Differential Diagnosis for Elevated BP and Urine Protein:Creatinine Ratio in a Postpartum Setting

Single Most Likely Diagnosis

• Preeclampsia: This condition is characterized by the onset of hypertension and proteinuria after 20 weeks of gestation. Given the context of a recent delivery and the presence of elevated blood pressure along with an elevated urine protein:creatinine ratio, preeclampsia is a highly plausible diagnosis, especially if these symptoms were present during pregnancy.

Other Likely Diagnoses

• Postpartum Preeclampsia: Although preeclampsia typically presents during pregnancy, it can also develop postpartum, often within the first 48-72 hours after delivery. The symptoms and lab findings presented are consistent with this condition.
• Chronic Hypertension with Superimposed Preeclampsia: If the patient had pre-existing hypertension, the development of proteinuria could indicate superimposed preeclampsia, which complicates chronic hypertension during pregnancy.
• Acute Kidney Injury (AKI): Postpartum AKI can present with proteinuria and hypertension due to various causes, including preeclampsia, but also other renal insults.

Do Not Miss Diagnoses

• HELLP Syndrome: A variant of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. It is critical to diagnose due to its high morbidity and mortality if not promptly treated.
• Thrombotic Microangiopathy (TMA): Conditions like thrombotic thrombocytopenic purpura (TTP) or hemolytic-uremic syndrome (HUS) can present with hypertension, proteinuria, and other systemic symptoms, requiring immediate intervention.
• Renal Vasculitis: Although rare, conditions like ANCA-associated vasculitis can cause renal dysfunction, hypertension, and proteinuria, necessitating early diagnosis and treatment to prevent long-term damage.

Rare Diagnoses

• Atypical HUS: A rare condition characterized by the formation of blood clots in small blood vessels throughout the body, which can lead to kidney failure and other complications.
• Postpartum Kidney Disease: Certain kidney diseases, such as minimal change disease or other glomerulopathies, can present postpartum, though they are less common than other conditions listed here.
• Reversible Cerebral Vasoconstriction Syndrome (RCVS): While primarily presenting with headaches and cerebral vasoconstriction, RCVS can occasionally be associated with hypertension and renal findings, making it a rare but interesting consideration in the differential diagnosis.