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Question: Renal
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An 8yo boy presents with a 1 month history of progressive periorbital and generalized facial swelling, worse in the morning. Urine dip is positive for proteinuria. You suspect nephrotic syndrome.
Kelly July 23, 2019 - 8:17 am
A) Nephrolithiasis
Nephrotic syndrome commonly presents with insidious onset edema, especially noted in the face/periorbital and sacral regions, and often worse in the morning. Urine may be descrbied as frothy or foamy. It is more common in young children , age 6 years, and in males (2:1). Infection is a leading cause of morbidity in patients with nephrotic syndrome, and spontaneous bacterial peritonitis (often caused by strep pneumoniae) is particularly serious and is associated with very low serum albumin levels < 1.5 g/dL. Patients with nephrotic syndrome are also hypercoagulable, and at risk for venous thromboembolic events such as DVT, PE, and cavernous sinus thrombosis. Nephrotic syndrome is also associated with dyslipidemias such as elevated cholesterol and triglycerides, thought to be due to loss of albumin as a transport protein. Nephrotic syndrome is not particularly associated with nephrolithiasis.