Long-standing Intravenous Heroin Use in Medicine / Internal Medicine — 36yo Man | Nephrology | SMLE Q#3330
SMLE Question #3330
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 36-year-old man with long-standing intravenous heroin use presents for follow-up. He reports no dyspnea, edema, rash, or gross hematuria. Examination shows multiple injection track marks and a firm, non-tender 3-cm left axillary lymph node present for several months. Urinalysis shows proteinuria with bland urine sediment. Serum creatinine is mildly elevated. Renal ultrasound shows bilaterally enlarged kidneys (about 13 cm each) with preserved cortical thickness. What is the most likely diagnosis?
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