MKSAP: 53-year-old woman with swelling of the face, hands, and feet
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms.
On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration rate is 18/min. Bilateral periorbital edema and swelling of the hands and legs are noted. The remainder of the examination is unremarkable.
Laboratory studies:
Complete blood count
Normal
Albumin
1.6 g/dL (16 g/L)
Blood urea nitrogen
28 mg/dL (10 mmol/L)
Complement (C3 and C4)
Normal
Serum creatinine
1.5 mg/dL (133 µmol/L)
Cryoglobulin
Negative
Serum protein electrophoresis
Normal
Rheumatoid factor
Negative
Hepatitis B surface antigen
Negative
Hepatitis C virus antibodies
Positive with low RNA titer
HIV antibodies
Negative
Antinuclear antibodies
Negative
Urinalysis
4+ protein; 4-7 erythrocytes/hpf; 4-7 leukocytes/hpf
24-Hour urine collection of protein
14 g/24 h
Ultrasound shows normal-sized kidneys.
Percutaneous kidney biopsy results show glomeruli of normal size and cellularity, with patent capillary lumina. Diffuse fusion of podocyte foot processes is noted on electron microscopy. Immunofluorescence studies show no immune deposits.
Which of the following is the most likely cause of this patient’s...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Kevin Tags: Conditions Nephrology Source Type: blogs
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