Intended for healthcare professionals

Endgames Case Review

A young woman with dyspnoea and oedema

BMJ 2019; 367 doi: (Published 24 October 2019) Cite this as: BMJ 2019;367:l5763
  1. Catherine Spilsbury, foundation doctor1,
  2. Mona Panahi, foundation doctor2,
  3. Gemma Bowsher, foundation doctor3,
  4. Ashkan Sadighi, consultant4
  1. 1Oxford University Hospitals Trust, Oxford, UK
  2. 2Imperial College London, UK
  3. 3Hammersmith Hospital, London, UK
  4. 4Acute Medical Unit, West Middlesex Hospital, London, UK
  1. Correspondence to C Spilsbury catherine.spilsbury{at}

A 25 year old woman was admitted with a five day history of worsening shortness of breath and peripheral oedema. She had a history of suboptimal glycaemic control for type 1 diabetes that was diagnosed 10 years ago. She had had chronic kidney disease (CKD) for the past two years, with a gradually declining estimated glomerular filtration rate (eGFR) and rising creatinine level (previously asymptomatic).

Examination revealed muscle spasm in both hands, bilateral pitting thigh oedema, abdominal distention, and facial swelling. Auscultation revealed reduced air entry bilaterally and fine bibasal crepitations. Chest radiograph showed subsegmental …

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