Young Man with Acute Renal Failure: What is the most likely diagnosis?

Author: Joshua Schwimmer, M.D., FACP, FASN
Reviewer: V. Dimov, M.D.

An otherwise healthy 30 year-old man presents with nausea and fatigue for 2 weeks.

He is found to have BUN of 172 mg/dL, creatinine of 13 mg/dL, and albumin of 4 mg/dL. His urinalysis reveals 3+ protein (quantified at 400 mg per day) and many RBCs.

There is no lower extremity edema. He is nonoliguric.

What is the most likely diagnosis?
1. HIV-associated nephropathy
2. ANCA-associated glomerulonephritis
3. Focal segmental glomerulosclerosis
4. Urinary tract obstruction
5. Minimal change disease

Answer: (highlight the line below with the mouse to see the answer)
2. ANCA-associated glomerulonephritis

Published: 11/01/2006
Updated: 09/08/2009


  1. Dear Anon,

    Answer: 5. Minimal change disease is incorrect. There should not be "many RBCs" on UA in minimal change disease.

  2. Ig A nephropathy is in DDx

  3. this ia a picture of agn as the sediment is nephritic. theanswer is anca + gn

  4. please send me the answer

  5. I would say the answer is 2. Most probable nephritic sx and rapidly progressive

  6. Minimal chain disease presenting with ARF.

  7. ANCA-associated glomerulonephritis

  8. Focal segmental glomerulonephritis

  9. ANCA-associated, and here's the why:

    Minimal change: should have gross oedema/nephrosis but no RBCs in urine
    Obstruction: too young, non-oliguruc
    FSGS: history is acute, sediment is active, piture not consistent and we have no predisposing pathology e.g DM, NSAIDs
    HIV-associated: otherwise well; HIV nephropathy late feature of low CD4 AIDS

    Leaving ANCA-associated - acute, active sediment, nephritic picture