Evolving presentation of leg cramps in a child with nephrotic syndrome: Questions

Excerpt

An 8-year-old African-American boy was diagnosed with nephrotic syndrome 3 months prior to presentation. He was noted to have proteinuria (4+ on urine dipstick) for four consecutive days while on prednisone wean and was restarted on prednisone 60 mg daily. The next day, he started experiencing intermittent cramps in his fingers and right lower leg. He presented to the emergency room (ER) 2 days later for evaluation of worsening right leg cramps. The cramps were described as intermittent, severe and not relieved with changes in position. Pain improved after administration of acetaminophen. Initial evaluation in the ER was unremarkable, and he was discharged home, but returned to the ER the same night after being woken up from sleep with severe and persistent right lower leg cramps with inability to bear weight without associated paresthesia or numbness. There was no history of trauma or acute illness, and review of systems was otherwise negative. …