Diagnostic Dilemma


Case Report: - An 8 year old boy presented with primary nocturnal enuresis and mild puffiness of eyelids since 1 year. There was no hypertension and examination findings were normal {Height = 125 cm}. Investigations showed:
• Urine Specific Gravity = 1.010
• Urine osmolality = 323 mosm , L
• Urine = Albumin 1 plus
• 24 hrs urine Albumin = 210 mg , day {7.5 mg , kg , day}
• BUN, S.electrolytes, Calcium, Phosphorus, alkaline phosphatase = Normal
• Serum creatinine = 0.9 mg , dl
• USG Abdomen = Normal
• Total proteins = 6.4 gm percent, Albumin = 3.4 gm percent
• Urine microalbuminuria = 50 mg percent
• Urine protein electrophoresis = Albumin trace – Other proteins absent.

He was treated with Imipramine for enuresis to which he responded.

What is the cause of proteinuria_? Is it a cause for concern_?
Expert Opinion :
This child continues to have albuminuria which is in non-nephrotic range. His serum Albumin is normal and other renal parameters are normal. However, his GFR by Schwartz formula is 78 ml per min which is in the lower range. Hence this child seems to have a renal disease. He will be monitored yearly for his growth, renal functions, GFR and albuminuria to determine if it is getting worse or is the same.
Answer Discussion :
shanthi shanthi
Since the child is otherwise normal, it could be benign persistent proteinuria. He has to be followed up periodically for renal functions. May not be of immediate concern.
14 years ago
dalia ghantous
roule out diabetes insipidus
14 years ago

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