Differential Diagnosis

The patient's symptoms of increased creatine kinase, decreasing GFR, intractable nausea and vomiting, and elevated blood pressure can be approached by considering the following categories:

• Single Most Likely Diagnosis

  • Rhabdomyolysis: This condition is characterized by the breakdown of muscle tissue, leading to increased creatine kinase levels. Decreasing GFR can occur due to myoglobinuria, which damages the kidneys. Nausea and vomiting can be associated with the pain and metabolic disturbances of rhabdomyolysis. Elevated blood pressure could be a response to pain or dehydration.

• Other Likely Diagnoses

  • Acute Kidney Injury (AKI) due to other causes: Various conditions such as dehydration, medication toxicity, or obstructive uropathy could lead to AKI, which in turn could cause nausea, vomiting, and elevated blood pressure. Increased creatine kinase could be secondary to another condition.
  • Severe Dehydration: Leading to prerenal AKI, which could explain the decreased GFR, nausea, vomiting, and elevated blood pressure. Muscle breakdown from severe dehydration could increase creatine kinase levels.
  • Malignant Hypertension: This condition can cause AKI (decreasing GFR), and the associated severe hypertension could lead to nausea and vomiting. Muscle damage from severely elevated blood pressure could result in increased creatine kinase.

• Do Not Miss Diagnoses

  • Preeclampsia/Eclampsia: In pregnant women, this condition can present with severe hypertension, AKI, and could potentially cause muscle damage leading to increased creatine kinase. Nausea and vomiting are common in pregnancy but could be exacerbated.
  • Vasculitis (e.g., ANCA-associated vasculitis): This could affect the kidneys (causing a decrease in GFR), muscles (increasing creatine kinase), and cause systemic symptoms including nausea, vomiting, and hypertension.
  • Sepsis: Although not directly implied, sepsis can cause AKI, muscle damage, and systemic inflammation leading to nausea, vomiting, and alterations in blood pressure.

• Rare Diagnoses

  • Hemolytic Uremic Syndrome (HUS): Characterized by the triad of hemolytic anemia, acute kidney injury, and thrombocytopenia. It could potentially cause some of the symptoms described, especially if there's significant muscle involvement.
  • Thrombotic Thrombocytopenic Purpura (TTP): Similar to HUS, TTP is a rare disorder that could lead to AKI and potentially some of the other symptoms listed, though it's less directly connected to increased creatine kinase.
  • Certain Toxins or Medications: Such as those causing toxic nephropathy or rhabdomyolysis, which could explain the combination of symptoms if the patient has been exposed to specific substances.