iatroX Rounds #42
The clues
- 1
A 4-year-old boy is brought to the paediatric emergency department by his father, who noticed the child's eyes looked swollen this morning.
- 2
His father also mentions that the child's tummy has become more rounded and his urine appears significantly more bubbly than usual.
- 3
The child has a history of eczema and hay fever, and he recently recovered from a minor viral upper respiratory tract infection.
- 4
On examination, there is obvious periorbital oedema, shifting dullness in the abdomen, and significant pitting oedema of the ankles.
- 5
A urine dipstick shows 4+ protein with no blood: blood results show a serum albumin of 18 g/L and a cholesterol of 8.2 mmol/L.
- 6
Renal biopsy shows no abnormalities on light microscopy, but electron microscopy reveals extensive effacement of the podocyte foot processes.
Minimal change disease is the most common cause of nephrotic syndrome in children, typically presenting with sudden-onset severe oedema and heavy proteinuria. It often follows a viral infection or occurs in children with a history of atopy.
- Sudden-onset facial and peripheral oedema
- Heavy proteinuria in the nephrotic range with hypoalbuminaemia
- Normal appearance of glomeruli on light microscopy
- Effacement of podocyte foot processes on electron microscopy
for education and entertainment. not medical advice.