A child with white urine: Questions

Excerpt

A 9-year-old boy hailing from eastern part of India was admitted for evaluation of episodic passing of milky white urine over the previous month (Fig 1), which was occasionally associated with flank pain, a low-grade fever, and progressive weight loss. There was no history of breathing difficulties, reddish urine, reduced urine output, or trauma; he was not on any long-term medication, and no relevant family history was elucidated. Although he did receive a few courses of antibiotics, there was no improvement in his symptoms. Physical examination revealed a thin and malnourished male child weighing 17.3 kg (<5th percentile), height 136 cm (50th–75th percentile), pulse 112/min, blood pressure 94/58 mmHg (<50th percentile), and bilateral pedal edema; there was no skin rash. The abdomen was soft and the liver palpable 3 cm below the right costal margin; there was no splenomegaly. Cardiac and pulmonary examinations were normal. Laboratory data were as shown in Table 1. Serologic tests for hepatitis B surface antigen, hepatitis B surface antibody, syphilis, human immunodeficiency virus, and antinuclear antibody were negative. Serum complement levels were within normal ranges, and abdominal ultrasonography, chest X-ray, and electrocardiogram were all reported normal. …