Atypical Relapse of Nephrotic Syndrome Without Edema in an Adolescent: A Case Report

Abstract

Introduction: Relapse of nephrotic syndrome in children is typically characterized by the recurrence of edema accompanied by proteinuria. However, some patients may present with atypical clinical manifestations without edema, which can lead to delayed diagnosis and treatment. This case report aims to describe an atypical relapse of nephrotic syndrome without edema in an adolescent and to highlight the diagnostic approach, clinical course, and management during hospitalization. Case Report: A 16-year-8-month-old male adolescent with a previous diagnosis of nephrotic syndrome presented with acute left flank pain, brownish and foamy urine, and no peripheral or periorbital edema. Clinical findings, laboratory investigations, treatment, and follow-up data were collected and analyzed. Laboratory evaluation revealed massive proteinuria, mild hypocalcemia, and vitamin D deficiency, while renal function remained within normal limits. Discussion: The patient was diagnosed with atypical relapse of nephrotic syndrome without edema and was treated with full-dose prednisone, supportive therapy, and serial clinical and laboratory monitoring. Potential precipitating factors included chronic productive cough and temporary nonadherence to prednisone therapy. Significant clinical improvement was observed during five days of hospitalization. At outpatient follow-up, urinalysis showed negative urinary protein and blood findings without the development of edema, indicating complete remission. Conclusion: Relapse of nephrotic syndrome in adolescents can occur without edema and present with atypical manifestations. Careful evaluation of proteinuria, prompt initiation of appropriate therapy, and close clinical monitoring are essential to achieve favorable clinical outcomes