Erschienen in:
01.02.2015 | Clinical Quiz
An 18-year-old with nephrotic syndrome and chest pain: Questions
verfasst von:
Lauren J. Becton, Beatrice Goilav, Yanhua Wang, Peter D. Cole, Frederick Kaskel
Erschienen in:
Pediatric Nephrology
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Ausgabe 2/2015
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Excerpt
A 15-year-old African American male presented with periorbital and lower extremity edema and was diagnosed with nephrotic syndrome (NS). Hepatitis B and C serologies, cytomegalovirus PCR and rapid human immunodeficiency virus tests were negative, and genetic studies revealed no abnormal variants in the NPHS2, ACTN4 or TRPC6 genes. The initial biopsy showed minimal change disease, although focal segmental glomerulosclerosis (FSGS) was suspected based on the patient’s age at presentation. Subsequent biopsy confirmed the diagnosis of FSGS. He was treated with high-dose prednisone for 6 weeks, and his NS was steroid-resistant. He subsequently received an 8-week course of oral cyclophosphamide, which was prematurely stopped due to an increased urine protein:creatinine ratio and worsening anasarca. He then received tacrolimus, which induced remission after 5 months. …