When listening for hoofbeats, sometimes there are zebras—an interesting case of a teenager with edema and high blood pressure: Questions

Excerpt

A 15-year-old female presented to Children’s Healthcare of Atlanta at Scottish Rite Emergency Department with a history of edema and headaches. She had first noticed the headaches 1 week prior to hospital admission and had seen her primary care provider who prescribed migraine medication. Over the next few days, she noticed swelling in her face and extremities. She initially presented to an outside urgent care center with a blood pressure of 168/125, and microscopic hematuria and proteinuria were noted on urinalysis. She was subsequently transferred to Children’s Healthcare of Atlanta at Scottish Rite Emergency Department for further evaluation and possible inpatient hospitalization. En route to the emergency department, she was given doses of nifedipine and furosemide, to which she showed a therapeutic response, bringing her blood pressure (BP) down to 145/110 on repeat measurement. …