Patient Information
Age: 6 years
Sex Assigned at Birth: F
Race/Ethnicity: unspecified
Site of Care: emergency department
History
Reason for Visit/Chief Concern: “My daughter’s eyes and legs are swollen.”
History of Present Illness:
- 2-week history of cough, congestion, and runny nose that seems to be improving
- parents report the patient’s eyes seemed swollen 4 days ago, which they initially attributed to the patient’s cold
- 2-day history of swelling over the tops of her feet
- this morning, she was unable to put on her shoes because her feet were too swollen
Past Medical History: unremarkable
Medications: none
Vaccinations: up to date
Allergies:
- no known drug allergies
Family History: Mother age 30 years, father age 32 years, and twin sisters age 10 years: alive with no chronic conditions
Physical Examination
Temp Pulse Resp BP O2 Sat Ht Wt BMI
37.0°C 140/min 20/min 120/70 mm Hg 99% 115 cm (3 ft 9
in)
25 kg (55 lb) 19 kg/m2
(98.6°F) on RA 50th %ile 90th %ile 95th %ile
- Appearance: mildly uncomfortable
- Skin: 2+ pitting edema of both extremities up to the knees
- HEENT: periorbital edema, no erythema; PERRLA; ocular movements are intact
- Pulmonary: clear to auscultation
- Cardiac: regular rhythm; no murmurs
- Abdominal: normoactive bowel sounds; soft, mildly distended, mildly tender to palpation in all quadrants
Diagnostic Studies
Urine
Specific gravity 1.020 (N=1.003–1.029)
Protein Large
Ketones Negative
Blood Negative
Leukocyte esterase Negative
WBCs Negative
RBCs 5–10/hpf
Question: Which of the following additional laboratory findings are most likely to be decreased in this patient?
(A) Hemoglobin
(B) Serum albumin concentration
(C) Serum C3 and C4 concentrations
(D) Serum triglycerides concentration
(E) Serum urea nitrogen concentration
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Answer
Nephrotic syndrome is a kidney disorder characterized by increased permeability of the glomerular filtration barrier, leading to the loss of proteins, particularly albumin, in the urine. The main components of nephrotic syndrome are proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
In this patient, the presence of 2+ pitting edema of both extremities up to the knees along with large proteinuria (proteinuria is indicated by the presence of large protein in the urine) suggests nephrotic syndrome.
Serum albumin is the most abundant protein in the blood and plays a crucial role in maintaining colloidal osmotic pressure in the vascular system. When there is significant loss of albumin in the urine, as seen in nephrotic syndrome, serum albumin concentration decreases, leading to hypoalbuminemia. Hypoalbuminemia results in a decrease in the oncotic pressure in the blood vessels, leading to fluid shifting from the intravascular space into the interstitial space, causing edema.
Therefore, in this patient with nephrotic syndrome, serum albumin concentration is most likely to be decreased.
The correct answer is (B) Serum albumin concentration
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