A 65-Year-Old Man With Hypertension and Proteinuria

Pradeep Arora, MD; Karen Convay, NP


October 12, 2015

Physical Examination and Workup

The physical examination reveals an obese male in no acute distress. His blood pressure is 180/98 mm Hg. His jugular vein is not distended.

A lung examination reveals normal breath sounds, with inspiratory rales heard at both lung bases. The heart rhythm is regular, with a grade 3 systolic murmur heard at the cardiac apex. The abdomen is soft and nontender, and no hepatosplenomegaly is noted. The kidneys are not palpable. He has 2+ swelling of the feet.

Laboratory workup reveals a hemoglobin level of 9.8 g/dL, a hematocrit of 28%, a mean corpuscular volume of 81 fL, a platelet count of 172,000 cells/µL, and a white blood cell count of 6700 cells/µL. A serum chemistry panel reveals a sodium level of 138 mEq/L, a chloride level of 101 mEq/L, a potassium level of 5.4 mEq/L, and a bicarbonate level of 18 mEq/L. His serum calcium level is 7.8 mg/dL, phosphate level is 5.5 mg/dL, blood urea nitrogen level is 53 mg/dL, and creatinine level is 2.4 mg/dL (eGFR, 28 mL/min).

Other laboratory findings include an alkaline phosphatase level of 150 U/mL, an albumin level of 3.3 g/dL, and an intact parathyroid hormone level of 240 pg/mL. Urinalysis reveals 2+ proteinuria, no hematuria, and no red blood cell (RBC) or white blood cell casts. His urinary protein/creatinine ratio is 6. Renal ultrasonography reveals that the right kidney measures 9.6 cm, and the left kidney is absent.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.