Differential Diagnosis
The patient presents with elevated BUN (24) and creatinine (1.35) levels, indicating impaired renal function, as evidenced by an eGFR of 38. The patient's blood pressure is 178/64, and they are complaining of a cough. Here's a differential diagnosis based on the provided information:
Single Most Likely Diagnosis
- Hypertensive Nephrosclerosis: Given the patient's high blood pressure (178/64) and impaired renal function (eGFR 38), hypertensive nephrosclerosis is a likely cause. Chronic hypertension can lead to renal damage and decreased kidney function over time, which aligns with the patient's lab results.
Other Likely Diagnoses
- Chronic Kidney Disease (CKD): The patient's eGFR of 38 indicates stage 3 CKD, which could be due to various causes, including diabetes, hypertension, or other renal diseases. The cough could be unrelated or a sign of fluid overload.
- Heart Failure: The cough could be a symptom of heart failure, especially if the patient has a history of hypertension. Impaired renal function can also be seen in heart failure due to decreased perfusion of the kidneys.
- Renal Artery Stenosis: Given the patient's high blood pressure and impaired renal function, renal artery stenosis is a possible cause. This condition can lead to decreased renal function and worsening hypertension.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less likely, a pulmonary embolism could cause a cough and must be considered, especially if the patient has risk factors such as immobility, cancer, or recent surgery.
- Aortic Dissection: The patient's high blood pressure increases the risk of an aortic dissection, which can present with a cough if the dissection involves the aortic arch or descending aorta.
- Sepsis: Sepsis can cause acute kidney injury, which might present with elevated creatinine and BUN levels. A cough could be a symptom of the underlying infection.
Rare Diagnoses
- Goodpasture Syndrome: This rare autoimmune disease can cause renal failure and pulmonary symptoms, including a cough. However, it is much less common than other diagnoses on this list.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): This rare condition can cause renal failure and respiratory symptoms, including a cough. It is characterized by the presence of autoantibodies against neutrophil cytoplasmic antigens (ANCA).