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Case 3
Presented by: Helen Liapis
Clinical History
A 12-year old girl presented to a pediatric nephrology clinic after proteinuria was detected during a routine sports physical. Her past medical history was significant for asthma, eczema, recurrent otitis media and environmental allergies to cats and trees. Her medications included polyhistine, Ventolin inhaler, and Vanceril. The patient had no history of edema, gross hematuria, hypertension, hearing loss, joint problems or rashes. Her family history was significant for asthma and environmental allergies as well as end stage renal disease as a complication of diabetes in a maternal uncle.
Physical examination was largely unremarkable. Her vital signs included a blood pressure of 128/90 and pulse of 76. The patient had a height and weight of 168.5 cm and 70.2 kg, respectively (>95th percentile for both height and weight; BMI of 24.6 kg/m2). Her lung examination was significant for diffuse wheezes and slightly prolonged expiration. Her cardiac examination was without murmurs and she had no peripheral edema. Her abdomen was non-tender without masses. The patient did not have any lymphadenopathy.
In-clinic urinalysis revealed 4+ proteinuria and trace blood. Previous urinalysis had revealed 3+ proteinuria. Serum creatinine was 0.8 mg/dL. 24-hour urine collection revealed 1.8 grams of total protein with a creatinine clearance of 159 ml/min/1.73m2. Renal ultrasound showed increased bilateral renal echogenicity with diminished corticomedullary differentiation consistent with medical renal disease. Kidney size was not enlarged (right kidney: 48 x 115 x 51 mm, left kidney: 50 x 110 x 51 mm). The collecting system and ureters were not dilated. Renal biopsy was performed.
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LIPOPROTEIN GLOMERULOPATHY
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28.12.2007 |
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