Differential Diagnosis for Anton's Case
The following differential diagnoses are categorized based on their likelihood and potential impact on the patient's health.
Single Most Likely Diagnosis
- Acute Post-Streptococcal Glomerulonephritis (APSGN): This diagnosis is highly likely due to the recent history of sore throat and fever, elevated Anti-streptolysin O (ASO) titer, hematuria, proteinuria, and the presence of RBC casts in the urinalysis. The clinical presentation of periorbital edema, lower extremity edema, hypertension, and decreased urine output with dark-colored urine also supports this diagnosis.
Other Likely Diagnoses
- Nephrotic Syndrome: Although less likely than APSGN given the acute presentation and recent infection, nephrotic syndrome could explain the edema, proteinuria, and low serum albumin. However, the presence of hematuria and RBC casts is more suggestive of a nephritic syndrome like APSGN.
- Henoch-Schönlein Purpura (HSP): This condition could present with edema, hematuria, and proteinuria, but it typically includes purpura, abdominal pain, and arthritis, which are not mentioned in the case.
Do Not Miss Diagnoses
- Rapidly Progressive Glomerulonephritis (RPGN): Although less common, RPGN can present similarly to APSGN but with a more severe and rapid progression to renal failure. It's crucial to monitor the patient's renal function closely.
- Severe Sepsis or Septic Shock: The history of recent infection and current symptoms could potentially indicate a severe systemic infection, especially if the patient's condition deteriorates.
Rare Diagnoses
- Alport Syndrome: A genetic disorder that affects the type IV collagen in the kidneys, ears, and eyes, leading to hematuria, proteinuria, and progressive renal failure. It's less likely given the acute presentation and recent infection.
- Membranoproliferative Glomerulonephritis: A rare cause of nephritic syndrome that could present with hematuria, proteinuria, and decreased renal function, but it's not typically associated with a recent streptococcal infection.
- Vasculitis (e.g., ANCA-associated vasculitis): These conditions can cause renal involvement with hematuria and proteinuria but are less common in children and not directly linked to recent streptococcal infections.