MEDizzy - A 45 year old man presents with a 6-week history of

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Nephrology and urology

A 45 year old man presents with a 6-week history of bilateral ankle swelling. On examination his pulse was 72beats/min, blood pressure (BP) 126/68 mmHg, jugular venous pressure (JVP) was not elevated and auscultation of heart and lungs was unremarkable. He had no stigmata of chronic liver disease. Which of the following is the most appropriate initial investigation?

ExplanationHe has no clinical evidence of heart failure (JVP not elevated, no basal crepitations, no third heart sound) or chronic liver disease and there is no history of obstructive urinary symptoms; therefore there is no indication to perform echocardiogram/abdominal ultrasound at this point. Bilateral leg swelling is unlikely to be due to a deep vein thrombosis (DVT), unless it affects the inferior vena cava. This raises the possibility of either renal failure or nephrotic syndrome and urinalysis may be helpful in either circumstance.