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Is the Big Imitator Back or Did He Never Leave?

2023; Volume: 37; Linguagem: Inglês

10.32932/pjnh.2023.06.240

2183-1289

Catarina Marouço, Maria Do Mar Menezes, Nuno Moreira Fonseca, Tiago Assis Pereira, João Borges de Sousa, Rita Magriço, Helena Viana, Mário Góis,

Renal Diseases and Glomerulopathies

We present a case of a 19-year-old Caucasian male patient without a relevant past medical history, medication or family history of kidney disease.He presented to the emergency department due to rapid sudden lower limb (godet sign +++) and peri-orbital edema that had started three days before.He also referred abdominal pain and diarrhea for 3 days and noticed enlarged cervical, axillary and inguinal lymph nodes for 1 month.He reported that he had no fever, recent infections and neither received new vaccines or took new drugs.No other organ involvement including arthralgias, dysuria, gross hematuria or previous gastrointestinal involvement was reported.No past allergies or malignancies were documented.Blood analysis revealed no alterations in blood counts, kidney, hepatic or electrolyte disfunction (serum creatinine of 1.01 mg/dL; urea of 36 mg/dL).Severe hypoalbuminemia of 18.8 g/L (35 -52 g/L) and hypercholesterolemia with a total cholesterol of 427 mg/dL (normal range < 190 mg/dL) and LDL 201 mg/dL (normal range < 207 mg/dL) were noticed.Urinalysis showed middle hematuria (46/UL) without leukocyturia and nephrotic range proteinuria with 7300 mg 24-hour urine sample was found.Renal ultrasound showed normal kidneys.He was diagnosed with new onset nephrotic syndrome and admitted in the nephrology ward.A kidney biopsy was performed.n