What is the clinical significance of an 82-year-old female with a history of heart disease (HLD) and dementia, presenting with normoglycemia, normal Blood Urea Nitrogen (BUN) levels, impaired renal function, hypercalcemia, and low albumin levels?

Differential Diagnosis for 82-year-old Female with History of Heart Disease and Dementia

Single Most Likely Diagnosis

• Chronic Kidney Disease (CKD): The patient's elevated creatinine level (1.23 mg/dL) and low non-African American GFR (44 mL/min) suggest impaired kidney function, which is consistent with CKD. The patient's age, history of heart disease, and dementia also increase the risk of developing CKD.

Other Likely Diagnoses

• Dehydration: The patient's elevated BUN (18 mg/dL) and BUN/creatinine ratio (15) may indicate dehydration, which is common in elderly patients, especially those with dementia.
• Hypercalcemia: The patient's high calcium level (10.2 mg/dL) could be due to various causes, including hyperparathyroidism, vitamin D toxicity, or malignancy.
• Hypoalbuminemia: The patient's low albumin level (3.5 g/dL) may indicate malnutrition, liver disease, or nephrotic syndrome.

Do Not Miss Diagnoses

• Acute Kidney Injury (AKI): Although the patient's creatinine level is only slightly elevated, AKI should be considered, especially if the patient has a history of recent medication changes, contrast exposure, or other nephrotoxic insults.
• Sepsis: The patient's elevated CO2 level (31 mEq/L) and low anion gap (9) may indicate a metabolic alkalosis, which can occur in sepsis. Sepsis is a life-threatening condition that requires prompt recognition and treatment.
• Malignancy: The patient's hypercalcemia and elevated alkaline phosphatase level (110 IU/L) may indicate underlying malignancy, such as multiple myeloma or bone metastases.

Rare Diagnoses

• Primary Hyperparathyroidism: Although the patient's hypercalcemia could be due to primary hyperparathyroidism, this diagnosis is less likely given the patient's age and lack of other symptoms.
• Familial Hypocalciuric Hypercalcemia: This rare genetic disorder causes hypercalcemia and is often asymptomatic, but it is unlikely given the patient's age and lack of family history.
• Pseudohyperparathyroidism: This rare condition causes hypercalcemia and is often associated with malignancy, but it is unlikely given the patient's lack of other symptoms and diagnostic findings.