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?  

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 Laboratory value     Results      Reference range    
 Serum    
 Albumin      2 g/dL     3.5-5.2 g/dL    
 Triglycerides      200 mg/dL     27-125 mg/dL    
 Cholesterol     250 mg/dL     45-182 mg/dL    
 Blood urea nitrogen     17 mg/dL     5-17 mg/dL    
 Creatinine      0.5 mg/dL     0.1-0.4 mg/dL    
 Complement C3     140 mg/dL     83-174 mg/dL    
 Complement C4     20 mg/dL      16-45 mg/dL    
 Urine     
 Specific gravity     1.018       1.003-1.035    
 pH     6       4.8-7.8    
 Protein     4+      Negative    
 Glucose     Negative       Negative    
 WBCs     1-5 /hpf       Negative    
 RBCs     2-5 /hpf       Negative    
 Urine protein/creatinine ratio     0.5 mg/mg     <0.2 mg/mg    
 Casts     Negative     Negative    

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