Differential Diagnosis for 60-year-old Man with Uncontrolled Hypertension, Haematuria, Renal Failure, and Intra-Renal Aneurysms
- Single Most Likely Diagnosis
- Polyarteritis Nodosa (PAN): This condition is a medium vessel vasculitis that can cause renal artery aneurysms, hypertension, and renal failure. The presence of intra-renal aneurysms on arteriography is highly suggestive of PAN, making it the most likely diagnosis.
- Other Likely Diagnoses
- Fibromuscular Dysplasia (FMD): FMD is a vascular disease that can cause renal artery stenosis and aneurysms, leading to hypertension and renal failure. While it's less likely than PAN given the specific combination of symptoms, it remains a plausible diagnosis.
- Renal Artery Atherosclerosis: Atherosclerotic disease can cause renal artery stenosis, leading to hypertension and renal failure. However, the presence of intra-renal aneurysms is less typical for atherosclerosis, making it less likely than PAN but still a consideration.
- Do Not Miss Diagnoses
- Vasculitis due to Other Causes (e.g., ANCA-associated vasculitis): Other forms of vasculitis, such as Granulomatosis with Polyangiitis (GPA) or Microscopic Polyangiitis (MPA), can present similarly to PAN and must be considered to avoid missing a potentially treatable condition.
- Malignant Hypertension: Severe, uncontrolled hypertension can lead to renal failure and haematuria. While not directly causing intra-renal aneurysms, malignant hypertension can exacerbate underlying vascular diseases, making it crucial not to overlook.
- Rare Diagnoses
- Kawasaki Disease: Although extremely rare in adults, Kawasaki disease can cause vasculitis and aneurysm formation. Given its rarity in this age group and the specific presentation, it's considered a rare diagnosis.
- Neurofibromatosis Type 1 (NF1): NF1 can be associated with renal artery aneurysms and hypertension due to vascular dysplasia. However, the combination of symptoms and findings in this case makes NF1 a less likely, rare consideration.