Differential Diagnosis for Decreased eGFR without Proteinuria
Single Most Likely Diagnosis
- Chronic tubulointerstitial disease (e.g., analgesic nephropathy, lead nephropathy): This condition is a common cause of decreased eGFR without significant proteinuria, as it primarily affects the tubules and interstitium rather than the glomeruli.
Other Likely Diagnoses
- Atherosclerotic renal artery stenosis: This condition can lead to decreased eGFR due to reduced blood flow to the kidneys, often without significant proteinuria.
- Diabetic nephropathy with predominantly tubular damage: While diabetic nephropathy typically presents with proteinuria, some patients may have predominantly tubular damage, resulting in decreased eGFR without significant proteinuria.
- Hypertensive nephrosclerosis: Chronic hypertension can cause damage to the kidneys, leading to decreased eGFR, often without significant proteinuria.
Do Not Miss Diagnoses
- Renal artery thrombosis or embolism: These conditions can cause sudden and severe kidney damage, leading to decreased eGFR, and are medical emergencies that require prompt diagnosis and treatment.
- Vasculitis (e.g., ANCA-associated vasculitis): Vasculitis can cause kidney damage and decreased eGFR, often without significant proteinuria, and can be life-threatening if left untreated.
- Sickle cell disease: Sickle cell disease can cause kidney damage and decreased eGFR, often without significant proteinuria, and requires prompt diagnosis and treatment to prevent long-term complications.
Rare Diagnoses
- Fabry disease: A rare genetic disorder that can cause kidney damage and decreased eGFR, often without significant proteinuria.
- Amyloidosis: A rare condition characterized by the deposition of abnormal proteins in the kidneys, which can cause decreased eGFR, often without significant proteinuria.
- Light chain cast nephropathy: A rare condition associated with multiple myeloma, which can cause kidney damage and decreased eGFR, often without significant proteinuria.