Differential Diagnosis
- Single most likely diagnosis
- Diabetic Nephropathy: The patient has a long history of type 2 diabetes mellitus, positive urine microalbumin concentration for 3 years, and progressively increasing creatinine levels, indicating kidney damage. The presence of edema, hypertension, and proteinuria (as suggested by the urinalysis results) further supports this diagnosis.
- Other Likely diagnoses
- Nephrotic Syndrome: The patient's low serum albumin level (2.9 g/dL) and edema could suggest nephrotic syndrome, which can be a complication of diabetic nephropathy or other glomerular diseases.
- Heart Failure: The patient's history of hypertension, edema, and difficulty controlling blood pressure could indicate heart failure, which can cause renal dysfunction and proteinuria.
- Renal Artery Stenosis: The patient's increasing blood pressure and renal dysfunction could be related to renal artery stenosis, which can cause renovascular hypertension and kidney damage.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vasculitis (e.g., ANCA-associated vasculitis): Although less likely, vasculitis can cause renal dysfunction, hypertension, and proteinuria, and can be life-threatening if not promptly diagnosed and treated.
- Obstructive Uropathy: The patient's increasing creatinine level and edema could be related to obstructive uropathy, which can cause renal failure and requires prompt intervention to prevent permanent damage.
- Rare diagnoses
- Amyloidosis: The patient's long history of diabetes and renal dysfunction could suggest amyloidosis, a rare condition that can cause nephrotic syndrome and renal failure.
- Membranous Nephropathy: The patient's proteinuria and renal dysfunction could be related to membranous nephropathy, a rare glomerular disease that can cause nephrotic syndrome.