Question

A 10 year old male child presented with generalised edema. His cholesterol was 238 mg/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:

Look for the combination of heavy proteinuria, oedema, and hyperlipidaemia in a child.

Answer 1

The Correct Option is C

Step 1: Identify the key clinical features. A 10-year-old boy presents with generalised edema, hypercholesterolaemia (238 mg/dl), heavy proteinuria (urine protein 3+), and fat in stool (steatorrhoea). This triad is classic for nephrotic syndrome.

Step 2: Define nephrotic syndrome. Nephrotic syndrome is characterised by the tetrad of:
1. Heavy proteinuria (> 3.5 g/day in adults; urine protein 3+ on dipstick)
2. Hypoalbuminaemia
3. Generalised oedema (due to reduced oncotic pressure)
4. Hyperlipidaemia and lipiduria (fat in stool/urine)

The liver compensates for protein loss by increasing lipoprotein synthesis, causing hypercholesterolaemia. Lipids appear in the urine and stool (lipiduria and steatorrhoea).

Step 3: Eliminate other options. Nephritic syndrome presents with haematuria, oliguria, hypertension, and mild proteinuria -- not the heavy proteinuria or marked hyperlipidaemia seen here. Goodpasture syndrome causes pulmonary haemorrhage and glomerulonephritis (haematuria), not heavy proteinuria with hypercholesterolaemia. Urine infection does not explain oedema or hyperlipidaemia.

Step 4: Confirm. Generalised oedema + cholesterol 238 mg/dl + proteinuria 3+ + fat in stool = classic nephrotic syndrome. The most common cause in children of this age group is minimal change disease.