Skill Checkup: A 56-Year-Old Man With Primary IgA Nephropathy and Fatigue, Abdominal Pain, and Frothy Urine

A. Brent Alper, Jr, MD, MPH


May 01, 2023

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

Six months ago, a 56-year-old Black man in the US was diagnosed with primary immunoglobulin (Ig) A nephropathy and was started on initial therapy with losartan 50 mg/d and prednisone 40 mg/d orally. He reported using analgesics regularly for leg pain. The patient is a smoker and is not diabetic. He was counseled to stop using the analgesics, begin a structured exercise program, and was referred to a smoking cessation program.

Today, he reports fatigue; abdominal pain; and cloudy, frothy urine. He reports medication adherence but has not participated in any of the lifestyle modifications that were prescribed previously.

Physical exam reveals edema in his legs, ankles, and periorbital and scrotal areas. He has gained 25 lb since his last visit and has decreased breath sounds on auscultation. His blood pressure is 140/80 mm Hg.

Laboratory tests are performed: Blood glucose and A1c are normal; total count is 250 mg/dL; low-density lipoprotein cholesterol is 180 mg/dL; high-density lipoprotein cholesterol is 70 mg/dL; and triglycerides is 250 mg/dL. Urinalysis is performed and shows UPCR > 1.5 g/24 h. The patient is referred to nephrology.


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