Question
A 65-year-old female with congestive heart failure and chronic renal failure presents with shortness of breath and generalized body swelling. She reports her symptoms have worsened since yesterday. On physical exam, there is distention of the jugular venous pulse (JVP), presence of S3 on cardiac auscultation, and the presence of crackles bilaterally on lung auscultation. There is pitting edema of both lower legs. There are waxy papules in the axilla and inguinal region. Laboratory analysis reveals serum creatinine of 6.1 mg/dL, total protein level of 9.2 g/dL, and blood urea nitrogen (BUN) level of 85 mg/dL. Urine analysis reveals 3+ protein but with the absence of cells or cellular casts. An echocardiogram shows a thickened left ventricle with preserved systolic function. Which of the following is the most appropriate next step in the management of this patient?
| A. |
Fat pad biopsy |
| B. | Renal ultrasound |
| C. |
Right heart catheterization |
| D. |
Bone marrow biopsy |
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