PT  - JOURNAL ARTICLE
AU  - Ebner Bon G Maceda
AU  - Michelle E Abadingo
AU  - Cheryll J Magbanua-Calalo
AU  - Melissa A Dator
AU  - Lourdes Paula R Resontoc
AU  - Leniza De Castro-Hamoy
AU  - Mary Ann R Abacan
AU  - Mary Anne D Chiong
AU  - Sylvia C Estrada
TI  - Maple syrup urine disease associated with nephrotic syndrome in a Filipino child
AID  - 10.1136/bcr-2021-242689
DP  - 2021 Jul 01
TA  - BMJ Case Reports
PG  - e242689
VI  - 14
IP  - 7
4099  - http://casereports.bmj.com/content/14/7/e242689.short
4100  - http://casereports.bmj.com/content/14/7/e242689.full
SO  - BMJ Case Reports2021 Jul 01; 14
AB  - A 22-month-old female child with maple syrup urine disease (MSUD) presented with generalised oedema. Diagnostic evaluation revealed nephrotic range proteinuria, hypoalbuminaemia and dyslipidaemia supporting the diagnosis of nephrotic syndrome (NS). Diet, being at the core of the management plan for both MSUD and NS, necessitated regular monitoring and evaluation via dried blood spot collection of leucine. The opposing requirement for total protein for both disorders (that is protein restriction in MSUD and protein supplementation in NS) prompted a careful balancing act of the dietary management. The monitoring, which revealed normal leucine levels on multiple determinations, allowed an eventual increase in dietary protein and daily administration of albumin to address the NS. Dietary protein increase, both in total protein (3.5 g/kg/day) and natural protein (1 g/kg/day) levels, was instituted. It was observed that NS does not trigger leucinosis and allowed easing of protein restriction in MSUD.