the patient's background, it remains a consideration in the differential diagnosis.
- D Minimal change glomerulopathy: Typically presents with nephrotic syndrome, but it's more common in children. However, it can occur in adults, especially those with a secondary form related to another condition (e.g., lymphoma, drugs).
Do Not Miss Diagnoses
- B Lupus nephritis: Although less likely given the lack of other systemic symptoms suggestive of lupus (e.g., joint pain, rash, fever), lupus nephritis can cause nephrotic syndrome and must be considered to avoid missing a potentially treatable and serious condition.
- Other systemic diseases (e.g., amyloidosis, diabetes mellitus): These conditions can also cause nephrotic syndrome and should be considered, especially if there are other suggestive symptoms or signs.
Rare Diagnoses
- Genetic disorders (e.g., Alport syndrome, thin basement membrane disease): While the family history of end-stage kidney disease might suggest a genetic component, these specific disorders typically present differently (e.g., with hematuria in Alport syndrome).
- Other glomerulopathies (e.g., membranoproliferative glomerulonephritis, IgA nephropathy): These can cause a variety of renal presentations, including nephrotic syndrome, but are less likely given the patient's specific presentation and background.