Differential Diagnosis for Painless Hematuria with Proteinuria

The patient presents with painless hematuria (blood in urine without pain) accompanied by proteinuria (protein in urine). This clinical presentation suggests glomerular pathology as the source of bleeding, since the combination of hematuria and proteinuria often indicates damage to the glomerular filtration barrier in the kidneys.

Single Most Likely Diagnosis

IgA Nephropathy (Berger's Disease)

• Most common primary glomerulonephritis worldwide
• Characterized by IgA deposits in the glomerular mesangium
• Typically presents with painless hematuria, often following an upper respiratory infection
• Variable proteinuria ranging from mild to nephrotic range
• More common in young adults, with male predominance

Other Likely Diagnoses

Membranous Nephropathy

• Common cause of nephrotic syndrome in adults
• Presents with significant proteinuria and microscopic hematuria
• Immune complex deposition along glomerular basement membrane
• Can be primary (idiopathic) or secondary to medications, infections, or malignancy

Lupus Nephritis

• Renal manifestation of systemic lupus erythematosus (SLE)
• Various patterns of glomerular injury can occur
• Presents with proteinuria and hematuria of varying severity
• Often accompanied by other systemic symptoms of SLE

Thin Basement Membrane Disease (Benign Familial Hematuria)

• Characterized by thinning of the glomerular basement membrane
• Typically presents with persistent microscopic hematuria
• Usually has mild proteinuria
• Generally has good prognosis with normal renal function

Post-Infectious Glomerulonephritis

• Follows streptococcal or other infections
• Immune complex-mediated glomerular injury
• Presents with hematuria, proteinuria, and sometimes hypertension
• Usually self-limited in children but may be more persistent in adults

Do Not Miss

Rapidly Progressive Glomerulonephritis (RPGN)

• Severe, rapidly declining kidney function over days to weeks
• Can present initially with just hematuria and proteinuria before symptoms worsen
• Includes anti-GBM disease (Goodpasture's), ANCA-associated vasculitis
• Requires urgent diagnosis and treatment to prevent irreversible kidney damage

Malignancy (Bladder, Kidney, Prostate Cancer)

• Though typically causing isolated hematuria, some cases may have proteinuria
• Bladder cancer can present with painless hematuria
• Renal cell carcinoma may cause hematuria and paraneoplastic glomerular disease
• More common in older adults and those with risk factors (smoking, chemical exposures)

Renal Vein Thrombosis

• Can present with painless hematuria and significant proteinuria
• Associated with hypercoagulable states, nephrotic syndrome, or renal cell carcinoma
• May lead to acute kidney injury if bilateral or in a solitary kidney

Rare Diagnoses

Alport Syndrome

• Hereditary disorder affecting glomerular basement membrane
• Progressive nephritis with hematuria and proteinuria
• Often associated with hearing loss and ocular abnormalities
• X-linked inheritance pattern most common

Fabry Disease

• X-linked lysosomal storage disorder
• Deficiency of alpha-galactosidase A enzyme
• Can present with proteinuria and hematuria in early stages
• Associated with neuropathic pain, angiokeratomas, corneal opacities

Amyloidosis

• Deposition of abnormal protein fibrils in kidney tissue
• Typically presents with heavy proteinuria, but can have hematuria
• Associated with chronic inflammatory conditions, multiple myeloma, or hereditary forms
• Often has multi-organ involvement

C3 Glomerulopathy

• Rare disorder with abnormal regulation of the complement system
• Characterized by C3 deposition in glomeruli
• Presents with variable proteinuria and hematuria
• Often progressive with poor renal outcomes