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, bilateral lower extremity edema, hypertension, and decreased urine output 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 Infection or Sepsis: Given the recent history of infection, it's essential to consider the possibility of a severe or complicated infection, especially if the patient's condition deteriorates or does not respond to initial treatment.
Rare Diagnoses
- Alport Syndrome: A genetic disorder characterized by hematuria, proteinuria, and progressive renal failure, often accompanied by hearing loss and eye abnormalities. It's less likely given the acute presentation and recent infection.
- Membranoproliferative Glomerulonephritis: A type of glomerulonephritis that can present with hematuria and proteinuria but is less common and might not have such a clear association with a recent streptococcal infection.
- Vasculitis (e.g., ANCA-associated vasculitis): These conditions can cause renal involvement with hematuria and proteinuria but are rare in children and would typically have additional systemic symptoms.