Glomerulonephritis patient with 39.5degree fever...?

A 59 year old man with 14 year history of focal segmental glomerulosclerosis. U-albumin 2-5g/day at last checkup, GFR OK at last checkup. Hypercholesterolaemia. BMI 33 kg/m2. Smoker.

High dose Felodipin, metoprolol and irbesartan, but still high BP at regular checkups.

Recently (2 weeks ago) returned from holiday in Turkey
Vomited 3 days ago, since then no more vomit, but fever and general aches. Feels tired, worn out. Slight cough, some throat soreness.

Presents today for tiredness...

Fully conscious
Temp 39.5
Puls 136
BP 137/104
Lungs sound fine
Cardiac sounds faint, no murmurs
No flank pain, no other pain
Normal abdominal sounds

And that's all I've got!

I'm thinking possible ANF, possible sepsis with a hidden pressure drop (maybe he's normally over 200 - I don't know!), possibly a malignancy...

Any pointers gratefully received!

Have you considered intravenous bisphosphonates? Or a referral to a Kidney specialist?

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　　Maple Syrup Urine Disease 　　Manic-Depressive Illness 　　Managed Care 　　Man-Made Disasters 　　Mammography 　　Mammaplasty 　　Malignancy 　　Male Menopause 　　Malaria 　　Magnetic Resonance Imaging 　　Magnesium 　　Mad Cow Disease 　　Macular Degeneration

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