Differential Diagnosis for Hematuria with Proteinuria and No Pain

• Single Most Likely Diagnosis
  • Nephrotic Syndrome: This condition is characterized by heavy proteinuria, often accompanied by hematuria, and is typically painless. The presence of significant proteinuria along with hematuria points towards a glomerular disease, with nephrotic syndrome being a leading consideration due to its high prevalence among glomerulopathies.
• Other Likely Diagnoses
  • IgA Nephropathy: Although often associated with episodic gross hematuria following infections, IgA nephropathy can also present with microscopic hematuria and proteinuria without pain. It's a common cause of kidney disease worldwide and should be considered in the differential.
  • Alport Syndrome: This genetic disorder affects the type IV collagen in the kidneys, leading to chronic kidney disease, hematuria, and often proteinuria. It typically presents in childhood or early adulthood and can be associated with hearing and vision impairments.
  • Membranous Nephropathy: An immune-mediated disease that can cause nephrotic syndrome, characterized by heavy proteinuria, and may also present with hematuria. It's an important consideration in adults presenting with these symptoms.
• Do Not Miss Diagnoses
  • Vasculitis (e.g., ANCA-associated vasculitis): Although less common, vasculitis can present with renal involvement, including hematuria and proteinuria, and is critical to diagnose early due to its potential for severe morbidity and mortality if left untreated.
  • Goodpasture Syndrome: An autoimmune disease that affects the kidneys and lungs, characterized by anti-GBM antibodies. It can present with hematuria and proteinuria, and prompt diagnosis is crucial due to its aggressive nature and potential for severe outcomes.
• Rare Diagnoses
  • Thin Basement Membrane Nephropathy: A genetic disorder that affects the glomerular basement membrane, leading to hematuria, which can be accompanied by mild proteinuria. It's typically benign but can be a consideration in familial cases of hematuria.
  • Fabry Disease: A lysosomal storage disorder that can affect multiple organs, including the kidneys, leading to hematuria and proteinuria. It's rare and typically presents with systemic symptoms, but should be considered in cases with unexplained renal involvement and systemic findings.