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 renal function closely to differentiate between these conditions.
- Severe Sepsis or Septic Shock: Infection can lead to acute kidney injury (AKI), and given the recent history of infection, it's essential to consider and rule out severe sepsis or septic shock, especially if the patient shows signs of hypotension, altered mental status, or other organ dysfunction.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by hematuria, proteinuria, and progressive kidney disease, often accompanied by hearing loss and eye abnormalities. It's less likely given the acute presentation following an infection.
- Membranoproliferative Glomerulonephritis: A type of glomerulonephritis that can present with hematuria and proteinuria but is less commonly associated with a recent streptococcal infection.
- IgA Nephropathy (Berger's Disease): Can present with hematuria, especially following an upper respiratory infection, but the presence of RBC casts and the specific clinical context make APSGN more likely in this case.