What is the diagnosis for a patient with a homogeneous pattern of Fluorescent Antinuclear Antibody (FANA) staining, impaired renal function, and hypertension, with negative Lupus testing?

Differential Diagnosis

• Single most likely diagnosis
  • Goodpasture's syndrome: This condition is characterized by the presence of anti-GBM antibodies, which can cause a homogenous pattern on FANA staining. The acute decline in kidney function and high blood pressure are consistent with the rapid progression of Goodpasture's syndrome. Although lupus testing is negative, Goodpasture's syndrome can present similarly to lupus nephritis.
• Other Likely diagnoses
  • Post-infectious glomerulonephritis: This condition can cause an acute decline in kidney function and may present with a homogenous pattern on FANA staining. However, the absence of a clear infectious trigger and the presence of high blood pressure make this diagnosis less likely.
  • IgA nephropathy: This condition can cause a rapid decline in kidney function and may present with a homogenous pattern on FANA staining. However, the absence of hematuria and the presence of high blood pressure make this diagnosis less likely.
  • Membranous nephropathy: This condition can cause a decline in kidney function and may present with a homogenous pattern on FANA staining. However, the acute onset and presence of high blood pressure make this diagnosis less likely.
• Do Not Miss diagnoses
  • Vasculitis (e.g., ANCA-associated vasculitis): This condition can cause a rapid decline in kidney function and may present with a homogenous pattern on FANA staining. Although lupus testing is negative, vasculitis can present similarly to lupus nephritis and is a potentially life-threatening condition if left untreated.
  • Thrombotic microangiopathy: This condition can cause a rapid decline in kidney function and may present with a homogenous pattern on FANA staining. Although less likely, thrombotic microangiopathy is a potentially life-threatening condition if left untreated.
• Rare diagnoses
  • Alport syndrome: This condition is a genetic disorder that can cause a decline in kidney function and may present with a homogenous pattern on FANA staining. However, the acute onset and presence of high blood pressure make this diagnosis less likely.
  • Dense deposit disease: This condition is a rare form of glomerulonephritis that can cause a decline in kidney function and may present with a homogenous pattern on FANA staining. Although rare, dense deposit disease is a potentially life-threatening condition if left untreated.