[Significance of the urine strip test in case of stunted growth].
Archives de Pédiatrie. 2015-07-01; 22(7): 756-762
DOI: 10.1016/j.arcped.2015.04.016
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1. Arch Pediatr. 2015 Jul;22(7):756-62. doi: 10.1016/j.arcped.2015.04.016. Epub 2015
Jun 3.
[Significance of the urine strip test in case of stunted growth].
[Article in French]
Bertholet-Thomas A(1), Llanas B(2), Servais A(3), Bendelac N(4), Goizet C(5),
Choukroun G(6), Novo R(7), Decramer S(8).
Author information:
(1)Néphrogones, centre de référence des maladies rénales rares, hôpital
Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France. Electronic address:
.
(2)Néphrologie pédiatrique, centre de référence du Sud-Ouest des maladies rénales
rares (SORARE), hôpital des Enfants, CHU de Bordeaux, 33076 Bordeaux, France.
(3)Service de néphrologie adulte, centre de référence MARRHEA, hôpital
Necker-Enfants-Malades, université Paris Descartes, AP-HP, 75015 Paris, France.
(4)Endocrinologie, diabète et maladies héréditaires du métabolisme, hôpital
Femme-Mère-Enfant, hôpitaux de Lyon, 69500 Lyon, France.
(5)Génétique médicale, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux,
France.
(6)Inserm UMR 1088, service de néphrologie-médecine
interne-dialyse-transplantation-réanimation, université de Picardie-Jules-Verne,
CHU d’Amiens, 80054 Amiens, France.
(7)Néphrologie pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille
cedex, France.
(8)Pédiatrie, néphrologie, médecine interne et hypertension pédiatrique, centre
de référence du Sud-Ouest des maladies rénales rares (SORARE), hôpital des
Enfants, CHU de Toulouse, 31300 Toulouse, France.
Observation of stunted growth in children usually leads the general practitioner
to refer the patient to endocrinologists or gastroenterologists. In most cases,
after a complementary check-up, the diagnosis is made and treatment is initiated.
However, certain cases remain undiagnosed, particularly renal etiologies, such as
proximal tubulopathy. The urine strip test at the initial check-up would be an
easy and inexpensive test to avoid delayed diagnosis. The aim of the present
paper is to increase general physicians’ and pediatricians’ awareness of the
significance of questioning the parents and using the urine strip test for any
child presenting stunted growth. We report a patient case of a 20-month-old child
admitted to the emergency department for severe dehydration. He had displayed
stunted growth since the age of 5 months and showed a negative etiologic check-up
at 9 months of age. Clinical examination at admission confirmed stunted growth
with loss of 2 standard deviations and signs of dehydration with persistent
diuresis. Skin paleness, ash-blond hair, and signs of rickets were also observed
and the urine strip test showed positive pads for glycosuria and proteinuria.
Polyuria and polydipsia were also revealed following parents’ questioning,
suggesting proximal tubulopathy (Fanconi syndrome). Association of stunted
growth, rickets, polyuria and polydipsia, glycosuria (without ketonuria and
normal glycemia), and proteinuria suggest nephropathic cystinosis. Ophthalmic
examination showed cystine deposits in the cornea. The semiotic diagnosis of
nephropathic cystinosis was confirmed by leukocyte cystine concentrations and
genetic investigations. This case report clearly illustrates the significance of
the urine strip test to easily and quickly concentrate the diagnosis of stunted
growth on a renal etiology (glycosuria, proteinuria), especially on proximal
tubulopathy for which the most frequent cause is nephropathic cystinosis.
Specificity of nephropathic cystinosis treatment is that the age of treatment
initiation is crucial and determinant for the prognosis of the disease and the
onset of final stage renal failure. Therefore, the urine strip test should be
included in the systematic check-up of stunted growth to identify any renal
etiology.
Copyright © 2015 Elsevier Masson SAS. All rights reserved.
DOI: 10.1016/j.arcped.2015.04.016
PMID: 26047745 [Indexed for MEDLINE]