A 5-year-old boy is brought to the office by his mother, who notes that her son's eyes and feet have looked puffy over the last several weeks. The boy has no pain but mentions that his shoes seem to fit tightly and bother him, especially when he runs outside during recess at school. The mother also remarks that the boy's urine has been excessively foamy recently. Physical examination is remarkable for periorbital edema and lower extremity edema. Urinalysis shows 4+ proteinuria but is otherwise unremarkable. Which of the following mechanisms is the most likely cause of this patient's abnormal laboratory findings?

Question

A 5-year-old boy is brought to the office by his mother, who notes that her son's eyes and feet have looked puffy over the last several weeks.  The boy has no pain but mentions that his shoes seem to fit tightly and bother him, especially when he runs outside during recess at school.  The mother also remarks that the boy's urine has been excessively foamy recently.    Physical examination is remarkable for periorbital edema and lower extremity edema.  Urinalysis shows 4+ proteinuria but is otherwise unremarkable. Which of the following mechanisms is the most likely cause of this patient's abnormal laboratory findings?

Quizplus · Accepted Answer

Eductional Objective: Minimal change disease is the most common cause of nephrotic syndrome in children.  Systemic T-cell dysfunction leads to the production of glomerular permeability factor, which causes podocyte foot process fusion and decreases the anionic properties of the glomerular basement membrane.  The loss of negative charge leads to selective albuminuria.

A 5-Year-Old Boy Is Brought to the Office by His