doc_clotaire
Forum Guru
Topics: 159
Posts: 1,247
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A 65-year-old man presents to the emergency room with complaints of
weakness, generalized swelling in his extremities, and right leg pain.
At the time of presentation, he appears to be in moderate distress
from the leg pain. The patient states that his symptoms started two
days ago. The patient also has frequent urination and increased
thirst. He states that he has felt weak for the past few months.
Physical examination reveals a tender, erythematous, and swollen right
calf. He also has 2+ pitting edema in all extremities. Blood pressure
is 107/55 mm Hg, and temperature is 100.3 F. Venous ultrasound is
positive for lower extremity deep vein thrombosis. Laboratory studies
reveal:
White cell count 11,000/mm3; hematocrit 32.3%; platelets 105,000/mm3;
K 4.0 mEq/L; BUN 24 mg/dL; creatinine 1.7 mg/dL. The PT/PTT are
normal.
Total bilirubin 0.4 mg/dL, AST 28 U/L, albumin l.9 g/dL, cholesterol
326 mg/dL; triglycerides 425 mg/dL.
Urine dipstick shows protein 3+, hemoglobin 1+, white cells 1+;
24-hour urine shows 6.2 grams of protein.
What is the next step in the treatment of this patient?
(A) Renal biopsy
(B) Plasmapheresis
(C) Anticoagulation
(D) Cyclophosphamide
(E) Prednisone
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| new_n_lost
Politically InCorrect
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(E) Prednisone ??
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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Symptomatic hypercoagualibility in nephrotic syndrome must be treated with anticoagulants to prevent fatal PE.
Answer : C.
Heparin might be usd but its effect is decreasd due to the absence of anti-thrombin iii.
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| nadiabarati
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it must be anticoagulation
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| Justice
Forum Fanatic
Topics: 106
Posts: 2,137
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(C)
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| dr.wad
Forum Senior
Topics: 3
Posts: 350
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indeed im confused....
it may be (C ) anticoagulation or ( B ) renal biopsy >>>>>>i go with ( C ).
by theway>>it is nephrotic syndrome but why platelet count is low, i think platelet count in nephrotic syndrome is normal >>>> it is the platelet function what is abnormal in nephrotic syndrom , not the count. am i wrong ???????????
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,247
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Answer:
(C) Anticoagulation
Explanation:
This patient has nephrotic syndrome based on the presence of edema,
hyperproteinuria, hypoproteinemia, and hyperlipidemia. Such patients
are predisposed to developing a hypercoagulable state secondary to the
renal losses of proteins C and S and antithrombin III, as well as
increased platelet activation. Patients with evidence of venous
thrombosis should be anticoagulated for at least 6 months. Recurrent
thrombosis and renal vein thrombosis warrant lifelong anticoagulation.
Although he may need a renal biopsy, he needs to have his thrombus
treated first as the "next" step. The same is true of using
cyclophosphamide and prednisone. This patient most likely has
membranous glomerulonephritis simply because he is an adult with
nephrotic syndrome, and this is the most common cause in adults.
Colonoscopy should also be done in a patient like this because there
is a strong association of glomerulonephritis with solid tumors, such
as colon and breast cancer.
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| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
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Yep...anticoagulate first... think about treatment of NS later.
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| ram3
Forum Guru
Topics: 48
Posts: 519
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The answer is anticoagulation patients with nephrotic syndrome have increased for hypercoagulability
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