Differential Diagnosis for a 7-year-old with Abdominal Pain, Intermittent Fever, and Other Symptoms
Single Most Likely Diagnosis
- Nephrotic Syndrome: This condition is characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The tea-colored urine suggests hematuria, which can be seen in nephrotic syndrome. The general edema and high blood pressure also support this diagnosis. The intermittent abdominal pain and fever could be related to the underlying kidney disease.
Other Likely Diagnoses
- Glomerulonephritis: This condition can present with hematuria (tea-colored urine), proteinuria, hypertension, and edema. The abdominal pain and fever could be related to the kidney inflammation.
- Henoch-Schönlein Purpura (HSP): Although HSP typically presents with palpable purpura, abdominal pain, and arthritis, the bruise on the thighs could be a manifestation of this condition. The tea-colored urine could indicate renal involvement.
- Systemic Lupus Erythematosus (SLE): SLE can present with a wide range of symptoms, including abdominal pain, fever, hypertension, and renal involvement (hematuria and proteinuria).
Do Not Miss Diagnoses
- Hemolytic Uremic Syndrome (HUS): This condition is characterized by hemolytic anemia, acute kidney injury, and thrombocytopenia. Although less likely, it is a critical diagnosis to consider due to its high morbidity and mortality.
- Abdominal Trauma: The bruise on the thighs could indicate trauma, which could be non-accidental. It is essential to consider this possibility, especially if there are any concerns about the child's safety.
- Malignancy (e.g., Wilms Tumor): Although rare, abdominal masses can cause pain, hypertension, and hematuria. It is crucial to consider this possibility, especially if the child has a palpable abdominal mass.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by hematuria, proteinuria, and progressive kidney disease. It is less likely but should be considered if there is a family history of kidney disease.
- Goodpasture Syndrome: A rare autoimmune disease that can cause hematuria, proteinuria, and renal failure. It is less likely but should be considered if there are any concerns about the child's immune system.