Differential Diagnosis for Paroxysmal Nocturnal Hematuria
- Single Most Likely Diagnosis
- IgA Nephropathy: This condition is a common cause of recurrent hematuria, especially if it occurs after an upper respiratory tract infection or strenuous exercise. The nocturnal nature of the hematuria could be related to the increased pressure and concentration of the urine during sleep, which might exacerbate the condition.
- Other Likely Diagnoses
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, leading to hematuria, which can be intermittent and may worsen at night due to the reasons mentioned above.
- Thin Basement Membrane Nephropathy: Similar to Alport Syndrome, this condition affects the basement membrane of the kidneys, leading to hematuria. The nocturnal aspect could be due to similar mechanisms as mentioned for IgA Nephropathy.
- Nephrolithiasis (Kidney Stones): While not exclusively nocturnal, the pain and hematuria associated with kidney stones can be more pronounced at night due to increased urine concentration and movement of stones.
- Do Not Miss Diagnoses
- Urinary Tract Infections (UTIs): Especially those involving the upper urinary tract, such as pyelonephritis, which can cause hematuria. Missing a UTI could lead to severe complications, including sepsis.
- Malignancies (e.g., Bladder or Kidney Cancer): Although less common, these conditions can present with hematuria. The nocturnal aspect might not be directly related, but any hematuria warrants a thorough investigation to rule out cancer.
- Vasculitis (e.g., ANCA-associated vasculitis): Conditions like granulomatosis with polyangiitis can cause renal involvement leading to hematuria. These are serious conditions that require prompt diagnosis and treatment.
- Rare Diagnoses
- Goodpasture Syndrome: An autoimmune disease causing damage to the lungs and kidneys, leading to hematuria. It's rare but can be life-threatening if not recognized and treated.
- Sickle Cell Disease or Trait: Can cause hematuria due to sickling in the kidney. The nocturnal aspect could be related to increased sickling during sleep due to dehydration or other factors.
- Nutcracker Phenomenon: A rare condition where the left renal vein is compressed, leading to hematuria. It might not exclusively cause nocturnal hematuria but is a rare cause of hematuria nonetheless.