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15th July 2024
A 21-year-old man presented with a 10 day history of bilateral ankle swelling as well as ankle and knee pain
A 21-year-old man presented with a 10 day history of bilateral ankle swelling as well as ankle and knee pain. He takes no medication and has no past medical history of note. He is an engineering student who has never smoked cigarettes or drank alcohol to excess. On examination, his blood pressure is 112/56 and he had pitting oedema to both mid calves. Cardiorespiratory and abdominal system examinations were normal. Small lymph nodes were palpable in his groin. Urinalysis showed blood +++ and protein ++++. Investigations were as follows:
| serum sodium | 140 mmol/L (137–144) |
| serum potassium | 4.0 mmol/L (3.5–4.9) |
| serum creatinine | 101 µmol/L (60-110) |
| serum albumin | 14 g/L (37-49) |
| urine protein: creatinine ratio | 739 mg/mmol (<30) |
Which of the below investigations is likely to be the most useful?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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