Question

Case Study #4 year-old boy has a history of several infections in the past few months. He is now very ethargic and swollen, with generalized edema. He tells his mother that his urine is very foamy when he urinates and that he feels "awful." He is seen by his pediatrician, and urinalysis is performed with the following results: Physical Appearance Color: Pale Transparency: Cloudy Chemical Screening pH: 6.0 Specific gravity: 1.010 Protein (reagent strip): >2000 mg/dL Blood: Trace Nitrite: Negative Leukocyte esterase: Negative Glucose: Negative Ketones: Negative Bilirubin: Negative Urobilinogen: Negative Microscopic Examination Red blood cells: 0-2/hpf White blood cells: 0-2/hpf Casts: 5-10 fatty casts/]pf; 2-5 hyaline casts/lpf Epithelial cells: Few renal epithelial cells; many oval fat bodies present Other: Moderate free fat globules seer

Answer 1

Case 4:

1. The likely diagnosis could be: Nephrotic syndrome

Lab values supporting it:

Urine protein : 4+ >2000 mg/dl ( normal : approximately 0 to 8 mg/dL in random urine sample)

Casts: 10-15 fatty casts/lpf, 2-5 hyalin casts/ lpf (fatty casts more than 2-5 indicates nephrotic syndrome, fatty casts are indicative of high urinary protein nephrotic syndrome. )

Epithelial cells: few renal epithelial cells and many oval fat bodies present

(not an infectious condition as the WBC, RBC are within normal range, no leukoterase esterase)

2. The child has generalized edema

History of frequent infections predispose to nephrotic syndrome

Cloudy and foamy urine

Lethargic