Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 146: A 73-Year-Old Female with Lower Extremity Swelling
May 15, 2025
Dive into the intriguing case of a 73-year-old woman battling lower extremity swelling and fatigue. The discussion emphasizes the role of physical exams and point-of-care ultrasounds in diagnosing her condition. Explore the complexities of glomerular diseases, with a spotlight on idiopathic membranous glomerulonephritis. A comparative analysis highlights the differences between minimal change disease and post-streptococcal glomerulonephritis. Learn why renal biopsies are crucial for accurate diagnosis and effective therapy in older patients.
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Presentation of Lower Extremity Swelling
- A 73-year-old woman presents with worsening lower extremity swelling progressing to anasarca over two months.
- The symptoms include fatigue and dyspnea on exertion without fever, weight loss, or jaundice, suggesting a possible renal or hepatic etiology.
Clinical Exam Points to Non-Cardiac Cause
- Physical exam reveals edema extending to thighs and coccyx, pleural effusions, and possible ascites without elevated neck veins or heart abnormalities.
- POCUS confirms pleural effusions and ascites, pointing away from heart failure as the cause.
Foamy Urine Suggests Nephrotic Syndrome
- The patient notes foamy urine without discoloration, indicating possible proteinuria without hematuria.
- This supports suspicion for nephrotic syndrome rather than liver disease or other causes of edema.
