Nephrotic syndrome is characterized by massive proteinuria, low serum albumin levels, and generally elevated cholesterol. It is most common in children and the male to female ratio is approximately 2:1. Focal segmental glomerulosclerosis can develop from minimal change nephrotic syndrome or present separately, and mutations in podocyte proteins have been implicated in its pathophysiology. Steroid dependent nephrotic syndrome involves relapsing while tapering steroids or within 4 weeks of stopping them.

1. NEPHROTIC SYNDROME MCQs

2. 1. Concerning Nephrotic Syndrome:
A. There is massive proteinuria of > 40mg/m2/day
or 3+ or 4+ on albustix
B. Serum albumin levels are usually > 2.5g/dL
C. The male:female ratio is about 2:1
D. It is the second most common chronic renal
disease of childhood
E. Cholesterol levels are generally raised >
250mg/dL

3. 2. Concerning Focal Segmental Glomerulosclerosis:
A. Response to steroids may be up to 40% of cases
B. Hypocomplementaemia is characteristic
C. It may develop from minimal change nephrotic
syndrome or present as a separate entity
D. Less than 1/3 of cases will progress to renal
failure
E. Mutations in podocyte proteins podocin and α-
actinin 4, and MYH9 gene have been implicated
in the pathophysiology

4. 3. The following statements are correct with respect
to outcome of Nephrotic Syndrome therapy, except:
A. Steroid dependent: relapse while on alternate
day steroid therapy, or within 28 days of
completing therapy
B. Steroid resistant: proteinuria (2+ or greater)
after 8 weeks of steroid therapy
C. Frequent relapsers: respond well to prednisone
therapy but relapse > 6 times in a 12 month
period
D. Relapse: 3-4+ proteinuria plus oedema for 3
consecutive days
E. Remission: diuresis, urine trace or negative for
protein for 3 consecutive days

5. 4. On pathology of Nephrotic Syndrome:
A. Complex disturbances in T-Cell mediated
immunity have been observed in primary
nephrotic syndrome
B. Effacement of the podocytes leads to a loss in
the positive charge of the glomerular basement
membrane
C. There is increase in blood levels of lipoprotein
lipase
D. Reduced plasma oncotic pressure leads to fluid
shift from the interstitium to the intravascular
space
E. Mutation in NPHS2 gene is implicated in steroid
resistant Nephrotic syndrome

6. 5. Concerning the clinical features of Nephrotic
Syndrome:
A. There is usually weight gain in spite of reduced
appetite
B. Gross haematuria is a typical feature
C. Urine output may be normal or reduced
D. Blood pressure is typically raised in the early
stages
E. Patient may present with features of infection
like UTI or pneumonia

7. 6. Identify the true statements concerning
nephrotic syndrome:
A. Renal biopsy may not be indicated in an 11
month old infant presenting for the 1st time
B. A patient with 1st episode of nephrotic
syndrome with tense scrotal oedema may be
managed as an outpatient
C. A 4year old child having 1st episode of nephrotic
syndrome with mild oedema may be
commenced on prednisone therapy
D. Hypocomplementaemia is an indication for renal
biopsy
E. Frequent relapsers who respond to prednisone
therapy may not require renal biopsy

8. 7. Concerning investigations for Nephrotic
syndrome:
A. Microscopic haematuria is seen in most cases
B. Spot Creatinine : Protein > 2 is diagnostic
C. Stool microscopy may show ova of
Schistosoma mansoni in some cases
D. HBV may be positive in secondary nephrotic
syndrome
E. Hypocomplementaemia may be a pointer to
membranous nephropathy

9. 8. Concerning treatment of Nephrotic Syndrome
A. Cautious administration of intravenous albumin
over 1-2 hours may be used to treat all cases of
oedema
B. Patients on long term prednisone therapy may
develop hypotension as a side effect
C. Haemorrhagic cystitis is a potential side effect of
cyclophosphamide therapy
D. Levamisole, an immune modulator, may be used
to treat frequent relapsers
E. Persistent hypertension usually responds to ACE
inhibitor therapy