A 7-year-old boy is brought to the clinic with puffiness around the eyes, especially in the morning, and swelling in the ankles. His mother reports recent weight gain and frothy urine. On physical examination, he has periorbital and pedal edema. Urinalysis reveals heavy proteinuria, and serum albumin is markedly reduced. What is the most likely diagnosis, and what is the pathophysiological basis of the edema seen in this condition?
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This sounds like Nephrotic Syndrome. His kidneys are sadly losing too much protein, causing fluid to leak out of his blood vessels and gather, which explains all that puffiness and swelling.
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Nephrotic syndrome is the most likely diagnosis (minimum change disease in this age group).
Pathophysiology: Hypoalbuminemia from heavy proteinuria lowers plasma oncotic pressure, which causes fluid to move into interstitial spaces and cause edema.
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It could be nephrotic syndrome
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The most likely diagnosis is nephrotic syndrome. Edema results from hypoalbuminemia, reducing plasma oncotic pressure, leading to fluid leakage into interstitial spaces, compounded by sodium and water retention by the kidneys.
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Nephrotic syndrome
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Diagnosis: Nephrotic Syndrome (likely Minimal Change Disease)
Edema Mechanism: ↓ Plasma oncotic pressure from hypoalbuminemia → fluid leakage into tissues + RAAS activation.
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