Nephrology

A 15-year-old male presents with fever, cough and

weight loss. He is of Indian origin and has recently
returned to the United Kingdom after four months in
India with his parents where he developed these
symptoms.
He is diagnosed with pulmonary tuberculosis and is
commenced on rifampicin, isoniazid, and
pyrazinamide.
Four weeks later he presents with fever, myalgia, and
lethargy.
Investigations:
Haemoglobin

145 g/L

(120-160)

WBC

7.5 109/L

(4-11)

Neutrophils

5.5 109/L

(1.5-7)

Lymphocytes

0.8 109/L

(1.5-4)

Monocytes

0.05 109/L

(0-0.8)

Eosinophils

1.14 109/L

(0.04-0.4)

Basophils

0.01 109/L

(0-0.1)

Platelets

350 109/L

(150-400)

Serum sodium

141 mmol/L

(137-144)

Serum potassium

5.1 mmol/L

(3.5-4.9)

Serum urea

27.9 mmol/L

(2.5-7.5)

Serum creatinine

400 mol/L

(60-110)

Serum bilirubin

7 mol/L

(1-22)

Serum aspartate transaminase

31 U/L

(5-35)

Serum alkaline phosphatase

97 U/L

(45-105)

Serum albumin

39 g/L

(37-49)

Urinalysis

Protein +
Leucocytes +

no bacteria
Urine culture

Negative

Which of the following is the most likely cause of his

renal impairment?
(Please select 1 option)
Acute interstitial nephritis

Correct

Isoniazid toxicity
Plasmodium vivax malaria
Renal tuberculosis
Rhabdomyolysis

Interstitial nephritis may be caused by infection,

autoimmunity or glomerular disease as well as
hypersensitivity to medicines.
A large number of medicines are reported to cause
acute interstitial nephritis.
The agents most commonly implicated are:

Lactams
Vancomycin
Rifampicin
Co-trimoxazole
Sulphonamides
Ciprofloxacin
NSAIDs
Ranitidine
Cimetidine
Furosemide
Thiazides, and
Phenytoin.

An acute allergic reaction, with infiltration of immune

cells, occurs in response to the causative drug,
causing direct cytotoxicity.
Typical clinical features include:

Renal failure with fever

Arthralgia
Eosinophilia and
Eosinophiluria.

2Kidney ultrasound

This 9-month-old boy presented with fever for four

days. He has gone off his food, and his fluid intake

has been poor today. Mother felt that his urine was
very concentrated and smelly.
He was a full term normal vaginal delivery weighing
2.98 kg and there were no neonatal problems. He
has not been admitted previously and is on no
regular medications. His immunisations are up to
date. Mother suffered from post-natal depression.
There is no other family history of note.
On examination his temperature 39.5C. Dry mucous
membranes. No jaundice, anaemia, cyanosis,
clubbing, oedema or lymphadenopathy. Heart rate
130/min, respiratory rate 25/min. Chest and ENT
clear. Abdomen soft, with slight tenderness in the left
renal angle. Alert and cooperative, with no neck
stiffness.
Investigations revealed:
Haemoglobin

White cell count

112 g/L

(130-180)

15.7 109/L

(4-11)

78% neutrophils
14% lymphocytes

Platelets

322 109/L

(150-400)

Serum urea

7.2 mmol/L

(2.5-7.5)

Sodium

135 mmol/L

(137-144)

Potassium

4.1 mmol/L

(3.5-4.9)

Creatinine

56 mol/L

(60-110)

3+ protein
Urine dipstix

3+ blood
+ nitrites

The picture is from his ultrasound scan of kidneys.

His fever responds rapidly to IV cefotaxime, settling

within 24 hours and with improvement in his feeding.
What is the most likely diagnosis?
(Please select 1 option)
Nephrocalcinosis

Incorrect answer selected

Nephronophthiasis
Perinephric abscess
Pyelonephritis

This is the correct answer

Renal calculus

What is the single most important abnormality shown in the image?

(Please select 1 option)
Enlarged kidney

Incorrect answer selected

Hyperechoeic areas

This is the correct answer

Hypoechoeic areas
Nephrocalcinosis
Shrunken kidney

What single item of management is most important?

(Please select 1 option)

IV cefotaxime

Correct

Meticulous monitoring of fluid balance

PO trimethoprim
Surgery

What single investigation should be done?

(Please select 1 option)
DMSA scan in 2 weeks
DMSA scan in 4 months

Incorrect answer selected

This is the correct answer

MAG3 scan in 2 weeks

MAG3 scan in 4 months
MCUG in 2 weeks
Repeat ultrasound scan of kidneys, ureters and bladder in 3 months

The image shows an enlarged kidney with several

hyperechoic areas within the cortex. The renal pelvis is
minimally dilated, but the wall appears thickened. The
appearances are consistent with acute pyelonephritis.
This should be treated with IV antibiotics. Gentamicin
or cefotaxime would be appropriate.
At 6 months of age should be investigated for possible
scarring using a dimercaptosuccinic acid (DMSA) scan
in a few months time. If this is done too early, non-scar
photopaenic areas may be present.
A micturating cystourethrogram (MCUG) would be
indicated if he had presented below the age of 6
months and the fever had not settled within 48 hours
(atypical UTI).
A MAG3 scan is not as sensitive as a DMSA scan in
the detection of scars. It may be combined with an

indirect CUG, but this is only possible when the child

can pass urine on demand (usually about 3 years).
Further Reading:

NICE. Urinary tract infection in children (CG54).

Image: 2007 Staffordshire General Hospital

3Kidney
A

Duplex kidney

Multicystic dysplastic kidney

Pelvi-ureteric junction obstruction

Polycystic kidney

Renal agenesis

Simple renal cyst

Vesico-ureteric reflux

From the given list what is the most likely diagnosis?

A 3-month-old baby boy sees you with the results of a MAG-3 scan following antenatal
scans showing multiple cysts in his left kidney. The MAG-3 shows no functioning renal
tissue on that side.
Duplex kidney

Incorrect - The correct answer is Multicystic dysplastic kidney

This is the typical appearance of a multicystic

dysplastic kidney. Some would advocate surgical
excision to eliminate the risk of malignancy or
hypertension. Polycystic kidneys are a different entity
and can be autosomal dominant, presenting with renal
cysts and hypertension in young adulthood or
recessive, presenting with multiple small cyst and renal
failure in infancy.
A 14-year-old girl has an ultrasound during an episode of abdominal pain. The report
states there is a 3cm diameter cyst in the right kidney.
Duplex kidney

Incorrect - The correct answer is Simple renal cyst

This is a simple benign cyst and requires no follow up.

A 15-year-old boy presents with loin pain and haematuria. He admits drinking beer at a
party the night before.
Duplex kidney

Incorrect - The correct answer is Pelvi-ureteric junction obstruction

This is the typical picture of Dietl's crisis when a fluid

load overwhelms the kidney's ability to drain because
of an obstruction at the PUJ, causing loin pain.

4-

A 16-month-old girl who is being followed up for antenatally diagnosed unilateral hydronephrosis has a
recent ultrasound scan showing an extra-renal pelvic
diameter of 24 mm (previously 19 mm), the intrarenal diameter is 14 mm (previously 13 mm).
A MAG-3 scan at 6 months of age showed delayed
drainage on the affected side with a differential
function of 42:58.
What is the most appropriate management option?
(Please select 1 option)
Check U&E

Incorrect answer selected

Operative pyeloplasty on the basis of current information

Repeat MAG-3

This is the correct answer

Repeat ultrasound in 3 months

Watchful waiting

This girl has pelvi-ureteric junction obstruction with

stable USS findings (only intra-renal pelvis
measurements are relevant as there is too much
variability in extra-renal measurement).
However, her MAG-3 showed delayed drainage and a
degree of functional impairment. This should now be
repeated; if the differential function on the affected side
is less than 40% then that is an indication for
pyeloplasty.
The differential function on MAG-3 needs to be lower
than 40% on the affected side for most urologists to
consider operative intervention, there is no definite
indication for surgery on the information given.

Even in severe unilateral cases the urea and

electrolytes (U&Es) are normal as the contralateral
kidney has sufficient reserve.

5Types of Nephrotic syndrome

A

Denys-Drash syndrome

Finnish-type congenital nephrotic syndrome

Henoch-Schonlein purpura

Nail-patella syndrome

Oculocerebrorenal syndrome

Steroid sensitive nephrotic syndrome

Steroid resistant nephrotic syndrome

Secondary congenital nephrotic syndrome

Which of the given options is the most likely answer

in the following scenarios?
A 12-month-old boy who develops proteinuria, generalised oedema and
hypoalbuminaemia. Whilst this is being investigated, a Wilms' tumour is discovered. He
also has a hypospadias.
Denys-Drash syndrome

Correct
A 6-month-old girl who was found to have nephrotic syndrome at 3 weeks of age and has
now developed end stage renal disease requiring transplantation. Both parents are
aware that they are carriers for the disease.
Denys-Drash syndrome

Incorrect - The correct answer is Finnish-type congenital nephrotic syndrome

A 2-year-old boy with normal renal function and mild haematuria associated with his
nephrotic syndrome. No other signs on physical examination. On biopsy was found to
have minimal change disease.
Denys-Drash syndrome

Incorrect - The correct answer is Steroid sensitive nephrotic syndrome

A 9-year-old girl with hypertension, persistent microscopic haematuria and focal
segmental glomerulosclerosis on biopsy. Has had several relapses of her nephrotic
syndrome.
Denys-Drash syndrome

Incorrect - The correct answer is Steroid resistant nephrotic syndrome

Nephrotic syndrome is characterised by a triad of

oedema, proteinuria and hypoalbuminaemia. It is
almost always idiopathic in childhood.
Idiopathic nephrotic syndrome is divided into steroidsensitive nephrotic syndrome (SSNS) and steroidresistant nephrotic syndrome (SRNS) because
response to steroids has a high correlation with
histological subtype and prognosis.
If it were to be biopsied, SSNS usually shows minimal
change disease, whereas SRNS is normally focal
segmental glomerulosclerosis.

Age at onset
Sustained
hypertension
Microscopic
haematuria
Renal function
Long term
prognosis
Usual histology

Steroid sensitive nephrotic syndrome

Steroid resistant nephrotic syndrome

(SSNS)

(SRNS)

Toddler, pre-school

<1 year or >8 year

No

Often

Mild, intermittent

Persistent

Normal

Often reduced

Excellent, even if frequently relapsing

Usually not biopsied, from historical
data known to be minimal change

Poor - significant risk of long term

hypertension and renal failure
Focal segmental glomerulosclerosis

Denys-Drash syndrome (DDS) is a rare disorder

consisting of the triad of congenital nephropathy,
Wilms' tumour, and intersex disorders resulting from
mutations in the Wilms' tumour suppressor (WT1)
gene.
Nephropathy is a constant feature; in the incomplete
forms of the syndrome, the nephropathy is present with
either Wilms' tumour or intersex disorders, but the vast
majority of patients with Denys-Drash syndrome are
destined to develop Wilms' tumour in any residual
renal tissue.
Congenital nephrotic syndrome of Finnish type
presents in utero or within the first 3 months of life. It is
characterised by nephrotic syndrome which
progresses rapidly to end-stage kidney disease.
Although more commonly seen in individuals of Finnish
descent, congenital nephrotic syndrome of Finnish
type has been reported worldwide. Congenital
nephrotic syndrome of Finnish type is inherited in an
autosomal recessive fashion and is caused by
mutations in the NPHS1 gene. At this time, kidney
transplantation seems to be the only treatment
available for this condition
Reference:
1.
Beattie RM, Champion MC (eds.) Essential Revision Notes in Paediatrics for the
MRCPCH. (3rd ed). Cheshire; Pastest: 2012.
2.
Medscape. Denys-Drash Syndrome.
3.
Medscape. Pediatric Nephrotic Syndrome.

6-

A 4-year-old boy is referred to the nephrologist with

faltering growth and polyuria and polydipsia.
He is found to be normotensive, and have a
hypochloraemic hypokalaemic alkalosis. Very high
levels of urinary chloride and sodium are seen with
normal urinary calcium.
What is the most likely diagnosis?
(Please select 1 option)
Bartter syndrome

Correct

Gitelman syndrome
Liddle syndrome
Nephrogenic diabetes insipidus
Pseudo-Bartter syndrome

Bartter syndrome is characterised by a hypokalaemic,

hypochloraemic alkalosis and hyperreninaemia with
normal blood pressure.
The underlying renal abnormality results in excessive
urinary losses of sodium, chloride, and potassium.
Urinary calcium is normal or high, unlike Gitelman's
syndrome. Symptoms are

Polyuria
Polydipsia
Episodes of dehydration
Faltering growth and
Constipation.

It is caused by an autosomal recessive defect in the

sodium-potassium-chloride co-transporter in the thick
ascending limb of loop of Henle, leading to sodium
chloride and water wasting. The resultant ECF volume
contraction causes secondary renin secretion and
sodium and water reabsorption in distal tubule and

reciprocal potassium and hydrogen secretion into

urine. Blood pressure is normal, as the
hyperreninaemia is a compensatory response to
maintain normal blood pressure in the presence of
chronic volume depletion. Loop diuretics produce
some biochemical changes.
Gitelman syndrome is considered to be a variant of
Bartter syndrome and is also an autosomal recessive
defect but this time in the distal tubule sodium chloride
co-transporter. It is often asymptomatic with transient
episodes of weakness and tetany with abdominal pain
and vomiting. A hypokalaemic metabolic alkalosis,
raised renin and aldosterone are present like Bartter's
but there is also hypocalciuria and hypomagnesaemia
which helps distinguish it from Bartter's. Thiazide
diuretics produce some biochemical changes.
Liddle syndrome (also called pseudoaldosteronism) is
a syndrome of low-renin hypertension. It is an
autosomal dominant disorder characterised by early,
and frequently severe, hypertension associated with
low plasma renin activity, metabolic alkalosis due to
hypokalaemia and hypoaldosteronism (low secretion of
aldosterone).
Liddle syndrome involves abnormal kidney function,
with excess reabsorption of sodium and loss of
potassium from the renal tubule and is treated with a
combination of low sodium diet and potassium-sparing
diuretic drugs (for example, amiloride).
Nephrogenic diabetes insipidus (DI) is caused by an
improper response of the kidney to ADH, leading to a
decrease in the ability of the kidney to concentrate the
urine by removing free water. Nephrogenic DI can be

acquired or inherited. Urinary osmolality is low as are

urinary electrolytes.
Pseudo-Bartter syndrome is associated with extrarenal losses of sodium and chloride. It has the same
plasma biochemistry as Bartter syndrome but
appropriately low levels of urine sodium and chloride.
Main causes are cystic fibrosis, cyclical vomiting and
laxative abuse.
Since the urinary calcium is normal, Gitelman
syndrome is incorrect in this case. If it were Gitelman's,
urinary calcium would be low.
Liddle syndrome is a low-renin hypertension. The boy
in the question was normotensive, as the
hyperreninaemia is a compensatory response to
maintain normal blood pressure in the presence of
chronic volume depletion.
Nephrogenic diabetes insipidus is incorrect in this
case. If it were nephrogenic diabetes insipidus all
urinary electrolytes would be low. Bartter syndrome
and loop diuretics work in the same site in the thick
ascending loop of Henle.
Pseudo-Bartter syndrome is incorrect. If it were
pseudo-Bartter's syndrome, the urinary sodium and
chloride would be appropriately low, but in this patient
they are very high, reflecting the defect in the thick
ascending loop of Henle.

7-

A 9-year-old boy presents with new onset enuresis

and polydipsia. His GP is concerned that he may
have diabetes insipidus but is unsure what type so he
performed a water deprivation test.
After water deprivation a urine osmolality of >750
mOsm was recorded.
What does this show?
(Please select 1 option)
Central diabetes insipidus

Incorrect answer selected

Desmospressin must be administered to distinguish primarypolydipsia from central diabetes insipidus

Desmospressin must be administered to distinguish primarypolydipsia from nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus
Primary polydipsia

This is the correct answer

Nephrogenic diabetes insipidus (DI) is caused by an

improper response of the kidney to ADH, leading to a
decrease in the ability of the kidney to concentrate the
urine by removing free water. Nephrogenic DI can be
acquired or inherited. Urinary osmolality is low as are
urinary electrolytes.
The definitive diagnostic study for diabetes insipidus is
the water deprivation test, which can be used both to
confirm the diagnosis and to distinguish between
central DI and nephrogenic DI on the basis of
response to a vasopressin analogue.
The water deprivation test is performed as follows:

Obtain baseline urine and blood for osmolality and electrolytes.

Deprive the patient of water after breakfast until significant dehydration occurs.

Weigh patient every two hours and limit dehydration to 2-5% loss of body weight.
Monitor urine specific gravity hourly; if the specific gravity is 1.014 or greater,
terminate the test and obtain urine and blood specimens for osmolality.

If polyuria persists, administer intranasal desmopressin and replace urine output

with fluids. After four hours (two hours in infants), obtain urine and blood for
osmolality.
If urine osmolality is >750 mOsm after fluid deprivation, primary polydipsia can be

diagnosed.
If urine osmolality is <300 mOsm before and after desmopressin, this shows a

defect in the kidney's response to ADH production, that is, nephrogenic diabetes
insipidus.
If urine osmolality is <300 mOsm after fluid deprivation but >750 mOsm after
desmopressin this shows a defect in ADH production, that is, central diabetes
insipidus.

If urine osmolality exceeds 750 mOsm this excludes

diabetes insipidus and you do not need to give
desmopressin (DDAVP). Therefore, administering
desmospressin to distinguish primarypolydipsia from
central diabetes insipidus or nephrogenic diabetes
insipidus is incorrect.
A very high urine osmolality after water deprivation
shows an appropriate response of the kidney to ADH,
that is, no diabetes insipidus. Therefore, central
diabetes insipidus or nephrogenic diabetes insipidus
are not shown in this case.
7-

A 9-month-old male infant presents to the children's

assessment unit with a history of fever and vomiting
for the last 24 hours.
His fever has been up to 40C. Urine microscopy
shows >100 WCC and 50 RBC with >100,000
organisms. The urine culture grows Escherichia coli.
Due to the significant nature of the UTI the infant has
a renal USS performed six weeks after the urinary
tract infection. This shows a left sided grade 4
hydronephrosis but no ureteral dilation.

What is the most likely diagnosis?

(Please select 1 option)
Congenital obstructive megaureter

Incorrect answer selected

Pelvo-ureteric junction obstruction

This is the correct answer

Posterior urethral valves

Unilateral muticystic dysplastic kidney
Wilms' tumour

Pelvo-ureteric junction (PUJ) obstruction is the most

common obstructive lesion in children and is usually a
result of a congenital intrinsic stenosis at the junction
between the renal pelvis and the ureter. As such it will
give the appearance on ultrasound of a dilated renal
pelvis but not a dilated ureter as the obstruction is
superior to the ureter.
PUJ obstruction may be diagnosed antenatally on
ultrasound scan, but if not often presents with a
palpable renal mass at newborn examination or a
febrile UTI later in childhood. PUJ obstruction is twice
as common in males as in females. Children with
known PUJ obstruction should receive antibiotic
prophylaxis with co-trimoxazole (trimethoprim and
sulfamethoxazole).
If the PUJ obstruction is bilateral and there is severe
hydronephrosis with renal compromise then urgent
surgical correction is required. In milder or unilateral
cases the situation can be managed by observation
and follow up ultrasound scans, however should
diminished function become apparent in the affected
kidney then surgical intervention is also required.
In this case a unilateral multicystic dysplastic kidney
and Wilms' tumour should have been identified on the

USS with a cystic mass or complex renal mass as

opposed to just straight hydronephrosis. Congenital
obstructive megaureter would have shown a dilated
ureter on USS and posterior urethral valves would also
cause dilated ureters if obstructing flow significantly
enough to cause hydronephrosis.

9-

A 12-year-old boy presents to the surgery with periorbital and mild ankle oedema which has increased
over the past few weeks.
Other history of note is a recent upper respiratory
tract infection. He has been feeling increasingly tired
and lethargic over the past few weeks.
On examination his BP is 118/72 mmHg. He has
periorbital oedema and pitting ankle oedema.
Investigations show:
Haemoglobin

124 g/L

(135-180)

White cell count

7.8 109/L

(4-10)

Platelets

191 109/L

(150-400)

Sodium

141 mmol/L

(134-143)

Potassium

4.6 mmol/L

(3.5-5)

Creatinine

104 mol/L

(60-120)

Serum albumin

28 g/L

(35-50)

Urine

Protein ++

Which of the following is the most likely cause?

(Please select 1 option)
IgA nephropathy

Incorrect answer selected

Alport's syndrome
Membranous nephropathy
Minimal change nephropathy

This is the correct answer

Post streptococcal glomerulonephritis

The history of periorbital oedema, normal blood

pressure and creatinine, but proteinuria and low
albumin is typical of minimal change disease.
The condition is much more common in this age range
than membranous nephropathy, which also causes
proteinuria.
The important point about making the diagnosis is that
the condition responds to corticosteroid therapy in 90%
or more of sufferers in childhood within two weeks,
although treatment is usually continued for a period of
eight weeks.
The lack of haematuria counts against post
stretococcal glomerulonephritis, and IgA nephropathy.

Alport's syndrome is a familial nephritis associated with

haematuria and progressive sensorineural hearing
loss.;

10Causes of Haematuria
A

Alport's syndrome

Anaphylactoid purpura

Goodpasture's syndrome

Haemolytic uraemic syndrome

Idiopathic haematuria

IgA nephropathy

Membranous glomerulopathy

Polycystic kidneys

Renal vein thrombosis

Systemic lupus erythematosus

From the given list of options, choose the single most

likely diagnosis which best fits the description below.

A 13-year-old boy presents with macroscopic haematuria. He is otherwise well, apart

from holding a statement of special educational needs for his severe hearing impairment
and short sightedness.
Alport's syndrome

Correct

Alport's syndrome is an x-linked condition although

inheritance can also be autosomal dominant with
variable expression and autosomal recessive.
It affects boys more than girls and tends to present in
the second decade with renal involvement.
Sensorineural deafness and ocular manifestations are
common features.
Dialysis and transplantation are common in the second
and third decades. Genetic counselling is
recommended.
A 5-year-old boy is admitted to hospital with moderate dehydration secondary to
diarrhoea and vomiting. Urinalysis is carried out to exclude infection. The report states
that there is no growth but there is a microscopic haematuria.
Alport's syndrome

Incorrect - The correct answer is Haemolytic uraemic syndrome

Haemolytic uraemic syndrome is the commonest

cause of acute renal failure in children. Its aetiology is
unknown although Escherichia coli 0157, Salmonella, Shigella and
viruses have been implicated.
It often follows a prodromal diarrhoeal illness, resulting
in lethargy, pallor and oliguria. Laboratory
investigations reveal a microangiopathic haemolytic
anaemia, haematuria, and acute renal failure.
Treatment is supportive and dialysis may be required.
A baby is born prematurely at 36 weeks gestation following an antepartum haemorrhage.
She has a seizure on day 2, develops haematuria and her urine output tails off.
Alport's syndrome

Incorrect - The correct answer is Renal vein thrombosis

This describes a baby with a history of asphyxia

presenting with renal vein thrombosis.
In neonates, other causes include sepsis,shock and
dehydration.
In the older child it may complicate nephrotic syndrome
and congestive cardiac failure. Patients may present
with pain, haematuria and have signs of an enlarged
kidney.
Treatment is supportive although if there is bilateral
involvement thrombolytic agents or thrombectomy may
be required.

11Proteinuria
A

Finnish-type nephrotic syndrome

Glomerulonephritis

Henoch-Schonlein purpura

Idiopathic nephrotic syndrome

Interstitial nephritis

Isolated asymptomatic proteinuria

Reflux nephropathy

Shunt nephritis

Systemic lupus erythematosus

For each scenario choose the most likely diagnosis:

A 2-month-old boy presents with weight gain and decreased frequency of wetting
nappies. On examination he has swollen eyelids, abdomen and scrotum. Urine dipstix
shows 4+ proteinuria.
Finnish-type nephrotic syndrome

Correct

The 2-month-old boy has severe proteinuria with

symptoms of fluid retention. This is most likely
nephrotic syndrome, and at this age Finnish-type is
commonest.
A 27/40 infant weighing 0.84 kg has a stormy neonatal course, complicated by posthaemorrhagic hydrocephalus requiring VA shunt. At 8 months of age she presents with
blood pressure of 120/90 mmHg, and urine contains 3+ proteinuria and 2+ haematuria.
Finnish-type nephrotic syndrome

Incorrect - The correct answer is Shunt nephritis

In the ex-prem with VA shunt there is symptomatic

proteinuria and hypertension, most likely shunt
nephritis.
A 12-year-old girl presents with 2+ proteinuria discovered incidentally when she
registered with her new family doctor. Examination (including blood pressure) are normal.
Repeat testing two weeks later confirms the finding.
Finnish-type nephrotic syndrome

Incorrect - The correct answer is Isolated asymptomatic proteinuria

The 12-year-old girl has persistent asymptomatic

proteinuria. This is most likely to represent isolated
asymptomatic proteinuria or orthostatic proteinuria.
Recumbent and standing dipstix testing will exclude
the latter.
In evaluating the child with proteinuria first establish
whether the child is symptomatic.
If not then repeat the test to see whether the
proteinuria is persistent.