Approach to proteinuria (pediatrics) Quiz: Ace Your Exams

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A 4-year-old boy is brought to the emergency department due to swelling around his eyes and in the legs bilaterally. The parents report that he had a viral upper respiratory tract infection one week ago that resolved spontaneously. Past medical and surgical history are non-contributory. Temperature is 37� C (98.6�F), pulse is 80/min, respirations are 20/min, and blood pressure is 110/60 mm Hg. Physical exam is significant for bilateral lower extremity pitting edema up to the knees and edema of the face as shown in the image below. Cardiopulmonary and abdominal exams are normal. Lab results are shown below. Which of the following is the most likely diagnosis?  

A close-up view of a child's face, sleeping with eyes closed. A hand gently supports the child's head, which has dark hair. The child's skin is dark.
Under the Creative Commons Attribution-Share Alike 3.0 Unported license. Reproduced from Wikimedia commons   


Laboratory ValueResults
Serum

 Albumin      2 g/dL    
 Triglycerides      200 mg/dL    
 Cholesterol     250 mg/dL    
 Blood urea nitrogen     17 mg/dL    
 Creatinine      0.5 mg/dL    
 Complement C3     140 mg/dL    
 Complement C4     20 mg/dL     
 Urine     
 Specific gravity     1.018      
 pH     6      
 Protein     4+     
 Glucose     Negative      
 WBCs     1-5 /hpf      
 RBCs     2-5 /hpf      
 Urine protein/creatinine ratio     0.5    
 Casts     None    



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