Lupus nephritis

Abstract

A 31-year-old African-American woman presents for evaluation of proteinuria. Several months earlier she was seen by her primary care physician for facial rash and pleuritic chest pain, and serologic evaluation revealed positive antinuclear antibodies (ANA) by immunofluorescence. In your office she complains of lower extremity swelling and foamy urine. The blood pressure is 155/90, and the exam is notable for the presence of oral ulcers and 3+ lower extremity edema. The urinalysis tests 3+ for protein and many dysmorphic red cells are seen on the microscopic examination of the sediment. Other testing reveals a serum creatinine of 1.3 mg/dl, serum albumin 2.9 g/dl, and her 24 h urine protein excretion is 4.5 g/day.