Differential Diagnosis for a 33-year-old Male with History of Nephrolithiasis and High Blood Pressure
- Single most likely diagnosis:
- Chronic Kidney Disease (CKD) secondary to nephrolithiasis: The patient's history of nephrolithiasis, presence of a small non-obstructing stone in the right kidney, and mild parenchymal scarring in the right kidney, along with proteinuria (2+ protein on UA) and elevated serum creatinine (1.28), suggest a possible intrarenal cause of his hypertension, which could be due to CKD.
- Other Likely diagnoses:
- Essential Hypertension: Given the patient's age, lack of significant family history of renal diseases, and absence of other systemic symptoms, essential hypertension remains a possibility, although the presence of proteinuria and renal scarring suggests a secondary cause.
- Renal Parenchymal Disease: Conditions such as glomerulonephritis or pyelonephritis could explain the patient's hypertension, proteinuria, and renal scarring, although the absence of urinary symptoms and systemic illness makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Renal Artery Stenosis: Although less common, renal artery stenosis could cause secondary hypertension and should be considered, especially if the patient does not respond to standard antihypertensive therapy.
- Pheochromocytoma: A rare cause of hypertension, pheochromocytoma can lead to severe, uncontrolled hypertension and should be ruled out, especially if there are episodes of paroxysmal hypertension.
- Rare diagnoses:
- Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes, which could explain the patient's nephrolithiasis, renal scarring, and hypertension, although it typically presents with hematuria and hearing loss.
- Primary Hyperparathyroidism: Can cause nephrolithiasis due to hypercalcemia and may also contribute to hypertension, although it would typically be associated with other symptoms such as bone disease or neuropsychiatric symptoms.