A teenage male presents with worsening shortness of breath and lower extremity edema. Prior history of 3 gram proteinuria with similar presentation 1.5 years prior, which was never worked up, but identified as part of routine physical for a summer job.
Medical history:
None
Family history:
Unable to obtain
Physical Exam:
Hypertensive and > 140/70 mmHg.
3+ lower extremity edema.
Laboratory and other data:
Serum albumin 1.8 mg/dl
LDL 270 mg/dl, TG 340 mg/dl
ANA and ANCA negative
C3 low, at 30 mg/dl,
C4 low at 12 mg/dl
Dysmorphic RBCs in urine
Urinary albumin 7.5g/g
LE ultrasound without venous thrombosis
Chest X-ray with small left pleural effusion
Short term follow-up:
Despite initial therapy with angiotensin-converting-enzyme inhibitor and statin, proteinuria and nephrotic syndrome persists.
Furosemide was stopped few weeks after presentation, statin increased as tolerated, angiotensin-converting-enzyme inhibitor switched to angiotensin receptor blocker due to cough. Recent initiation of every-other-day prednisone.