title: A 17-Year-Old With Steroid-Resistant Nephrotic Syndrome.
abstract: A 17-year-old girl presented with facial swelling and shortness of breath to an outside emergency department. She was treated for an allergic reaction with steroids and antihistamines, and discharged from the hospital. Subsequently, she was referred as an outpatient to pediatric nephrology for recurrent edema and proteinuria. Initial laboratory workup by nephrology was significant for a normal complete blood count and reassuring electrolyte panel. Pertinent laboratories were a creatinine of 0.5 mg/dL (0.4-1.1 mg/dL) and an albumin 2.3 g/dL (3.5-5.0 g/dL). The urine protein-to-creatinine ratio was >7 (<0.2). A renal ultrasound showed symmetrically sized kidneys with normal echotexture. The patient's renal biopsy results were consistent with minimal change disease. Based on the biopsy results, prednisone was started. Due to a poor response to prednisone, an alternate immunomodulator therapy was selected. Her subsequent complete blood counts showed a downward trend of all cell lines and an elevated serum uric acid. Concurrently, she reported worsening fatigue, low back pain, nausea, vomiting, night sweats, and pruritus. More details of her case and the outcome are presented.
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut; and mband@connecticutchildrens.org.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Band
authors.affiliation: Division of Nephrology, Department of Pediatrics, Stanford School of Medicine, Stanford University, Palo Alto, CA.
authors.forename: Candice
authors.initials: C
authors.lastname: Sheldon
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut; and.
authors.forename: John
authors.initials: J
authors.lastname: Brancato
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut; and.
authors.forename: Nehal S
authors.initials: NS
authors.lastname: Parikh
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut; and.
authors.forename: Cynthia
authors.initials: C
authors.lastname: D'Alessandri-Silva
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D004351:Drug Resistance; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology; D004487:Edema / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006689:Hodgkin Disease / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D009404:Nephrotic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D006633:Histamine Antagonists; D011241:Prednisone