A 7-year-old boy is brought to the office due to swelling of the hands and feet. Two weeks ago, the patient was treated for anaphylaxis following a bee sting. During the past 10 days, he has had progressive hand and foot swelling, and his pants feel tighter than usual. Urinalysis shows massive proteinuria with no hematuria. Further analysis reveals that urine protein consists principally of albumin with only trace amounts of IgG and alpha-2-macroglobulin. Which of the following pathologic changes is the most likely cause of this patient's urinary protein loss?

Question

A 7-year-old boy is brought to the office due to swelling of the hands and feet.  Two weeks ago, the patient was treated for anaphylaxis following a bee sting.  During the past 10 days, he has had progressive hand and foot swelling, and his pants feel tighter than usual.  Urinalysis shows massive proteinuria with no hematuria.  Further analysis reveals that urine protein consists principally of albumin with only trace amounts of IgG and alpha-2-macroglobulin.  Which of the following pathologic changes is the most likely cause of this patient's urinary protein loss?

Quizplus · Accepted Answer

Eductional Objective: Minimal change disease is caused by immune dysregulation and overproduction of a glomerular permeability factor, which damages podocytes and decreases the anionic properties of the glomerular basement membrane.  This results in selective loss of albumin in the urine, in contrast to the nonselective proteinuria seen in other forms of nephrotic syndrome.

A 7-Year-Old Boy Is Brought to the Office Due to Swelling