Hey, folks, just a quick reminder that this podcast is not meant to be used for medical advice, just good old-fashioned education.

The next case is by Dr. Verroval Vakal, who is a nephrologist at the University of Minnesota, and it's the case of a

55-year-old woman presenting with bilateral leg swelling. She's had the leg swelling for three days,

without any dysphnia, paroxysmal nocturnal dysphnia, or orthopnia. She hasn't had any changes

in her urine color or frequency, and she hasn't had any respiratory symptoms.

In talking to her, you find out that she does have a history of idiopathic pulmonary fibrosis,

but she's not sure if it was ever confirmed by biopsy.

All right, so what I'll do is I'll tackle the lower extremi endema and use resists help to address how the presumed IPF fits in here.

And, you know, having an approach to lower extreme edema is actually fairly helpful because it really comes down to three things initially, which is, is this a cardiac problem, a renal problem or a hepatic problem?

In reality, there are a whole variety of other causes that are maybe sometimes occasionally

more common depending on what other symptoms the patient has that include hypothyroidism, medications

like amylotapine.

But in reality, when you're first meeting somebody with bilateral, lower extremat,

the onus is for you to disprove that it's not the kidney, the liver, or the heart.

And in reality, you can do that with the moment you walk in the room, quite honestly.

If there's such advanced cardiac disease that the patient has edema from it,

you should be able to be able to visually assess a respiratory component to it,

if not analyze the JVP, which if you need practice with, you should totally check out the

Twitter feeds of Dr. Andre Mansour and Zavid Sargassian. They're incredible. So edema and then

cardiac, but in reality you can assess for that fairly easily. Similarly, with liver involvement,

it's very hard to get such advanced portal hypertension leading to bilateral lower extrema edema without an abdominal component to it, and even more helpfully, without significant jaundice that you would be able to appreciate the second you walk into the room. So for me, when I walk in and I see lower extremitya and really nothing else, but while I'm talking to the patient, I'm already worried about their kidneys being involved. Of course, I'm cheating and this is Nephrology week, but I guarantee you that that is a real

fact. Oh my God. So, Robbie, thanks for leaving the interesting part of this case for me to discuss.

...