A 56-year-old man presents with a 3-day history of fatigue,…
A 56-year-old man presents with a 3-day history of fatigue, decreased urine output, and dark-colored urine. He denies dysuria, urinary frequency, urgency, or flank pain. Two weeks ago, he completed treatment for streptococcal pharyngitis. His blood pressure is 168/94 mmHg, and physical examination demonstrates bilateral lower extremity edema. Laboratory studies reveal: Urine dipstick: 3+ blood, 2+ protein, negative nitrites, negative leukocyte esterase Urine microscopy: Dysmorphic RBCs, numerous RBC casts, no bacteria Urine culture: No growth after 48 hours Serum creatinine: 2.6 mg/dL (baseline 0.9 mg/dL) eGFR: 29 mL/min/1.73 m² UACR: 620 mg/g Based on these findings, what is the most appropriate next step?
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