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Differential Diagnosis for a 2-year-old with Hematuria and Proteinuria

Single most likely diagnosis

  • Poststreptococcal Glomerulonephritis (PSGN): This is a common cause of nephritic syndrome in children, characterized by hematuria, proteinuria, and often follows a streptococcal infection. The age of the patient and the presence of 200 rbc/uL and protein 3g/L in the urine test support this diagnosis.

Other Likely diagnoses

  • IgA Nephropathy: Also known as Berger's disease, it is a common cause of recurrent hematuria in children and can present with proteinuria. It often follows a viral infection.
  • Minimal Change Disease: Although it primarily presents with nephrotic syndrome (heavy proteinuria), some cases can have hematuria, making it a consideration in this scenario.
  • Alport Syndrome: A genetic disorder affecting the type IV collagen in the glomerular basement membrane, leading to hematuria and progressive kidney disease. However, it typically presents with sensorineural hearing loss and eye abnormalities.

Do Not Miss diagnoses

  • Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can cause renal involvement, presenting with hematuria and proteinuria, along with the classic triad of purpura, joint pain, and abdominal pain. Missing this diagnosis could lead to delayed treatment and potential long-term renal damage.
  • Goodpasture Syndrome: An autoimmune disease causing glomerulonephritis and pulmonary hemorrhage. It is rare in children but can be life-threatening if not recognized and treated promptly.

Rare diagnoses

  • Membranoproliferative Glomerulonephritis (MPGN): A group of diseases characterized by changes in the glomeruli, leading to hematuria and proteinuria. It is less common in children and often associated with chronic infections or autoimmune diseases.
  • Nephrotic syndrome due to other causes: Such as focal segmental glomerulosclerosis (FSGS), membranous nephropathy, or congenital nephrotic syndrome, which are less likely given the age and presentation but should be considered if initial diagnoses are ruled out.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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