08-09-2008, 05:26 AM
26. A 36-year-old African-American woman with hypertension comes to the office because of a 3-day history of intermittent, painless, gross hematuria. Symptoms started spontaneously, and she has not had fever, chills, flank pain or dysuria. Her only medication is hydrochlorothiazide. Vital signs are: temperature 37.0°C (98.6°F), pulse 72/min and blood pressure 128/84 mm Hg. Physical examination is normal; there is no costovertebral angle tenderness. Laboratory studies show:
Serum
Urine
Electrolytes
Normal
Protein
3+
Glucose
78 mg/dL
Blood
Positive
BUN
8 mg/dL
Microscopic
RBCs too numerous to count
Blood
No WBCs, bacteria or casts
CBC
Normal
Nitrite
Negative
Partial thromboplastin time
Normal
Urine culture
Pending
Platelet count
268,000/mm3
Prothrombin time
Normal
Which of the following is the most appropriate next step?
A
) Cystoscopy
B
) Determination of protein excretion in a 24-hour urine sample
C
) Initiation of antibiotic therapy
D
) Renal biopsy
E
) Transvaginal ultrasonography of the uterus
Serum
Urine
Electrolytes
Normal
Protein
3+
Glucose
78 mg/dL
Blood
Positive
BUN
8 mg/dL
Microscopic
RBCs too numerous to count
Blood
No WBCs, bacteria or casts
CBC
Normal
Nitrite
Negative
Partial thromboplastin time
Normal
Urine culture
Pending
Platelet count
268,000/mm3
Prothrombin time
Normal
Which of the following is the most appropriate next step?
A
) Cystoscopy
B
) Determination of protein excretion in a 24-hour urine sample
C
) Initiation of antibiotic therapy
D
) Renal biopsy
E
) Transvaginal ultrasonography of the uterus