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26th February 2025
You are called to see a 54-year-old female who has been referred to the medical take by her GP with deranged renal function on routine blood tests.
You are called to see a 54-year-old female who has been referred to the medical take by her GP with deranged renal function on routine blood tests.
She has a past medical history of diffuse cutaneous systemic sclerosis. She had been recently given a course of 20 mg oral prednisolone for joint inflammation.
On examination, she is hypertensive with a blood pressure of 172/105 mmHg. She has noticeable sclerodactyly and digital ulcers. She has no focal neurology, is oriented, and fundoscopy is normal.
Blood tests show the following:
| On admission | 4 months ago | Normal range | |
|---|---|---|---|
| Hb | 125 | 129 | (135-170) |
| WCC | 9.3 | 8.9 | (3.5-11.0) |
| Plt | 325 | 250 | (140-400) |
| Neut | 4.5 | 4.1 | (1.7-7.5) |
| ESR | 15 | 5 | |
| Na | 137 | 136 | (135-145) |
| K | 4.1 | 4.2 | (3.5-5.1) |
| Urea | 5.2 | 4.3 | (2.9-8.2) |
| Creat | 110 | 73 | (66-112) |
| eGFR | 52 | >90 | |
| CRP | 6 | <1 | (0-5) |
Given the above information, what is the most appropriate initial management?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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