Differential Diagnosis for CVA Tenderness with Proteinuria
Single Most Likely Diagnosis
- Nephrotic Syndrome: This condition is characterized by heavy proteinuria, often leading to hypoalbuminemia, which can cause edema and potentially lead to costovertebral angle (CVA) tenderness due to fluid accumulation and possible kidney enlargement.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney that can cause CVA tenderness due to inflammation and can also lead to proteinuria. The presence of fever, dysuria, and flank pain would support this diagnosis.
- Glomerulonephritis: Inflammation of the glomeruli can cause both proteinuria and hematuria, potentially leading to CVA tenderness if there is significant kidney involvement or if it progresses to a more severe form affecting kidney function.
Do Not Miss Diagnoses
- Renal Cell Carcinoma: Although less common, it's crucial not to miss this diagnosis. Proteinuria can be a presenting feature, and CVA tenderness could be due to a mass effect or metastasis. A palpable abdominal mass or significant weight loss would raise suspicion.
- Polycystic Kidney Disease (PKD): PKD can cause proteinuria and significant kidney enlargement, leading to CVA tenderness. Family history and the presence of cysts on imaging would support this diagnosis.
- Vasculitis (e.g., ANCA-associated vasculitis): Certain types of vasculitis can affect the kidneys, leading to proteinuria and potentially CVA tenderness due to inflammation. Systemic symptoms such as fever, rash, and arthralgias might be present.
Rare Diagnoses
- Amyloidosis: A condition where abnormal proteins (amyloid) accumulate in various organs, including the kidneys, leading to proteinuria. CVA tenderness could occur if there is significant kidney involvement. Diagnosis often requires tissue biopsy.
- Diabetic Nephropathy with Infection: While diabetic nephropathy itself is common, the combination with a superimposed infection (like pyelonephritis) that causes CVA tenderness is less common but should be considered in diabetic patients with proteinuria.
- Lupus Nephritis: A complication of systemic lupus erythematosus (SLE) that can cause proteinuria and CVA tenderness due to kidney inflammation. Other systemic symptoms of SLE, such as joint pain and skin rashes, would be present.