A 40-Year-Old Woman Is Referred for Evaluation of Chronic Kidney

question 782

Multiple Choice

A 40-year-old woman is referred for evaluation of chronic kidney disease (CKD) .  She has a two-year history of intermittent back, bilateral flank, and central abdominal pain.  She has lost approximately 15 lbs (6.8 kg) and is easily fatigued.  She had an episode of deep venous thrombosis one year ago that has not recurred.  She has noticed mild bilateral pedal edema.  She works in an office and denies using tobacco or illicit drugs.  Up until two years ago, she felt well and is unaware of any chronic medical problems.  Her current medications include over-the-counter acetaminophen and ibuprofen for pain control.
Her examination is unremarkable except for diffuse mild abdominal tenderness and bilateral, 2+, brawny lower extremity edema.
Laboratory results are as follows:

On renal ultrasound, both kidneys measure 12.5 cm (normal 9-12 cm) .  There is bilateral clubbing and mild-to-moderate dilation of the calices without dilation of the mid or distal ureters.
Which of the following is the most likely diagnosis?

• A)Cervical cancer with spread into the broad ligament
• B)Chronic glomerulonephritis
• C)Chronic interstitial nephritis
• D)Renal tuberculosis
• E)Retroperitoneal fibrosis

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A tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences.

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Describes a condition, often in children, characterized by excessively energetic, fidgety, or impulsive behaviors.

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