A 67 year old women comes to GP for managment of her rheumatoid arthritis which is poorly controlled. She also notes her urine has been frothy. Vitals are normal. Exam shows joint deformity and restricted motion in her hands as well as scattered nodules. Additionally there is periorbital ecchymosis, macroglossia nad bilateral lower extremity edema. Labs show HB 10.3 Platelets 196 000 Leukocytes 8800 Creatinine 3.1 Albumin 3.1 Total protein 10.2 1. What is your diagnosis regarding the symptoms she is presenting with in addition to her rheumatoid arthritis? What features suggest this? 2. What is likely to be seen on kidney biopsy? 3. What will be seen on Congo red stain?

How do you remember renal physiology?
Use the mnemonic, A WET BED: A) maintenance of ACID-base balance; W) maintenance of WATER balance; E) balance of ELECTROLYTES; T) removal of TOXINS; B) control of BLOOD pressure; E) production of ERYTHROPOIETIN; and D) metabolism of vitamin D.