A 10 year old boy presented with generalized swelling. This had been present for 4 days and included swollen ankles and puffiness of the face. It started a few days after a mild cold with a runny nose. His only past medical history was of mild eczema. On examination, there were no abnormalities apart from the swelling, which included pitting edema around both ankles.
Urinalysis showed protein +++ and 24-h urine collection contained 10 g protein/24h (10.000 mg/24h). His serum creatinine was normal at 60umol/L (0,7 mg/dL), but his serum albumin was low at 20 g/L (2.0 g/dL).
- What clinical syndrome does he have?
- What is the prbable pathological diagnosis ?
- What is the usual treatment ?
Answer :
1. This boy has nephrotic syndrome with heavy proteinuria (>3,5 g/24h), hypoalbuminemia, and peripheral edema causing the swelling.
2. In children, the most common cause of the nephrotic syndrome is minimal change nephropathy. This typically follows an upper respiratory infection and is more common in children with atopy (allergic, eczema, asthma, and hay fever).
3. Minimal change nephropathy responds well to steroids. Proteinuria usually resolves completely and does not leave permanent renal damage. If the disease does relapse, ciclosporin is sometimes used to prevent further relapse.
Source : The Renal System at a Glance, 3rd edition, Chris O'Callaghan, Willey-Blackwell.
regards, taniafdi ^_^
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