Sunday, December 3, 2023
This educational activity is intended for an international audience of non-US primary care providers (PCPs), nephrologists, and allergists & clinical immunologists.
The goals of this activity are that learners will better understand best practices for evaluation, diagnosis, differential diagnosis, and management of rare complement-mediated kidney diseases and the challenges and limitations of current standard of care.
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Joseph is a 50-year-old financial consultant with a history of hypertension. He is referred to a nephrologist for a mild increase in serum creatinine (sCr) and elevated blood pressure of 148/98 mm/Hg. His medical history and the results of his physical exam and laboratory tests are shown in Table 1.
You note his elevated blood pressure despite adherence to an angiotensin converting enzyme (ACE) inhibitor and diuretic. Analysis of his renal function shows proteinuria, hematuria, and mildly increased sCr.
Table 1. Joseph’s Medical Record
| History | Findings |
|---|---|
| Medical | Controlled hypertension x 15 years, recently became elevated despite treatment |
| Current Medications | Lisinopril 20 mg/d, hydrochlorothiazide 25 mg/d, simvastatin 20 mg/d |
| Social/Occupational | Financial consultant, married, lives with wife and dog; non-smoker, non-drinker; has 2 adult daughters; on Dietary Approaches to Stop Hypertension (DASH) diet and walks 3 times a week |
| Physical exam | Findings |
| Vital Signs | BP: 148/98 mmHg HR: 78 bpm |
| Body measurements | Weight 76 kg, BMI = 24 kg/m2 |
| Extremities | No edema |
| Neck | No distended neck veins |
| Heart | LVEF = 60% |
| Lungs | No rales |
| Abdomen | Soft, nontender |
| CBC | Results |
| Normal | |
| Metabolic Panel | Results |
| FPG | 90 mg/dL |
| HbA1c | 6.8% |
| Lipid panel | LDL: 70 mg/dL; HDL: 35 mg/dL; TG: 155 mg/dL |
| Kidney Panel | |
| eGFR | 55 mL/min/1.73 m2 |
| UACR | 200 mg/g |
| Serum Creatinine | 1.5 mg/dL |
| Urine dipstick | +WBC, +RBC |
BMI, body mass index; BP, blood pressure; CBC, complete blood count; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HDL, high density lipoprotein; HTN, hypertension; HR, heart rate; LVEF, left ventricular ejection fraction; LDL, low density lipoprotein; RBC, red blood cell; TG, triacylglycerol; UACR, urine albumin-to-creatinine ratio; WBC, white blood cell.
