A 35-year-old man comes to the office due to a one-month history of weight gain and facial edema. The facial edema resolves at the end of the day, but ankle edema develops. Temperature is 37.2 C (99 F), blood pressure is 138/76 mm Hg, pulse is 80/min, and respirations are 16/min. Examination shows 2+ ankle edema. Laboratory studies show: Urinalysis:
This patient is most likely at risk for developing which of the following?

Question

A 35-year-old man comes to the office due to a one-month history of weight gain and facial edema.  The facial edema resolves at the end of the day, but ankle edema develops.  Temperature is 37.2 C (99 F), blood pressure is 138/76 mm Hg, pulse is 80/min, and respirations are 16/min.  Examination shows 2+ ankle edema.  Laboratory studies show:  Urinalysis:
 This patient is most likely at risk for developing which of the following?

Quizplus · Accepted Answer

This patient has nephrotic syndrome, a clinical complex characterized by: Proteinuria (> 3-3.5 g/day - most important manifestation)HypoalbuminemiaEdemaHyperlipidemia and lipiduria Proteinuria (> 3-3.5 g/day - most important manifestation) Hypoalbuminemia Edema Hyperlipidemia and lipiduria The basic pathology is altered permeability of the glomerular membrane for proteins. Diseases commonly causing nephrotic syndrome are minimal change disease (in children), membranous glomerulopathy, focal segmental glomerulosclerosis, mesangial proliferative glomerulonephritis, and membranoproliferative glomerulonephritis. Nephrotic syndrome is frequently complicated by hypercoagulation, with a consequent risk of thromboembolic complications. The etiology of hypercoagulation in nephrotic syndrome is multifactorial and includes: increased urinary loss of antithrombin 3, altered levels of protein C and S, increased platelet aggregation, hyperfibrinogenemia due to increased hepatic synthesis, and impaired fibrinolysis. Renal vein thrombosis is a common manifestation of coagulopathy (especially with membranous glomerulopathy), but arterial thrombosis and pulmonary embolism may also occur. Coagulopathy is less common but more severe in children as compared to adults with nephrotic syndrome. Complications of nephrotic syndrome include: protein malnutrition, iron-resistant microcytic hypochromic anemia due to transferrin loss, vitamin D deficiency due to increased urinary excretion of cholecalciferol-binding protein, decreased thyroxin levels due to loss of thyroxine-binding globulin, and increased susceptibility to infection (due to loss of immunoglobulins). (Choices A and B) Rupture of a brain aneurysm and abdominal aortic aneurysms are more likely to be seen in patients with adult polycystic kidney disease. Such patients do not present with nephrotic syndrome. (Choice D) Pulmonary hemorrhage is a manifestation of anti-glomerular basement membrane disease or granulomatosis with polyangiitis. These cause nephritic (not nephrotic) syndrome. (Choice E) Although nephrotic syndrome is associated with hyperlipidemia (which may predispose to gallstone formation), gallstone pancreatitis is not a commonly recognized complication of nephrotic syndrome. Educational objective: Nephrotic syndrome is a hypercoagulable condition which manifests as venous or arterial thrombosis, and even pulmonary embolism. Renal vein thrombosis is the most frequent manifestation. Complications of nephrotic syndrome include: protein malnutrition, iron-resistant microcytic hypochromic anemia, increased susceptibility to infection, and vitamin D deficiency.

A 35-Year-Old Man Comes to the Office Due to a One-Month