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 is typically accompanied by 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 rapid decline in renal function. It is crucial to monitor the patient's renal function closely to differentiate between these conditions.
- Severe Sepsis or Septic Shock: The history of recent infection and the presence of fever could suggest a systemic infection. Although the patient's current presentation does not strongly suggest sepsis, it is a condition that could lead to acute kidney injury and must be considered, especially if the patient's condition deteriorates.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by hematuria, proteinuria, and progressive kidney disease, often accompanied by hearing loss and eye abnormalities. It is less likely given the acute presentation following a streptococcal infection.
- Membranoproliferative Glomerulonephritis: A type of glomerulonephritis that can present with hematuria and proteinuria but is less commonly associated with a recent streptococcal infection and the specific clinical findings in this case.
- IgA Nephropathy (Berger's Disease): Could be considered in the differential for hematuria, especially if recurrent and following infections, but the presence of RBC casts and the specific pattern of proteinuria and hematuria in this case make APSGN more likely.