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September 22, 2004

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Question from New Orleans, Louisiana, USA:

My son has nephrotic syndrome. He is currently in remission, but over the last several years has had roughly 20 episodes where he gets a stomachache and headache, and when I check his urine, he is passing large amounts of ketones. I then check his blood sugar, only to find it is always normal. We have been checking blood sugars for years on and off, because of this, but he is always in the normal range. The endocrinologist has no explanation, and neither does the geneticist, nor the nephrologist. He is on Prograf for his kidney disease (no transplant, just for obtaining remission). Do you have any idea what could be causing this? It lasts for a few hours, and when it stops he feels better. I am so frustrated!

Answer:

Ketones present in the urine, or blood levels that rise, just indicate that the body is using fat for energy. They do not tell you why this is occurring. Often, when ketonuria or ketonemia occur there is associated stomach discomfort, mostly nausea. You may want to arrange for a joint meting with both your nephrologist and endocrinologist so that they can review this together and see what else they should be checking. I would suggest that this may be related to medications, exertion and/or food intake if it is only an intermittent occurrence.

SB