An 8-year-old boy is brought to the office because of bilateral ankle swelling that occurred overnight. He has stopped wearing socks because they feel too tight. He has type 1 diabetes mellitus treated with insulin. He has received all scheduled immunizations. His temperature is 37.0°C (98.6°F), pulse is 90/min, respirations are 16/min, and blood pressure is 112/75 mm Hg. Cardiopulmonary and abdominal examinations show no abnormalities. There is moderate scrotal edema, and 2+ pitting edema of the lower extremities. Urinalysis shows 4+ proteinuria but is otherwise unremarkable. Which of the following secondary changes is most likely in this patient?

Question

An 8-year-old boy is brought to the office because of bilateral ankle swelling that occurred overnight. He has stopped wearing socks because they feel too tight. He has type 1 diabetes mellitus treated with insulin. He has received all scheduled immunizations. His temperature is 37.0°C (98.6°F), pulse is 90/min, respirations are 16/min, and blood pressure is 112/75 mm Hg. Cardiopulmonary and abdominal examinations show no abnormalities. There is moderate scrotal edema, and 2+ pitting edema of the lower extremities. Urinalysis shows 4+ proteinuria but is otherwise unremarkable.  Which of the following secondary changes is most likely in this patient?

Quizplus · Accepted Answer

Eductional Objective: Minimal change disease is the most common childhood nephrotic syndrome.  Increased glomerular capillary permeability causes massive protein (eg, albumin) loss in the urine.  Hypoalbuminemia reduces plasma oncotic pressure, which causes a fluid shift into the interstitial space, resulting in edema.  Low oncotic pressure also triggers increased lipoprotein production in the liver (ie, hyperlipidemia).

An 8-Year-Old Boy Is Brought to the Office Because of Bilateral