Young Diabetic with Swelling

A 7 year old patient named Tommy is seen by his physician.  His mother brought him in concerned about edema around his eyes.  Tommy has previously been diagnosed with Type I Diabetes Mellitus.  His mother also notices he has been urinating less often than usual.  The following urinalysis results were obtained:

Physical Examination

Color	Yellow
Clarity	Hazy

Chemical Examination

Glucose	250 mg/dL
Bilirubin	Negative
Ketone	15 mg/dL
Specific Gravity	1.020
Blood	Negative
pH	6.0
Protein	500 mg/dL
Urobilinogen	0.2 mg/dL
Nitrite	Negative
Leukocytes	Negative

Confirmatory Tests

SSA	3+
Clinitest	trace

Microscopic Examination

RBC/hpf	0-2
Hyaline casts/lpf	10-20
Granular casts/lpf	2-5
Renal epithelial cells/hpf	0-2

View photomicrographs

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• What would you conclude as the diagnosis given these urinalysis results?
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• What is the significance of the increased glucose and ketone results?  Why is it significant that the patient is diabetic?
  
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• What type of protein do you expect contributes most to the proteinuria?
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• What else could be seen microscopically to indicate this condition (see answer to first question)?
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• Why does the chemical examination show negative blood but the microscopic examination shows 0-2 red blood cells?
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• What causes the edema?
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• How can testing the blood aid in this diagnosis?  What would you expect to find?
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• What are some common complications associated with nephrotic syndrome?
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