How Would You Manage This Patient With Edema of the Lower Extremities?

AUTHOR:
James Matera, DO
Practicing Nephrologist, Senior Vice President for Medical Affairs, and Chief Medical Officer CentraState Medical Center, Freehold, New Jersey

CITATION:
Matera J. Lupus Nephritis, update 2021. Consultant360. Published online March 22, 2021.

A 28-year-old Black woman presented to a clinic with edema of her lower extremities and a rash. She had no significant medical history except for 3 pregnancies—all vaginal deliveries—and 2 elective terminations of pregnancy, with the last child born 4 years prior to presentation. No history of preeclampsia, gestational diabetes, or hypertension was reported. She had not seen a physician since that time 4 years ago.

She reported edema of her lower legs and face for 4 months. She also reported polyuria and “foam” in her urine since that time. She did not take any regular medication. She denied drinking alcohol but had used nasal cocaine 2 to 3 times per week.  

The physical examination findings were significant for hypertension (180/112 mmHg in both arms). She was afebrile and had normal heart rate and rhythm, with a pulse rate of 92 beats/min. Periorbital edema was noted. Findings from a chest examination revealed diminished breath sounds on her right side one-third of the way up. Findings from an abdominal examination showed normal bowel sounds and no tenderness. Her extremities showed 3+ pitting edema up to her mid-thigh, and her urinalysis revealed 2+ red blood cells and 4+ protein on dipstick, a qualitative measurement tool.

Initial laboratory tests were conducted, and she was started on amlodipine, 10 mg/d, and furosemide, 20 mg po/d. A chest radiograph scan was also conducted.