Oedema and Haematuria

🗒️ Question

A 28 year old man presents to A&E with generalised swelling, dark urine, and reduced urine output over the past three days. He reports fatigue and a mild sore throat a week ago. His medical history is unremarkable and he takes no regular medications.

On examination, his blood pressure is 160/95 mmHg and his heart rate is 88 bpm. He has periorbital oedema and pitting oedema up to his knees bilaterally. Cardiovascular and respiratory examinations are unremarkable.

Investigations

• Urinalysis: Protein 3+, Blood 3+

• Serum creatinine: 250 µmol/L (60–110)

• Urea: 12 mmol/L (2.5–7.8)

• eGFR: 30 mL/min/1.73m² (≥90)

• Potassium: 5.2 mmol/L (3.5–5.3)

What is the most appropriate immediate action?

(A) Administer intravenous furosemide

(B) Commence oral prednisolone

(C) Give intravenous fluids

(D) Monitor closely with repeat bloods in 24 hours

(E) Refer urgently to nephrology