Which set of findings best characterizes nephrotic syndrome?

• A. Massive proteinuria (>3.5 g/day), hypoalbuminemia, edema, and typically hyperlipidemia.
• B. Proteinuria <0.3 g/day, normal albumin, no edema, hypolipidemia.
• C. Hematuria, red cell casts, hypertension, oliguria.
• D. Waxy casts, nocturia, azotemia.

Answer: (B)

Nephrotic syndrome shows a heavy loss of protein in the urine, which lowers the blood’s albumin level and reduces oncotic pressure. That drop in oncotic pressure pulls fluid into tissues, causing edema. The liver senses the low albumin and compensates by making more lipoproteins, leading to hyperlipidemia (often with lipiduria). So the classic quartet is massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The other patterns fit different kidney problems: minimal proteinuria with normal albumin and no edema isn’t nephrotic; hematuria with red cell casts and hypertension suggests nephritic syndrome; waxy casts with nocturia and azotemia point to chronic kidney disease.