A 60-year-old woman is brought to the clinic in a wheelchair by her husband. She reports progressive skin tightening and a palpable “woody feeling” in the lower extremities, leading to decreased ambulation. She has a medical history of osteomyelitis and diabetic chronic kidney disease while receiving hemodialysis, and was hospitalized six months back for a minor stroke, during which she underwent magnetic resonance imaging studies with gadolinium.
Physical examination Her blood pressure is 120/70 mm Hg, her pulse is 72 beats/min and regular, and her extremities appear woody and sclerotic, with non-pitting swelling in both lower extremities. Medications Darbepoetin: 60 μg subcutaneously monthly Pioglitazone: 15 mg/d orally Furosemide: 60 mg/d orally Aspirin: 81 mg/d orally Laboratory results Sodium:140 mEq/L Potassium: 4.0 mmol/L Hemoglobin: 10.5 g/dL Creatinine: 2.0 mg/dL What is the…
