科研之友
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摘要
A 67-year-old white man with a history of kidney transplant for hypertensive kidney disease 9 months ago presents for follow-up, concerned by vague abdominal discomfort and loss of appetite. He lost 15 pounds during the preceding 3 months without an obvious cause. He also reports drenching night sweats during the past several weeks. Before his transplant, he had been maintained on hemodialysis therapy for similar to 1 year, and other than these new concerns, he has done well after receiving a deceased donor organ. Serum creatinine level is stable at 1.3-1.4 mg/dL (estimated glomerular filtration rate, 54-59 mL/min/1.73 m(2)). Immunosuppressive medications include tacrolimus, 2 mg, twice daily; mycophenolate mofetil, 500 mg, twice daily; and prednisone, 7.5 mg/d. His physical examination is notable for obvious weight loss. Blood pressure is 143/88 mm Hg, pulse is 95 beats/min, and he is afebrile. He has no signs of peripheral lymphadenopathy and has normal cardiopulmonary examination findings. Abdominal examination is notable for a nontender palpable mass in the midepigastric region similar to 8-10 cm in diameter. He has no hepatosplenomegaly and has a well-healed right-sided abdominal incision. Laboratory data show a serum creatinine level of 1.4 mg/dL (estimated glomerular filtration rate, 54 mL/min/1.73 m(2)) and otherwise normal extended metabolic panel results. Complete blood cell count is notable for a hemoglobin level of 10.2 mg/dL (previously 12.5 mg/dL) and white blood cell count of 12,000/mu L with a normal differential count. Finally, urinalysis is notable for only mild proteinuria. What further evaluation is appropriate to determine the cause of his concerns and laboratory abnormalities?
- 出版日期2010-1
