October 31, 2024

35-year-old woman presents with edema, stage 1 HTN

By Med-Challenger · 1 minute read

A 35-year-old woman presents with a history of type 2 diabetes and hypertension. Her blood pressure is 135/86 mm Hg. You note the presence of trace edema on both extremities. Urinalysis is positive for 2+ protein and no blood. You obtain urinalysis for a spot protein/creatinine ratio, which is 0.3 g/g (normal < 0.2 g/g). Her serum creatinine level is 0.6 mg/dL (normal range, 0.6-1.2).

Which of the following statements is correct?

She has stage 2 kidney disease.
She has stage 3 kidney disease.
She has stage 1 kidney disease.
She does not have kidney disease.

The correct answer is:

She has stage 1 kidney disease.

Key Point:

Even with a normal serum creatinine level, proteinuria is a marker of kidney dysfunction.

Explanation:

The patient, by virtue of proteinuria, has stage 1 kidney disease, defined as renal disease with a normal glomerular filtration rate (GFR). This patient is likely to have a normal GFR with a creatinine level of 0.6 mg/dL; however, because proteinuria is present, her kidneys are not functioning normally. A normal protein/creatinine ratio is defined as 0.2 g protein/ g creatinine or less, corresponding to a urinary protein level of 200 mg.

Stage kidney disease 2 is defined as a GFR of 60 to 89 mL/minute; stage 3 is defined as a GFR of 30 to 59 mL/minute; and stage 4 is defined as a GFR of 15 to 29 mL/minute.

References:

Kidney Disease Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:5. Accessed February 28, 2019.

This question appears in Med-Challenger Family Medicine Exam Review with CME.

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