Contributed by Maria Parizhskaya, M.D. and
Sheldon Bastacky, M.D.
Published on line in February 1997
Disclosure Statement: In accordance with the policies on disclosure of the Accreditation Council for Continuing Medical Education and the Faculty Advisory Committee for Continuing Education in the Health Sciences, University of Pittsburgh, presenters for this program have identified no personal relationships with a health care product company which, in the context of their topics, could be perceived as a real or apparent conflict of interest.
The patient was a 68 year old normotensive, non-diabetic man with chronic renal insufficiency, congestive heart failure related to non-ischemic left ventricular dysfunction (previously treated with enalopril) and diarrhea (endoscopically negative, treated with imodium) who presented with nephrotic range proteinuria (4 gm/24 hrs) and minimal edema. There were no additional medications. Pertinent labs included: creatinine 1.8-2.0 mg%, ANA- negative, rheumatoid factor- negative, cryoglobulin screen- negative, hepatitis A/B/C serologies-negative, complements- normal, urine sediment-granular casts and oval fat bodies.