Question

A 10 year old male child presented with generalised edema. His cholesterol was 238mg/dl and urine protein was 3+. Stool microscopy showed fat in stool.

• A. Goodpasture syndrome
• B. Urine infection
• C. Nephrotic syndrome
• D. Nephritic syndrome

Hint:

Think about the condition that combines massive proteinuria, generalised oedema, and hypercholesterolaemia in a child.

Answer 1

The Correct Option is C

Nephrotic Syndrome -- Diagnostic Tetrad:
1. Proteinuria >3.5 g/day (adults) / >40 mg/m2/hr (children) -- urine protein 3+
2. Hypoalbuminaemia -- causes generalised oedema
3. Hyperlipidaemia / Hypercholesterolaemia -- cholesterol 238 mg/dl
4. Oedema (generalised, pitting)

Fat in stool explained: Massive lipid synthesis by liver overflows into GI secretions; lipid-laden shed enterocytes appear in stool as steatorrhoea.

Most common cause in children aged 1-8 years: Minimal Change Disease (MCD) -- responds well to steroids.

Differentiating from Nephritic Syndrome:
| Feature | Nephrotic | Nephritic |
|---------|-----------|-----------|
| Proteinuria | Massive (>3.5 g/day) | Mild (<3 g/day) |
| Haematuria | Absent | Present (hallmark) |
| Hypertension | Mild | Prominent |
| Oedema | Severe | Mild |

\[\boxed{\text{Nephrotic Syndrome}}\]