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15th July 2024
A 56-year-old woman presented to her GP with a suspicious looking crusty lesion on the side of her nose
A 56-year-old woman presented to her GP with a suspicious looking crusty lesion on the side of her nose. She had a 10-year history of hypertension, which had been initially treated with atenolol, but she had not renewed her prescription or seen a doctor for at least 4 years. On examination, her blood pressure was 174/83. Cardiopulmonary and abdominal examinations were normal. Urinalysis showed blood + and protein ++++. Bilateral micro-aneurysms, hard exudates and cotton-wool spots were seen on fundoscopy. Investigations were as follows:
| serum creatinine | 181 µmol/L (60–110) |
| fasting plasma glucose | 15.9 mmol/L (3.0–6.0) |
| urinary albumin: creatinine ratio | 301 mg/mmol (<2.5) |
| renal tract ultrasound | unremarkable |
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