Differential Diagnosis for Elevated CK, Protein in Urine, AKI, Elevated BNP and Troponin, and Hypertensive Urgency

Single Most Likely Diagnosis

• Hypertensive Emergency with Cardiorenal Syndrome: This diagnosis is the most likely due to the combination of hypertensive urgency, elevated BNP and troponin indicating cardiac strain, and AKI with protein in urine suggesting kidney involvement. The elevated CK could be due to muscle damage from severe hypertension or associated conditions like hypertensive heart disease.

Other Likely Diagnoses

• Acute Coronary Syndrome (ACS) with Renal Injury: Elevated troponin and BNP suggest myocardial injury, which could be due to ACS. The presence of AKI and proteinuria could be secondary to the cardiac event or due to contrast-induced nephropathy if imaging was performed.
• Severe Pre-eclampsia or Eclampsia: Although less common, severe pre-eclampsia or eclampsia could present with hypertensive urgency, AKI, and protein in urine. Elevated CK could be seen due to the systemic nature of the disease affecting multiple organ systems.
• Vasculitis (e.g., ANCA-associated vasculitis): This could lead to kidney injury (AKI and proteinuria), cardiac involvement (elevated BNP and troponin), and muscle damage (elevated CK). Hypertension could be a feature due to renal involvement.

Do Not Miss Diagnoses

• Aortic Dissection: A life-threatening condition that could present with hypertensive urgency and could lead to AKI if the dissection involves the renal arteries. Elevated BNP and troponin could be seen if there's involvement of the aortic root affecting the coronary arteries.
• Pulmonary Embolism with Cardiac Strain: Could present with elevated BNP and troponin due to right heart strain. AKI could occur due to decreased perfusion, and protein in urine might be seen in the context of renal vein thrombosis, although this is less common.
• Cardiac Tamponade: Although less likely, cardiac tamponade could lead to elevated BNP and troponin due to cardiac compression and decreased output, potentially causing AKI and hypertensive urgency due to decreased renal perfusion.

Rare Diagnoses

• Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS): These conditions could lead to AKI, hypertension, and potentially elevated cardiac biomarkers due to systemic microangiopathy affecting multiple organs.
• Scleroderma Renal Crisis: A rare condition characterized by severe hypertension and rapid kidney injury, which could also lead to cardiac involvement and elevated CK due to systemic disease.