Differential Diagnosis for Episodic Hematuria in a 30-Year-Old Male

Single Most Likely Diagnosis

• IgA Nephropathy: This condition is a common cause of recurrent hematuria, especially in young adults. It often presents with episodic gross hematuria, particularly following upper respiratory tract infections.

Other Likely Diagnoses

• Urinary Tract Infections (UTIs): While more common in women, UTIs can cause hematuria in men and should be considered, especially if there are other symptoms like dysuria or frequency.
• Kidney Stones: Nephrolithiasis can cause episodic hematuria, often accompanied by severe pain (renal colic).
• Glomerulonephritis: Various forms can present with hematuria, including post-streptococcal glomerulonephritis, though these might be less common in the absence of other symptoms.

Do Not Miss Diagnoses

• Bladder or Renal Cancer: Although rare in young adults, these conditions can present with painless hematuria and are critical to diagnose early.
• Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, leading to hematuria, hearing loss, and eye abnormalities.
• Vasculitis (e.g., ANCA-associated vasculitis): Conditions like granulomatosis with polyangiitis can cause renal involvement and hematuria, along with other systemic symptoms.

Rare Diagnoses

• Sickle Cell Disease or Trait: Can cause hematuria due to sickling in the renal medulla.
• Goodpasture Syndrome: An autoimmune disease causing glomerulonephritis and pulmonary hemorrhage, presenting with hematuria among other symptoms.
• Hereditary Nephritis: Other than Alport syndrome, there are rare genetic conditions that can lead to hematuria and renal disease.
• Nephrocalcinosis: Can cause hematuria, though it's more commonly associated with other symptoms like renal colic or signs of renal failure.

Each of these diagnoses requires a thoughtful approach to history taking, physical examination, and diagnostic testing, including urinalysis, imaging studies (like ultrasound or CT scans), and potentially renal biopsy for definitive diagnosis.