Secondary glomerular diseasesDownloads

A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 3-month history of fatigue and weakness. Her hemoglobin A1c concentration was 13.5% 12 weeks ago. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. Serum studies show: K+ 5.1 mEq/L Phosphorus 5.0 mg/dL Ca2+ 7.8 mg/dL Urea nitrogen 60 mg/dL Creatinine 2.2 mg/dL Which of the following is the best parameter for early detection of this patient’s renal condition?

A 50-year-old woman comes to the emergency department because of fever and productive cough with blood in the sputum for 1 day. She also reports a sharp pain under her ribs that is worsened on taking deep breaths. Over the past 2 years, she has had repeated episodes of sinusitis, for which she used over the counter medication. She has recently started a new job at a wire-mesh factory. Her temperature is 38.3°C (100.9 °F), pulse is 72/min, respirations are 16/min, and blood pressure is 120/80 mm Hg. Physical examination shows palpable nonblanching skin lesions over her hands and feet. Examination of the nasal cavity shows ulcerations of the nasopharyngeal mucosa and a small septal perforation. Pulmonary examination shows stridor on inspiration. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 10,300/mm3 Platelet count 205,000/mm3 Serum Urea nitrogen 24 mg/dL Creatinine 2.4 mg/dL Urine Protein 2+ RBC 70/hpf RBC casts numerous WBC 1–2/hpf A chest x-ray shows multiple cavitating, nodular lesions bilaterally. Which of the following additional findings is most likely to be present in this patient?