NE
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36-year-old African American man comes to you for a physical examination. He was recently told at his employment physical that he had high blood pressure and has protein in his urine. He says that he has felt good all his life and has not seen a physician in many years. He denies any skin rashes, oral ulcers, joint pain, or burning during micturition. Vital signs are: blood pressure 202/110 mm Hg, pulse 90/min, respirations 20/min, and temperature 36.8 C (98.2 F). Physical examination shows a displaced PMI. His lungs are clear to auscultation. Abdominal and neurologic exams are normal. He has bilateral 1+ pitting pedal edema. Laboratory studies are normal (includes HIV negative , except urinary proteins- 5 g/24H)
A kidney biopsy shows evidence of focal segmental glomerulosclerosis. He is started on an ACE inhibitor. Which of the following is the most appropriate additional management?
A. No additional therapy is indicated at this time
B. Prescribe cyclophosphamide
C. Prescribe cyclosporine
D. Prescribe prednisone
E. Recommend aspirin
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| doc_clotaire
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D. Prescribe prednisone
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| Adam
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A. ??
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| Justice
Forum Fanatic
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I guess we have to start with D. Prescribe prednisone
B&C are to suppress T cell-mediated effect which is not the case...
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| doyoudig
Forum Guru
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agree w/ D)
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| sprint123
Forum Guru
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I think it is A....Since there is already sclerosis and immunosuppressive therapy is not useful
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| webjeee
Forum Guru
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why ACEI should be Diuretics and ccb
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| NE
Forum Guru
Topics: 53
Posts: 504
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Prednisone is the answer; focal segmental glomerulos sclerosis with no other risk factors ( HIV) could respond at a prednisone trial!
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