Differential Diagnosis for Edema, Fatigue, and Abdominal Pain in a Child
Single Most Likely Diagnosis
- Minimal Change Disease: This condition is the most common cause of nephrotic syndrome in children, characterized by significant proteinuria (4+ in this case), edema, fatigue, and abdominal pain, without hematuria. The absence of hematuria and the presence of significant proteinuria strongly point towards minimal change disease.
Other Likely Diagnoses
- Poststreptococcal Glomerulonephritis: Although less likely given the absence of hematuria, this condition can sometimes present with minimal or no hematuria. It typically follows a streptococcal infection and can cause edema, fatigue, and abdominal pain, along with proteinuria.
- IgA Nephropathy: This condition can present with a variety of symptoms including edema, abdominal pain, and fatigue, but it is more commonly associated with hematuria, especially following a respiratory infection. The absence of hematuria makes it less likely but not impossible.
Do Not Miss Diagnoses
- Systemic Lupus Erythematosus (SLE): Although rare in children, SLE can cause nephrotic syndrome, edema, fatigue, and abdominal pain. Missing this diagnosis could be catastrophic due to the potential for severe renal and systemic complications.
- Hemolytic Uremic Syndrome (HUS): This condition, often associated with E. coli infections, can lead to acute kidney injury, presenting with edema, fatigue, and abdominal pain. It's crucial to consider HUS due to its severe prognosis and the need for prompt treatment.
Rare Diagnoses
- Membranous Nephropathy: A rare cause of nephrotic syndrome in children, characterized by proteinuria and edema. It's less common than minimal change disease and often associated with other systemic diseases or infections.
- Focal Segmental Glomerulosclerosis (FSGS): Another rare cause of nephrotic syndrome, which can present similarly to minimal change disease but is less responsive to steroid treatment. It's a consideration in cases where minimal change disease is suspected but the patient does not respond to typical treatment.