Let's move to another clinical case. We have a 35-year-old woman.
She presents to the hospital with weight gain, worsening edema over the past month,
and recently, she really hasn't felt well.
She's kind of felt nauseated and anorexic, and food's not tasting very well.
On review of systems, she notes that she's had some pain in her joints,
arthralgias, swelling in her wrists and ankles, she also notes some subjective fevers.
On exam, her blood pressure is elevated. It's 152/92 mmHg
and when you do a good musculoskeletal exam, you find that her joints are boggy.
So, she has kind of a bogginess to her wrists and her ankles.
She's got also a scaly, erythematous plaque or rash that's over her face and neck,
and she's got 3+ lower extremity edema.
Her laboratory data shows a creatinine of 4.8 mg/dL that's elevated.
Her urinalysis shows numerous red blood cells,
nearly all of them have dysmorphic features
and she also has a spot albumin-to-creatinine ratio estimating 5 g of albumin or proteinuria.
And serologically, she has a low serum complement C3 and C4, as well as CH50.
So, the question is, what is the most likely etiology of this particular woman's renal presentation?
Let's take a look at our case and see if we have some clues here.
So, she's a young woman, that's something that I'm keeping in mind,
and she's coming in with weight gain, lower extremity edema,
and in the setting of nephrotic range proteinuria, that means greater than 3.5 g.
I'm thinking about a nephrotic-type syndrome. She also has symptoms of renal failure.
She's nauseated, she's anorexic, and we have a creatinine of 4.8 mg/dL,
which confirms that her renal function is severely compromised.
Now, the other important clues are what's happening from an extrarenal standpoint.
She's talking about arthralgias, she's talking about swelling in her joints,
she's got subjective fevers, and on physical exam,
you also document that she's got these boggy joints,
maybe perhaps effusions in her wrist and her ankles.
And then lastly, she's got these skin manifestations
with an erythematous plaque seen over her face and neck.
Taken together, all of these are really highly suspect for lupus.
And so, the question is, or the answer is, rather, this patient has lupus nephritis.