A patient has K+: 3.0 mmol/L; URIC: 50 μmol/L; Urinalysis: GLU POS; PROT 2+. What is the likely diagnosis?

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Multiple Choice

A patient has K+: 3.0 mmol/L; URIC: 50 μmol/L; Urinalysis: GLU POS; PROT 2+. What is the likely diagnosis?

Proximal tubule dysfunction causing a generalized reabsorption defect is what this pattern points to. The proximal tubule normally reabsorbs glucose, amino acids, phosphate, bicarbonate, and uric acid; when this reabsorption fails, you get glycosuria with normal blood glucose, low serum uric acid due to uric acid wasting in the urine, and loss of proteins and electrolytes in the urine. The presence of glucose in the urine despite presumably normal plasma glucose, along with 2+ proteinuria and hypokalemia, fits with Fanconi syndrome, a classic proximal tubule disorder. This makes it the best match among the options. Nephrotic syndrome would mainly show heavy proteinuria with edema and hypoalbuminemia, without the glycosuria pattern. Acute tubular necrosis and acute gout don’t explain the combination of glycosuria with low uric acid and proximal-tubule-type proteinuria.

Proximal tubule dysfunction causing a generalized reabsorption defect is what this pattern points to. The proximal tubule normally reabsorbs glucose, amino acids, phosphate, bicarbonate, and uric acid; when this reabsorption fails, you get glycosuria with normal blood glucose, low serum uric acid due to uric acid wasting in the urine, and loss of proteins and electrolytes in the urine. The presence of glucose in the urine despite presumably normal plasma glucose, along with 2+ proteinuria and hypokalemia, fits with Fanconi syndrome, a classic proximal tubule disorder. This makes it the best match among the options. Nephrotic syndrome would mainly show heavy proteinuria with edema and hypoalbuminemia, without the glycosuria pattern. Acute tubular necrosis and acute gout don’t explain the combination of glycosuria with low uric acid and proximal-tubule-type proteinuria.

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