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nadiabarati

04/26/07 - 04:35 PM       #1

A 72-year-old man comes to the physician because of a 2-month history of urination twice nightly and occasional urinary frequency and urgency. He has a 15-year history of type 2 diabetes mellitus now moderately well controlled with glyburide. His father was diagnosed with prostate cancer at the age of 70 years, and his sister died of complications from systemic lupus erythematosus. His blood pressure is 135/86 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows no suprapubic fullness or tenderness. There is mild enlargement of the prostate with no palpable nodules. His postvoid residual volume is 10 mL. Serum studies show a urea nitrogen (BUN) level of 45 mg/dL and creatinine level of 3.8 mg/dL. Urine dipstick shows 3+ protein. Which of the following is most likely to have prevented progression of this patient's renal disease?

A
) Intermittent Foley catheterization

B
) Intravenous mannitol therapy

C
) Oral cyclophosphamide and prednisone therapy

D
) Oral enalapril therapy

E
) Oral finasteride therapy

F
) Oral prednisone therapy only

G
) Oral terazosin thera






vradojc1
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04/26/07 - 04:50 PM       #2

D) -diabetic/renal disease/hypertension
Keyword in q - "prevented"

doc_clotaire
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04/26/07 - 04:58 PM       #3

What about post-renal azotemia secondary to BPH ? You ruled it out ?

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vradojc1
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04/26/07 - 05:06 PM       #4

Well, based on duration of his "prostatic" symptoms (2 months) and duration of DM2 (15 years diagnosed, probably over 20 present), I would say that DM presents more chronic problem than BPH.

vradojc1
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04/26/07 - 05:11 PM       #5

+ normal residual urine is from 50-100 mL. 10 mL make BPH really insignificant.

doc_clotaire
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04/26/07 - 05:16 PM       #6

Good point !

I agree with you vradojc1 especially when looking at the " ALBUMINURIA " in urine dipstik and the mild elevation of BP ( Actually ACE inhibitors are even recomended in normotensive cronic type 2 DM to prevent diabetic nefropaty , this is Big Time on boards now )

D would be my best pick too nod




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Justice
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04/26/07 - 09:17 PM       #7

(D) Oral enalapril therapy

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arlete
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04/27/07 - 10:16 AM       #8

A huge clap for vradojc1!

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