The Heart and the Kidney: What One Tells You about the Other

​BY AN​UMEHA SINGH, MDA 56-year-old man presented to the ED with shortness of breath and pleural effusions diagnosed by an outside treating physician. The workup included urinalysis, which showed proteinuria, and the exam was consistent with myxedema and pedal edema. He had a history of rheumatoid arthritis, leukocytoclastic vasculitis and Sjögren's syndrome, diabetes, and monoclonal gammopathy of unknown significance (MGUS).The patient also had shortness of breath for a month and pleural effusions on outpatient chest x-ray. He had taken Humira, methotrexate (MTX), and steroids, but his arthritis and Sjögren's were currently well controlled without medications. His MGUS was monitored annually with no medical intervention. He felt excessive thirst, but had normal urine output. The patient appeared well, but would not stop taking sips of water in between every sentence of a conversation despite obvious myxedema.He noted face and hand swelling that morning, which gave way to more significant pedal edema at the end of the day and progressively worsening exertional dyspnea. He noted low-grade fever and loss of appetite. His initial vitals were a blood pressure of 185/96 mm Hg, oxygen saturation of 97% on room air, heart rate of 106 bpm, respiratory rate of 20 bpm, and temperature of 100.1°F.The differential diagnoses for this case included an infectious process such as viral or bacterial infiltrate and lung mass or atypical presentation of myeloma given the patient's histor...

Source: The Case Files - July 17, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research