Differential Diagnosis for a 32-year-old Pregnant Woman with Type 1 Diabetes Mellitus
Single Most Likely Diagnosis
- Chronic Hypertension with Superimposed Preeclampsia: The patient's elevated blood pressure (144/88 mm Hg) and proteinuria (2+ protein on urinalysis) in the presence of type 1 diabetes mellitus, which is a risk factor for preeclampsia, make this diagnosis the most likely. The slight increase in creatinine from baseline also supports this diagnosis, as it can indicate renal involvement.
Other Likely Diagnoses
- Pregnancy-Induced Hypertension: Given the patient's blood pressure and the absence of proteinuria before pregnancy, pregnancy-induced hypertension is a possible diagnosis. However, the presence of proteinuria leans more towards preeclampsia.
- Diabetic Nephropathy: The patient's type 1 diabetes mellitus and the slight elevation in creatinine could suggest diabetic nephropathy, especially with proteinuria. However, the acute presentation with hypertension in pregnancy suggests a pregnancy-related condition is more likely.
Do Not Miss Diagnoses
- Preeclampsia with Severe Features: Although the patient does not currently exhibit severe symptoms like headaches or vision changes, the potential for rapid progression to severe preeclampsia, which can be life-threatening, makes it crucial not to miss this diagnosis.
- Renal Disease (e.g., Glomerulonephritis): Other renal diseases could present with proteinuria and elevated creatinine. While less likely, missing a diagnosis of renal disease could have significant implications for both mother and fetus.
Rare Diagnoses
- Primary Aldosteronism: This condition could cause hypertension but would be unusual in pregnancy and not directly explained by the proteinuria.
- Renal Artery Stenosis: Although a possible cause of hypertension, it would be rare and not directly related to the proteinuria or the pregnancy itself.
- Autoimmune Disorders (e.g., Lupus Nephritis): These could cause renal dysfunction and proteinuria but would be less common and typically associated with other systemic symptoms or a known history of autoimmune disease.