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.
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Cite this: Pradeep Arora, Karen Convay. A 65-Year-Old Man With Hypertension and Proteinuria - Medscape - Oct 12, 2015.
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