The case is that of 69 year old female who went on vacation and fell on her knees. She noticed progressive swelling of both legs over 2 weeks duration. During this period she gained 44 pounds in weight. She presented with sudden onset of edema of the lower extremity and weigh gain. She had 16 g/day of proteinuria. Past medical history is significant of hypertension of unknown duration. She had never seen a doctor in the last year. Her laboratory data showed 30 grams protein in 24 hrs urine, and her serum creatinine was 1.7 mg/dl. The baseline serum creatinine was not known.