Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 65 year old woman with the same patient characteristics. She reports that “Over the last few weeks I’ve noticed I haven’t been urinating as much, I have some swelling in my legs, and I sometimes notice a red tinge to my urine.”
HPI: Patient reports that her symptoms began several weeks ago. She had worsening of her arthralgias, and started noticing that she didn’t urinate as much as she usually does. She states that sometimes she has a red tinge in her urine, which makes it burn a little when she urinates. She notices that her legs swell up more than normal recently. She has not had recent fever, chills, nausea, vomiting, or diarrhea. Her fluid intake has been “normal.” She does note that she takes her BP daily, as recommended by her PCP, and that over the last several weeks her blood pressure has been more elevated that normal.
PMH: The same except as in the long case, but in addition, 6 year history of SLE.
FMH and SH: same as in the long case.
ROS: General: no fever or chills, but does admit to some fatigue. No weight loss or gain. Skin: Occasionally some skin rash related to her SLE, but none currently. GU: Oliguria, hematuria, and occasional dysuria per HPI. Rest of ROS is negative.
PE: Vitals are same as the long case. General: Sitting upright in chair, in no acute distress. Skin: No active rashes or lesions noted, but some areas of scarring from prior rashes are noticeable. Abd: negative for CVA tenderness. Extremities: 1+ pitting edema to lower extremities bilaterally. Rest of PE is normal.
Labs: 24hr urine collection for protein, which shows 2g of proteinuria in 24hr.