howMed Know Yourself
Case Scenario: A child with edema and decreased urine output
History:
A 10 years old child presented to the hospital complaining of swelling of his ankles, abdomen and eyelids for the past 4 days. He also thought that he had gained weight recently. In the morning his legs were less swollen, but his eyes appeared ‘puffy’. He thought that he might be urinating less frequently.
Examination:
On examination blood pressure was 110/68 mm Hg. There was mild edema of the eyelids. There was pitting edema on the ankles. A chest film was obtained and showed bilateral pleural effusions.
Laboratory Investigations:
Urine routine examination report revealed:
| Urinalysis | Results | Reference Range |
| pH | 6 | 4.6 – 8.0 |
| Specific Gravity | 1.050 | 1.001 – 1.036 |
| Protein | +++ | Negative |
| Glucose | Negative | Negative |
| Serum Urea | 6.9 | 3.9 – 6.7 mmol/L |
| Serum Creatinine | 88 | 53 – 106 mmol/L |
Tasks:
- Explain the sign and symptoms in this patient.
- Describe the biochemical basis of disease.
- What other laboratory tests should be done?
- What is the diagnosis?
This child has generalized anasarka, eye, ankle edema, bilateral pleural effusion, proteinuria, mostly due to nephrotic syndrome. We have to ask for 24 hours urinary protein, plasma protein & serum albumin, cholesterol level, then ultrasound guided renal biopsy.