Stephen was diagnosed with minimal-change nephrotic syndrome; which of the following signs and symptoms are characteristics of the said disorder?
A. Hypertension, edema, hematuria
B. Hypertension, edema, proteinuria
C. Gross hematuria, fever, proteinuria
D. Poor appetite, edema, proteinuria
Correct Answer: D. Poor appetite, edema, proteinuria
Clinical manifestations of nephrotic syndrome include loss of appetite due to edema of the intestinal mucosa, proteinuria, and edema. The classic NS presentation is edema, in the early phase is located in the face in the morning on waking with puffiness of the eyelids and the impression of the folds of sheets on the skin and ankles at the end of the day.
Option A: Proteinuria that is more than 85% albumin is selective proteinuria. Albumin has a net negative charge, and it is proposed that loss of glomerular membrane negative charges could be important in causing albuminuria.
Option B: Hypertension alone or accompanied by hematuria is associated with glomerulonephritis. Moderate arterial hypertension is present in 25% of cases, and hypotension may reveal a state of effective hypovolemia.
Option C: Gross hematuria is not associated with nephrotic syndrome. Fever will occur only if infection also exists. Functional renal failure is possible. Microscopic hematuria is noted in about 20% of cases, macroscopic hematuria being exceptional and having to make look for thrombosis of the renal veins.