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How Would You Manage This Patient With Edema of the Lower Extremities?

    James Matera, DO

    Practicing Nephrologist, Senior Vice President for Medical Affairs, and Chief Medical Officer CentraState Medical Center, Freehold, New Jersey

    Matera J. Lupus Nephritis, update 2021. Consultant360. Published online March 22, 2021.


    A 28-year-old Black woman presented to a clinic with edema of her lower extremities and a rash. She had no significant medical history except for 3 pregnancies—all vaginal deliveries—and 2 elective terminations of pregnancy, with the last child born 4 years prior to presentation. No history of preeclampsia, gestational diabetes, or hypertension was reported. She had not seen a physician since that time 4 years ago.

    She reported edema of her lower legs and face for 4 months. She also reported polyuria and “foam” in her urine since that time. She did not take any regular medication. She denied drinking alcohol but had used nasal cocaine 2 to 3 times per week.  

    The physical examination findings were significant for hypertension (180/112 mmHg in both arms). She was afebrile and had normal heart rate and rhythm, with a pulse rate of 92 beats/min. Periorbital edema was noted. Findings from a chest examination revealed diminished breath sounds on her right side one-third of the way up. Findings from an abdominal examination showed normal bowel sounds and no tenderness. Her extremities showed 3+ pitting edema up to her mid-thigh, and her urinalysis revealed 2+ red blood cells and 4+ protein on dipstick, a qualitative measurement tool.

    Initial laboratory tests were conducted, and she was started on amlodipine, 10 mg/d, and furosemide, 20 mg po/d. A chest radiograph scan was also conducted.

    Answer and discussion on next page.