Quiz Page November 2013: An Unusual Cause of Nephrotic Syndrome

American Journal of Kidney Diseases Quiz Page November 2013: An Unusual Cause of Nephrotic Syndrome

A 56-year-old man presented after 6 months of generalized body swelling and frothy urine. He reported no history of hypertension, diabetes, or other medical conditions. He was treated with diuretics intermittently but never received steroids or other treatments for this illness. However, he reported that when he was 10 years old, he had experienced a swelling of his right leg associated with low-grade fever, which subsequently was treated by a practitioner of traditional ayurvedic Indian medicine. On examination, the patient's blood pressure was 100/70 mm Hg and he had small pleural effusions, ascites, and anasarca. Urinalysis showed proteinuria (4+), quantitated at protein excretion of 4.6 g in a 24-hour collection, and microscopy showed bland urine sediment. Laboratory values included the following: serum urea, 33 mg/dL; serum creatinine, 1.12 mg/dL; estimated glomerular filtration rate, 73 mL/min/1.73 m2 (calculated using the CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equation); cholesterol, 438 mg/dL; albumin, 1.8 g/dL; and hemoglobin, 8 g/dL. Serology test results were negative for hepatitis B surface antigen, anti-hepatitis C virus, HIV (human immunodeficiency virus), antinuclear antibodies, and anti-streptolysin O titers, and results were normal for serum and urine electrophoresis. Results of ultrasonography of the abdomen also were normal. A kidney biopsy was performed ().


http://www.ajkd.org/article/S0272-6386(13)01105-0/abstract?rss=yes