Differential Diagnosis for Hematuria with Proteinuria and Pain
Single Most Likely Diagnosis
- Nephrotic Syndrome with Nephritic Component: This condition is characterized by heavy proteinuria, hematuria, and often pain due to inflammation and damage to the glomeruli. The presence of both significant proteinuria and hematuria, along with pain, makes this a leading consideration.
Other Likely Diagnoses
- IgA Nephropathy: Also known as Berger's disease, this condition often presents with hematuria and can be accompanied by proteinuria and flank pain, especially following a respiratory or gastrointestinal infection.
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the glomerular basement membrane, leading to hematuria, proteinuria, and often progressive kidney disease. Pain can be present due to associated kidney damage.
- Kidney Stones (Nephrolithiasis): While primarily causing pain and hematuria, significant stones can also lead to obstructive nephropathy, resulting in proteinuria. The pain is typically severe and colicky.
- Pyelonephritis: An infection of the kidney, which can cause pain, hematuria, and proteinuria due to inflammation of the renal parenchyma.
Do Not Miss Diagnoses
- Vasculitis (e.g., ANCA-associated vasculitis): Conditions like granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) can present with renal involvement, including hematuria and proteinuria, and are critical to diagnose early due to their potential for severe morbidity and mortality.
- Malignancy (e.g., Renal Cell Carcinoma): Although less common, malignancies of the kidney can cause hematuria, proteinuria, and pain. Early detection is crucial for treatment and prognosis.
- Sickle Cell Disease: Can cause sickle cell nephropathy, leading to hematuria and proteinuria, and may also cause pain crises.
Rare Diagnoses
- Goodpasture Syndrome: A rare autoimmune disease that affects the lungs and kidneys, causing hematuria, proteinuria, and often renal failure. It is characterized by anti-GBM antibodies.
- Lupus Nephritis: A complication of systemic lupus erythematosus (SLE), which can cause hematuria, proteinuria, and kidney pain due to immune complex deposition in the kidneys.
- Membranoproliferative Glomerulonephritis: A rare glomerular disease that can present with hematuria, proteinuria, and decreased kidney function, often associated with complement pathway abnormalities.