An established office patient with worsening proteinuria...

CC: Proteinuria

Interval History: The patient has severe nephrotic range proteinuria which was found on a routine screening UA about six months ago and is now associated with worsening lower extremity edema.

PFSH/ROS: Reviewed and unchanged from previous note. For details, please refer to the dictated note in this chart dated 3/24/09.

EXAM: 150/90, 78, 20. HEENT: remarkable for periorbital edema. Lungs are clear. Heart is RRR with no MRGs. Extremities show 3+ edema.

Labs: Creatinine is up to 2.1 compared to 1.6 one month ago. Electrolytes are stable. Protein/creatinine ratio is up to 9800 mg/G.

IMPRESSION: 45 year old gentleman with poorly controlled HTN and worsening severe nephrotic range proteinuria now accompanied by abruptly worsening renal failure.

PLAN: Will add TEKTURNA 150 mg PO QD to ongoing therapy with ACE inhibitor and ARB. At this point renal
biopsy is indicated to look for reversible causes of nephrotic syndrome and renal failure. Patient consents. Will make the arrangements and see him back in the office next week to go over results.

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