Differentials
Acute glomerulonephritis
SIGNS / SYMPTOMS
Edema associated with hematuria and hypertension.
INVESTIGATIONS
Low complement C3; elevated creatinine; decreased GFR; wet lungs on chest x-ray.
Focal segmental glomerulosclerosis
SIGNS / SYMPTOMS
Can be either primary (idiopathic) or secondary to another condition (e.g., sickle cell disease, leukemia, kidney scarring, or hypoplasia).
Hypertension may be present; otherwise, physical exam is nonspecific.
INVESTIGATIONS
Microscopic hematuria.
kidney biopsy: focal and segmental sclerosis of the glomeruli.
Congestive heart failure
SIGNS / SYMPTOMS
Patients can present with shortness of breath.
Cardiac murmur, cardiomegaly, and hepatomegaly may be present on physical exam.
INVESTIGATIONS
Abnormal ECG and echocardiogram findings; absence of significant proteinuria on urinalysis.
Kwashiorkor (severe childhood malnutrition)
SIGNS / SYMPTOMS
Patients present with a swollen or a pot belly, alternating bands of pale and dark hair (flag sign), and weight loss.
Common skin symptoms include dermatitis and depigmented skin.
Most common cause of edema associated with hypoalbuminemia in the developing world; rare in the US.
INVESTIGATIONS
Urinalysis: absence of proteinuria.
Normal lipid profile.
Cirrhosis
SIGNS / SYMPTOMS
Patients present with hepatomegaly in early stages. Ascites with abdominal venous engorgement and jaundice are common signs.
INVESTIGATIONS
Abnormal liver enzymes; elevated bilirubin; abnormal coagulation profile with bleeding tendency; positive tests for etiology (e.g., hepatitis B or C); absence of heavy proteinuria on urinalysis.
Protein-losing enteropathy
SIGNS / SYMPTOMS
Gastrointestinal signs of malabsorption: diarrhea, steatorrhea, and/or blood in the stool.
INVESTIGATIONS
Stool sample: positive for occult blood and fat.
Plasma albumin markedly reduced.
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