Case 16-1982

Presentation of CaseA 63-year-old man was admitted to the hospital because of flank pain.He was well until 13 years earlier, when peripheral edema developed. One month later he noticed impaired vision. On the following day he had a grandmal seizure and was brought to the hospital. Physical examination showed that the blood pressure was 230/110 mm Hg. No peripheral edema was evident. Neurologic examination revealed signs of cortical blindness and confusion; no focal neurologic defect was apparent. The urine gave a ++++ test for protein; the sediment contained 4 white cells, 6 red cells, and rare coarsely granular . . .