Differential Diagnosis
- Single most likely diagnosis
- IgA Nephropathy (Berger's disease): This condition is characterized by the deposition of IgA antibodies in the glomeruli, often presenting with recurrent episodes of hematuria (bloody urine) following a sore throat, which matches the patient's symptoms. The presence of red blood cell casts and normal renal ultrasonography also supports this diagnosis.
- Other Likely diagnoses
- Alport Syndrome: Although less likely given the acute presentation, Alport syndrome could be considered due to the family history of systemic lupus erythematosus (which might suggest a genetic predisposition to renal diseases) and the presence of hematuria. However, Alport syndrome typically presents with sensorineural hearing loss and eye abnormalities, which are not mentioned.
- Post-Streptococcal Glomerulonephritis (PSGN): This condition could be considered given the sore throat and subsequent hematuria, suggesting a post-infectious glomerulonephritis. However, the recurrent nature of the episodes and the lack of a clear recent streptococcal infection make IgA nephropathy more likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Systemic Lupus Erythematosus (SLE): Given the family history of SLE and the patient's symptoms, it's crucial to consider SLE as a potential diagnosis. SLE can cause a wide range of renal manifestations, including glomerulonephritis. Missing this diagnosis could lead to significant morbidity and mortality.
- Goodpasture Syndrome: This is an autoimmune disease that can cause glomerulonephritis and pulmonary hemorrhage. Although less common, it's a critical diagnosis to consider due to its potential for severe outcomes, including renal failure and life-threatening pulmonary complications.
- Rare diagnoses
- Membranoproliferative Glomerulonephritis: This condition involves changes in the glomeruli that can lead to hematuria and renal dysfunction. It's less common and might be considered if other diagnoses are ruled out.
- Thin Basement Membrane Nephropathy: A genetic disorder that affects the glomerular basement membrane, leading to hematuria. It's typically benign but could be considered in the differential diagnosis of a patient with recurrent hematuria.