Differential Diagnosis for a 14 Week Pregnant Female with Hypertension and Urine Abnormalities

Single Most Likely Diagnosis

• Preeclampsia: This condition is characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. However, it can occasionally present earlier, especially in women with a history of chronic hypertension or renal disease. The presence of protein and casts in the urine, along with hypertension, makes preeclampsia a strong consideration, even at 14 weeks.

Other Likely Diagnoses

• Chronic Hypertension with Superimposed Preeclampsia: If the patient had pre-existing hypertension, the current presentation could indicate superimposed preeclampsia, which is a worsening of hypertension and the development of proteinuria in a woman with chronic hypertension.
• Urinary Tract Infection (UTI) with Hypertension: The presence of infection in the urine could be a separate issue from the hypertension and proteinuria. UTIs are common in pregnancy and can sometimes present with systemic symptoms, including hypertension.
• Nephritic Syndrome: This condition, characterized by inflammation of the kidneys, can cause hypertension, proteinuria, and hematuria (blood in the urine), which could be indicated by the presence of casts.

Do Not Miss Diagnoses

• Severe Preeclampsia or Eclampsia: Although less likely at 14 weeks, severe preeclampsia or eclampsia (which includes seizures) is a life-threatening condition that must be considered, especially if the patient shows signs of severe hypertension or other systemic symptoms.
• Acute Kidney Injury (AKI): Any condition that leads to a rapid decline in kidney function could present with similar symptoms and must be promptly identified and treated to prevent long-term damage.
• Systemic Lupus Erythematosus (SLE) Flare: SLE can cause renal involvement, leading to hypertension, proteinuria, and casts. A flare during pregnancy could present similarly to preeclampsia but requires different management.

Rare Diagnoses

• Primary Glomerulonephritis: This is an inflammation of the glomeruli, the filtering units of the kidneys, which can cause proteinuria, hematuria, and hypertension. It is less common in pregnancy but should be considered if other diagnoses are ruled out.
• Thrombotic Microangiopathy (TMA): Conditions like thrombotic thrombocytopenic purpura (TTP) or hemolytic-uremic syndrome (HUS) are rare but can present with hypertension, renal failure, and other systemic symptoms, making them important to consider in a differential diagnosis.