Nephrotic syndrome secondary to lupus nephritis
Three weeks of weight loss, intermittent fevers, worsening peripheral oedema, and ascites. Cachectic and anaemic.
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Severe generalised fluid overload (pleural effusions, pericardial effusion, large volume ascites, subcutaneous oedema). Right renal vein thrombosis. These findings can be seen in nephrotic syndrome - consider urinalysis.
Two hypodense with peripheral enhnacement liver lesions likely represent haemangiomata. No clear evidence of malignancy.
Initial blood tests showed hypoalbuminemia (6 g/L) and anaemia (Hb 92 g/L). Urinalysis performed after the CT showed a protein concentration of 4.92 g/L (protein/creatinine ratio 593). Together with the severe fluid overload seen on CT, these findings are diagnostic of nephrotic syndrome. Nephrotic syndrome is known to cause a hypercoagulable state, and it is a common cause of renal vein thrombosis. The patient was subsequently diagnosed with SLE and lupus nephritis (positive ANA and anti-dsDNA, weak positive ENA and Anti-Sm).