TY - JOUR T1 - Maple syrup urine disease associated with nephrotic syndrome in a Filipino child JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2021-242689 VL - 14 IS - 7 SP - e242689 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 Y1 - 2021/07/01 UR - http://casereports.bmj.com/content/14/7/e242689.abstract N2 - 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. ER -