02-24-2008, 03:18 PM
A 75-year-old woman is hospitalized for blood-streaked sputum, lower-extremity edema, and accelerated hypertension. She has a 3-year history of diet-controlled type 2 diabetes mellitus, atrial fibrillation with pacemaker implantation, hypertension, and osteoporosis. Several weeks ago, she was evaluated in the emergency department after developing an acute onset of lower back pain after a fall. She was diagnosed with three lumbar vertebral compression fractures and was treated symptomatically with oxycodone three times daily.
On physical examination, she is afebrile, pulse rate is 60/min, respiratory rate is 25/min, and blood pressure is 138/76 mm Hg. Cardiac examination reveals a grade 2/6 systolic murmur at the lower left sternal border and no gallops. There is no jugular venous distention. Pulmonary examination reveals bibasilar crackles. The point of maximal impulse is not displaced. There is 4+ edema in the bilateral lower extremities.
Laboratory Studies
Leukocyte count
6600/μL (6.6 × 109/L)
Hemoglobin
12.2 g/dL (122 g/L)
Hematocrit
37.6
Platelet count
294,000/µL (294 × 109/L)
Blood urea nitrogen
21 mg/dL (7.5 mmol/L)
Creatinine
1.7 mg/dL (150.31 μmol/L)
Sodium
134 meq/L (134 mmol/L)
Potassium
3.6 meq/L (3.6 mmol/L)
Chloride
100 meq/L (100 mmol/L)
Bicarbonate
26 meq/L (26 mmol/LAlbumin
3.2 mg/dL (32 g/L)
Urinalysis
pH 5.0, specific gravity 1.015, 1+ blood, 4+ protein, 5“10 erythrocytes and several erythrocyte casts/hpf
Urinary protein“creatinine ratio
3.5 mg/g
Renal ultrasound reveals small bilateral 1-cm simple cysts, normal-sized kidneys, and no hydronephrosis. Chest radiograph shows bilateral infiltrates and a normal cardiac silhouette.
Which of the following is the most appropriate next step in the management of this patient's kidney disease?
A Echocardiography
B Kidney biopsy
C Corticosteroids
D Antibiotics)
On physical examination, she is afebrile, pulse rate is 60/min, respiratory rate is 25/min, and blood pressure is 138/76 mm Hg. Cardiac examination reveals a grade 2/6 systolic murmur at the lower left sternal border and no gallops. There is no jugular venous distention. Pulmonary examination reveals bibasilar crackles. The point of maximal impulse is not displaced. There is 4+ edema in the bilateral lower extremities.
Laboratory Studies
Leukocyte count
6600/μL (6.6 × 109/L)
Hemoglobin
12.2 g/dL (122 g/L)
Hematocrit
37.6
Platelet count
294,000/µL (294 × 109/L)
Blood urea nitrogen
21 mg/dL (7.5 mmol/L)
Creatinine
1.7 mg/dL (150.31 μmol/L)
Sodium
134 meq/L (134 mmol/L)
Potassium
3.6 meq/L (3.6 mmol/L)
Chloride
100 meq/L (100 mmol/L)
Bicarbonate
26 meq/L (26 mmol/LAlbumin
3.2 mg/dL (32 g/L)
Urinalysis
pH 5.0, specific gravity 1.015, 1+ blood, 4+ protein, 5“10 erythrocytes and several erythrocyte casts/hpf
Urinary protein“creatinine ratio
3.5 mg/g
Renal ultrasound reveals small bilateral 1-cm simple cysts, normal-sized kidneys, and no hydronephrosis. Chest radiograph shows bilateral infiltrates and a normal cardiac silhouette.
Which of the following is the most appropriate next step in the management of this patient's kidney disease?
A Echocardiography
B Kidney biopsy
C Corticosteroids
D Antibiotics)
