Differential Diagnosis for Ana 1:160 Speckled, Negative RF, Anti-CCP, Hematuria, Negative CRP

• Single Most Likely Diagnosis
  • Systemic Lupus Erythematosus (SLE): Although the RF and anti-CCP are negative, a low-titer ANA (1:160) with a speckled pattern can be seen in SLE. The presence of hematuria also points towards renal involvement, which is common in SLE.
• Other Likely Diagnoses
  • Mixed Connective Tissue Disease (MCTD): This condition often presents with a high-titer ANA, but a low-titer ANA with speckled pattern can also be seen. The absence of RF and anti-CCP does not rule out MCTD, and hematuria could indicate renal involvement.
  • Sjögren's Syndrome: Although primarily known for causing dry eyes and mouth, Sjögren's can also present with renal involvement, including hematuria. A low-titer ANA with speckled pattern is consistent with this diagnosis.
• Do Not Miss Diagnoses
  • Vasculitis (e.g., ANCA-associated vasculitis): While the ANA pattern and titer might not strongly suggest vasculitis, the presence of hematuria is a red flag for renal vasculitis. Missing this diagnosis could lead to severe renal damage or other complications.
  • Membranous Nephropathy: This condition can cause hematuria and may be associated with a low-titer ANA. It's crucial to consider this diagnosis to avoid missing a treatable cause of renal disease.
• Rare Diagnoses
  • Autoimmune Hepatitis: Although less likely, autoimmune hepatitis can present with a low-titer ANA and does not always correlate with liver function tests. The absence of other typical autoimmune markers does not rule out this diagnosis.
  • Undifferentiated Connective Tissue Disease (UCTD): Patients with UCTD may have a low-titer ANA and some features of autoimmune diseases without meeting full criteria for a specific disease like SLE or Sjögren's. The clinical presentation can be varied and includes renal manifestations.