Author Affiliation: Dr Chertow is Director of Clinical Services, Divisions of Nephrology, Moffitt-Long Hospitals and UCSF-Mt Zion Medical Center, Department of Medicine, University of California, San Francisco.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR SHIP: Mrs C is a 43-year-old woman who has
had renal insufficiency for 23 years. She works as a nurse assistant part
time and lives with her husband and son outside Boston. She has indemnity
Mrs C was first found to have protein in her urine when she was 20 years
of age. No intervention was made at that time. She was followed up clinically
until her 30s, when a new internist referred her to a kidney specialist. In
1995, she underwent a kidney biopsy and was diagnosed as having focal segmental
glomerular sclerosis. Soon after, she became pregnant and was told that her
pregnancy might speed the progression of her kidney disease. She chose to
proceed and had a healthy pregnancy and delivery without any symptoms or complications.
Chertow GM. A 43-Year-Old Woman With Chronic Renal Insufficiency. JAMA. 2004;291(10):1252-1259. doi:10.1001/jama.291.10.1252