Differential Diagnosis for Microscopic Hematuria and Thrombocytopenia
Single Most Likely Diagnosis
- Idiopathic Thrombocytopenic Purpura (ITP) with renal involvement: This condition primarily affects platelets but can have associated renal manifestations, including microscopic hematuria, due to immune complex deposition or other secondary effects.
Other Likely Diagnoses
- Nephrotic Syndrome: Conditions like minimal change disease, focal segmental glomerulosclerosis, or membranous nephropathy can lead to significant proteinuria, hypoalbuminemia, and potentially thrombocytopenia due to urinary loss of proteins involved in platelet production or function. Microscopic hematuria can also be present.
- Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can cause thrombocytopenia, microscopic hematuria, and other symptoms like purpura, abdominal pain, and arthritis due to immune complex deposition.
- Systemic Lupus Erythematosus (SLE): An autoimmune disease that can affect multiple systems, including the kidneys (lupus nephritis) and hematologic system (thrombocytopenia), leading to microscopic hematuria among other symptoms.
Do Not Miss Diagnoses
- Thrombotic Thrombocytopenic Purpura (TTP): A life-threatening condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurological symptoms, and fever. Microscopic hematuria can be a part of the renal involvement.
- Hemolytic Uremic Syndrome (HUS): Similar to TTP, HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. It often follows a diarrheal illness caused by E. coli O157:H7 and can present with microscopic hematuria.
- Antiphospholipid Syndrome: An autoimmune disorder that can cause thrombocytopenia and renal manifestations, including microscopic hematuria, due to antiphospholipid antibodies.
Rare Diagnoses
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the glomerular basement membrane, leading to progressive kidney disease, hearing loss, and eye abnormalities. Thrombocytopenia is not a primary feature but can occur in some cases.
- Goodpasture Syndrome: An autoimmune disease causing glomerulonephritis and pulmonary hemorrhage due to antibodies against the glomerular basement membrane. Thrombocytopenia is not a typical feature but can occur in the context of systemic disease.
- Thrombocytopenia with Absent Radius (TAR) Syndrome: A rare genetic disorder characterized by thrombocytopenia and bilateral absence of the radius. Renal abnormalities, including microscopic hematuria, can be part of the syndrome's spectrum.