Hypoalbuminemia with hypertension

A 6-year-old male child born of second-degree consanguineous marriage presented with generalized edema gradually increasing since 6 months. Edema first started with ascitis and then involved the rest of the body. He had been treated with Furosemide intermittently. His young brother also had similar complaints but was now all right. On examination he had anasarca and blood pressure was 140/100 mm of Hg. Other examination findings were normal. His investigations revealed:
· Urine Albumin: 1+
· 24 hours urine albumin = 126 mg/24 hours.
· Serum total proteins = 4.2 gm/dl.
· Serum albumin = 1.7 gm/dl
· S. SGOT = 72 IU/L
· S. SGPT = 97 IU/L
· BUN, Creatinine, Cholesterol, S. electrolytes – Normal
· USG Abdomen – Mild hepatomegaly with increased echogenicity of both kidneys. Color Doppler was normal.
· Ascitic tap = 99 cells (30% polymorphs, 70% lymphocytes) with proteins = 0.45 gm%.
· HIV, HBsAg, ANA, dsDNA, S. Ceruloplasmin, 24 hours urinary copper = Normal.

He was treated with Furosemide, Spironolactone, Nifedipine, IV antibiotics to which he responded.

His repeat LFT after 14 days showed improvement:
· Serum total proteins = 4.9 gm/dl.
· Serum albumin = 2.3 gm/dl
· S. SGOT = 69 IU/L.
· S. SGPT = 50 IU/L.
· Technetium liver scan showed normal liver.

A liver biopsy could not be done due to ascitis. Thus this child has unexplained ascitis with generalized edema, hypoalbuminemia, hypertension and marginally dysfunctional liver functions and normal renal function tests.