Harriet is presenting with diabetic nephropathy

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Reference no: EM133913664

Question

Martha is a 56 year old female with type 2 diabetes diagnosed about 5 years ago. Her initial oral diabetic treatment was complicated by poor glycemic control. As a result, she was started insulin.

Two years ago, she developed hypertension which was treated with HCTZ 25 mg daily. Recent fundoscopic examination has revealed that she has nonproliferative diabetic retinopathy. Her baseline BUN at that time was 23 mg/dl; creatinine was 0.9 mg/dl, dipstick urinalysis was negative for protein; blood pressure adequately controlled at 135/74.

She now presents with accelerated hypertension, 178/108 mmHg, and 3+ pitting edema of the legs distal to the knees. Urinalysis reveals 3+ protein and 2+ blood. Urine microscopic analysis reveals hyalin and red blood cell casts. Her BUN is 37 mg/dl and her creatinine is 1.5 mg/dl. A 24 hour urine revealed 9.7 grams of protein with a creatinine clearance of 58 ml/min. Her total cholesterol was 279 mg/dl.

1. Do you think Harriet is presenting with diabetic nephropathy?

2. Which diagnosis is most likely?

3. What are your detailed treatment plan and diagnostic work-up?

4. Are there any other tests you need? If so, why? What are you looking for?

Reference no: EM133913664

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