Differential Diagnosis
The patient presents with persistently elevated blood pressure, impaired renal function, and abnormal proteinuria. The following differential diagnoses are considered:
- Single most likely diagnosis
- Chronic Kidney Disease (CKD) with Hypertension: The patient's elevated creatinine, decreased eGFR, and abnormal proteinuria suggest CKD. The persistently elevated blood pressure is likely contributing to the progression of CKD. The elevated NT-proBNP and increased renin levels also support this diagnosis.
- Other Likely diagnoses
- Renovascular Hypertension: The patient's elevated blood pressure, impaired renal function, and increased renin levels are consistent with renovascular hypertension. The borderline elevation of normetanephrine also raises the possibility of a renal vascular issue.
- Diabetic Nephropathy: Although not explicitly mentioned, the patient's abnormal proteinuria and impaired renal function could be indicative of diabetic nephropathy, especially if the patient has a history of diabetes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pheochromocytoma: Although the metanephrine level is normal, the borderline elevation of normetanephrine warrants consideration of pheochromocytoma, which can cause severe hypertension and cardiovascular complications if left untreated.
- Aortic Stenosis: The patient's elevated NT-proBNP and decreased eGFR could be indicative of cardiac involvement, and aortic stenosis is a potentially life-threatening condition that must be ruled out.
- Rare diagnoses
- Renal Artery Stenosis due to Fibromuscular Dysplasia: This rare condition can cause renovascular hypertension and impaired renal function, especially in younger patients.
- Glomerulonephritis: Although less likely, the patient's abnormal proteinuria and impaired renal function could be indicative of glomerulonephritis, which can be caused by various underlying conditions, including autoimmune disorders or infections.