Renal Case: 32-year-old Woman with Abrupt Onset of Edema

00:01 Let's move onto another clinical case.

00:04 You have a 32 year old woman who presents with abrupt onset of lower extremity edema and weight gain over the past three weeks.

00:11 Her serum creatinine is normal at 0.78 milligrams per deciliter.

00:15 Her albumin is low at 1.8 grams per deciliter and our urine analysis shows 4+ protein on the dipstick, nocellular elements, no white blood cells are red blood cells by microscopy, but she has 16 grams of protein estimated on a spot protein to creatinine ratio.

00:31 She notes and questioning her further that she's been taking very high dose ibuprofen over the past three months because she had a back injury and has had some muscle pains.

00:40 So the question is what is the most likely etiology of her nephrotic syndrome? So let's go through our clinical history to see if we have some clues.

00:52 One thing that I think stands out in the history is that she really developed this onset of lower extremity edema relatively abruptly.

01:00 It's not insidious as it may happen in our former disease like membranous.

01:03 This is something that she could actually recall.

01:05 Hey three weeks ago, I developed this edema.

01:08 So it's very suggestive of certain types of nephrotic syndromes.

01:12 She's also profoundly hypoalbuminemic.

01:14 She's at 1.8 grams per deciliter and she has very high grade proteinuria.

01:18 She also has very interestingly a temporal correlation with ibuprofen use and the onset of her nephrotic syndrome.

01:26 So taken together.

01:27 This is very very suggestive of minimal change disease.