Differential Diagnosis for 50-year-old Female with Long-term NSAID Use, Hypoalbuminemia, Proteinuria, Elevated BP, and No Hematuria

• Single Most Likely Diagnosis
  • FSGS (Focal Segmental Glomerulosclerosis): This condition is a common cause of nephrotic syndrome in adults and can be associated with long-term NSAID use, which may cause renal injury leading to FSGS. The presence of hypoalbuminemia, proteinuria, and elevated blood pressure without hematuria supports this diagnosis.
• Other Likely Diagnoses
  • Minimal Change Disease: Although more common in children, minimal change disease can occur in adults and is characterized by nephrotic syndrome with minimal glomerular changes on light microscopy. The lack of hematuria and the presence of significant proteinuria make this a possible diagnosis.
  • Membranoproliferative Glomerulonephritis: This condition can present with nephrotic or nephritic syndrome and is associated with immune complex deposition. However, the absence of hematuria makes it less likely compared to FSGS.
• Do Not Miss Diagnoses
  • Amyloidosis: Although rare, amyloidosis can cause nephrotic syndrome and is associated with significant morbidity and mortality if not recognized and treated. The long-term use of NSAIDs could potentially be linked to secondary amyloidosis, especially if there's an underlying chronic inflammatory condition.
• Rare Diagnoses
  • Other Glomerulonephritides: Conditions such as IgA nephropathy, membranous nephropathy, or post-infectious glomerulonephritis are less likely given the clinical presentation but should be considered in the differential diagnosis, especially if the more common conditions are ruled out.
  • NSAID-induced Nephropathy: While NSAID use is a risk factor for various renal conditions, direct NSAID-induced nephropathy could also be considered, though it might not fully explain the nephrotic syndrome presentation without additional renal injury patterns.