A 22-year-old African-American woman is admitted to hospital because of swelling of the legs and a weight gain of 4 kg (10 lbs) over the past week. She has felt extremely tired for the past month. On physical examination she is afebrile. Her blood pressure is 145/95 mm Hg. A chest radiograph shows marked pleural effusions.

Questions:

1. What is suggested by these findings?

The presence of RBC's, WBC's, and numerous casts suggests a nephritis.

2. What are possible underlying disease processes?

Systemic lupus erythematosus should be high on the list. Other diseases such as membranoproliferative glomerulonephritis can give a similar picture.

3. What additional laboratory tests would be helpful?

Serologies: ANA, anti-dsDNA, C3 complement. Renal biopsy.