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Question: Edema

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You are seeing a 4 year old boy who presents with a few weeks of periorbital edema and generalized fatigue. He occasionally complains of abdominal pain. There has been no fever, rash, vomiting, diarrhea, or joint pains. His work-up shows proteinuria and a low serum albumin.

What is the first-line therapy for his likely diagnosis?

pemsou5_wp • May 24, 2022

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  1. Kelly May 25, 2022 - 5:52 pm Reply

    D) Corticosteroids
    The patient is presenting with findings of nephrotic syndrome. Pediatric nephrotic syndrome is most commonly due to minimal change disease, and 80% of those with MCD present before age 6 years. Parents often notice periorbital edema first, and physical exam may reveal sacral and/or scrotal edema. Nonspecific malaise and fatigue are common. Hypertension is uncommon in MCD, but may occur with nephrotic syndrome. MCD is generally responsive to steroid therapy. Cyclosporine and rituximab are two of the immunosuppressant alternative agents used for steroid-resistant patients. Dialysis is not needed unless end-stage renal disease occurs as a complication. C1-esterase inhibitor is used to treat hereditary angioedema, a different cause of periorbital edema.

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