MRCP2-4016

MRCP2-4016

A 50-year-old male of African–Caribbean descent presented to the emergency department complaining of leg swelling, shortness of breath, and nausea that had been progressively worsening over the past 6 weeks. He had recently relocated to the UK from South Africa about 3 months ago. The patient had a history of mild peripheral vascular disease and was taking atorvastatin and clopidogrel.

Upon examination, the patient was comfortable at rest but had significant pitting edema in both lower limbs and bilateral dullness to percussion at the lung bases. His blood pressure was 181/101 mmHg.

The urine dipstick showed 2+ blood and 4+ protein. Blood test results revealed a urea level of 21 mmol/L (2.0 – 7.0), creatinine level of 256 µmol/L (55 – 120), and albumin level of 24 g/L (35 – 50). The 24-hour urine protein measurement was 8g/day.

Further blood tests were conducted, including ANA, ANCA, complement (C3 and C4), hepatitis serology, HIV screening serology, and serum protein electrophoresis, which all came back negative. A renal ultrasound was performed, which showed an increased echogenicity bilaterally but no hydronephrosis. Peak flow velocities were normal and equal bilaterally. A renal biopsy was also performed, revealing segmental areas of scarring affecting some of the glomeruli, with no hypercellularity or crescents visible.

What is the appropriate management plan for this patient, given the likely diagnosis?