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Review Question - QID 214547

Nephrotic Syndrome Studies  Nephrotic SyndromeTypePathophysiologyRenal BiopsyTreatment and NotesFocal segmental glomerulosclerosis <ul><li>Podocyte injury or decreased glomerular filtration barrier integrity</li></ul><ul><li>Light microscopy<ul><li>segmental scarring</li></ul>< QID: 214547 (M2.OMB.4877)
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QID 214547 (Type "214547" in App Search)
A 47-year-old man presents to the emergency department with leg swelling. He first noticed the swelling in his legs 5 days ago. He denies any trauma and is not experiencing pain. The swelling remains consistent throughout the day. He has a history of type 2 diabetes mellitus, HIV, and hypertension. He is a postman, drinks 2-3 beers per day, and smokes a pack of cigarettes daily. His medications include metformin, amlodipine, zidovudine, didanosine, and nevirapine. His temperature is 97.6°F (36.4°C), blood pressure is 155/80 mmHg, pulse is 74/min, respirations are 15/min, and BMI is 37.2 kg/m^2. On exam, he has periorbital edema and bilateral lower extremity pitting edema up to his mid thighs with no warmth or erythema. He has 5/5 strength and intact sensation bilaterally.

Serum:
CD4+ count: 278 cells/mm^3
HbA1c: 6.8%

Urine:
Epithelial cells: Scant
Glucose: Negative
Protein: 3+
WBC: 4/hpf
Bacteria: None
Leukocyte esterase: Negative
Nitrites: Negative

Kidney biopsy results are shown in Figure A. Which of the following is the most likely diagnosis?

  • A
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  • A