![]() Current medications are tacrolimus, mycophenolate mofetil, prednisone, fluconazole, valganciclovir, and trimethoprim-sulfamethoxazole. Before kidney transplantation, he had been anuric and underwent dialysis. Two weeks ago, he underwent living unrelated kidney transplantation for end-stage kidney disease secondary to focal segmental glomerulosclerosis. A 33-year-old man comes for a follow-up evaluation.Heavy proteinuria, occasionally mild hematuria.Near perfect correlation with retinopathy in type I, 67% in class II.Requires ~10 years of diabetes before abnormal proteinuria, decreased GFR.Hyaline casts – normal more with dehydration ĭysmorphic RBCs muddy brown casts tubular cell casts oval fat body.Granular casts – nonspecific many = ATN.WBC casts – interstitial nephritis, pyelo.Which of the following is the most appropriate next step in this patient’s management? A. There is no hydronephrosis, and no kidney masses are seen. On kidney ultrasound, the right kidney is 12.2 cm and the left kidney is 12.7 cm. There is 3+ pitting edema of the lower extremities to the level of the thighs bilaterally. Cardiopulmonary and funduscopic examinations are normal. On physical examination, vital signs are normal except for a blood pressure of 162/90 mm Hg.Medications are enalapril, insulin glargine, insulin aspart, and low-dose aspirin. At her last office visit 4 months ago, the urine albumin-creatinine ratio was 100 mg/g. She was diagnosed with type 1 diabetes mellitus 10 years ago. A 35-year-old woman is evaluated for a 1-month history of progressive bilateral lower-extremity edema.Section of Nephrology University of Chicago MKSAP Review – Glomerular Diseases Patrick Cunningham M.D. ![]()
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