Facial Swelling and Heavy Proteinuria

🗒️ Question

A 55 year old man presents to the Emergency Department with generalised swelling especially noticeable in his legs and face that has developed over the past three weeks. He reports recent fatigue and reduced urine output. He has no significant medical history apart from hypertension managed with an ACE inhibitor.

On examination, his blood pressure is 145/92 mmHg, heart rate is 88 bpm and there is marked bilateral pitting oedema to his thighs. Jugular venous pressure is not raised.

Investigations

• Urinalysis: protein 4+, no blood

• Serum albumin: 17 g/L (35–50)

• Serum creatinine: 90 µmol/L (60–110)

• Serum cholesterol: 9.2 mmol/L (<5)

What is the most appropriate immediate action?

(A) Administer intravenous furosemide

(B) Begin high-dose corticosteroids

(C) Commence ACE inhibitors

(D) Refer for urgent renal biopsy

(E) Start statins