A 34-year-old man complains of pale edema of the face, feet, shins, and lumbar area. elevated blood pressure up to 160/100 mm Hg, and general weakness. He has a clinical history of nonspecific ulcerative colitis. Objectively: pulse – 84/min., rhythmic, blood pressure – 165/100 mm Hg: edemas all over the body: the skin is pale and dry with low turgor. The kidneys cannot be palpated, on an attempt to palpate them they are painless. Blood test: erythrocytes – 3.0 × 1012/L, Hb- 100 g/L erythrocyte sedimentation rate – 50 mm/hour. Urinalysis: proteins – 3.5 g/L, erythrocytes – 7-10 in the vision field, leukocytes – 5-6 in the vision field. Daily proteinuria – 6 grams. What analysis should be conducted additionally to verify the diagnosis?

Answer options

1. Gingival biopsy for the diagnosis of amyloid disease
2. Renal ultrasound
3. Urinalysis for Bence-Jones protein
4. Radioisotopic examination of kidneys
5. Survey and excretory urography

Explanation

A 34-year-old man complains of pale edema of the face, feet, shins, and lumbar area. elevated blood pressure up to 160/100 mm Hg. and general weakness. He has a clinical history of nonspecific ulcerative colitis. Objectively: pulse – 84/min., rhythmic, blood pressure – 165/100 mm Hg: edemas all over the body: the skin is pale and dry with low turgor. The kidneys cannot be palpated, on an attempt to palpate them they are painless. Blood test: erythrocytes – 3.0 – 1012/L, Hb- 100 L erythrocyte sedimentation rate – 50 mm/hour. Urinalysis: proteins – 3.5 L, erythrocytes – 7-10 in the vision field, leukocytes – 5-6 in the vision field. Daily proteinuria – 6 grams. What analysis should be conducted additionally to verify the diagnosis?Amyloidosis is any of a group of disparate conditions characterized by extracellular deposition of insoluble fibrils composed of mis aggregated proteins. These proteins may accumulate locally, causing few symptoms, or widely, involving multiple organs and causing severe multiorgan failure. Amyloidosis can occur de novo or be secondary to various infectious, inflammatory, or malignant conditions. Diagnosis is by biopsy of affected tissue; the amyloidogenic protein is typed using a variety of immunohistology and biochemical techniques. Treatment varies with the type of amyloidosis.