Question

A patient with untreated HepC and a long history of IVDU presents with peripheral edema, weakness, hypertension, a BMI of 16, high BUN, high Cr, and a urinalysis positive for protein and blood that are mostly acanthocytes with irregular membrane protrusions. What is the next best step?

1) Order a liver biopsy
2) Start antiviral therapy
3) Refer to a nephrologist
4) Initiate dialysis

Answer 1

The patient with signs of kidney damage and chronic Hepatitis C should be referred to a nephrologist for specialized evaluation and management of the kidney disease.

Step-by-step explanation:

The patient presenting with peripheral edema, weakness, hypertension, low BMI, high BUN, high Cr, and a urinalysis positive for protein and blood mostly as acanthocytes with irregular membrane protrusions likely has kidney involvement secondary to chronic Hepatitis C infection and a history of Intravenous Drug Use (IVDU). The presence of acanthocytes in the urine and the other symptoms suggest a form of glomerulonephritis, which can occur as a complication of HepC. It is likely that the next best step for this patient is to refer them to a nephrologist for further evaluation and management of the kidney disease. A nephrologist can provide comprehensive care including further investigation like a kidney biopsy and the management of chronic kidney disease, which may include anti-viral therapy to address Hepatitis C as the underlying cause of the renal pathology.