I have a 29 year-old lady today, 6 month post partum, with 1 week of shortness of breath on exertion, pedal edema, and HTN on furosemide and amlodipine. There is no significant PMH. BP 170/100 (on amlodipine 5 mg q D), +1 pedal edema up to knee (on furosemide), UA: Blood +1 (she does not have menses today), Protein +2, Leukocytes negative. Hgb 9.9 g/dL, total cholesterol 157 mg/dL, serum creatinine 1.15 mg/dL, albumin 3.69 g/dL, AST/ALT normal, HBs Ag/Anti-HCV negative, Abdominal US: kidneys are normal size and echo-structures. I just added losartan and iron to her amlodipine and furosemide and asked her to come back in a week. I was wondering if I should start immunosuppressive drugs or should I wait and see (just treat conservatively/supportively)? What is the most likely diagnosis if there is no kidney biopsy? What are symptoms/signs that indicate that kidneys are in advanced fibrosis/sclerosis and that immunosuppressive drugs are futile? Thanks again for the answers. Kind regards, Bunse