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

Step 1: Identify the key findings.
Generalised edema + hypercholesterolaemia (238 mg/dl) + heavy proteinuria (3+) + fat in stool (steatorrhoea) in a 10-year-old boy.

Step 2: Apply the definition of nephrotic syndrome.
Nephrotic syndrome is defined by the tetrad: (1) massive proteinuria (>3.5 g/day in adults, >40 mg/m2/hr in children), (2) hypoalbuminaemia, (3) generalised oedema, (4) hyperlipidaemia / hypercholesterolaemia. Lipiduria and steatorrhoea occur because fat-laden casts and free fat droplets are lost in urine and gut.

Step 3: Understand fat in stool in nephrotic syndrome.
The liver increases lipoprotein synthesis to compensate for albumin loss, leading to hypercholesterolaemia. Lipids are filtered into the tubular fluid and appear in urine (lipiduria / oval fat bodies) and stool.

Step 4: Eliminate distractors.
Goodpasture syndrome: haematuria + haemoptysis (pulmonary-renal syndrome) -- no gross proteinuria tetrad.
Urine infection: dysuria, pyuria, not oedema or hypercholesterolaemia.
Nephritic syndrome: haematuria, hypertension, mild proteinuria (<3 g/day), oliguria -- not massive proteinuria with hypercholesterolaemia.

The complete picture of massive proteinuria + hypercholesterolaemia + oedema + fat in stool = nephrotic syndrome.