This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'The following are the hallmarks of nephrotic syndrome in children except \nSelect and explain. \nA. Gross hematuria, B. Hypoalbuminemia < 2.5 g/dL, C. Severe proteinuria >2 gm/m²/day, D. Edema', 'role': 'user'}, {'content': 'Answer: A \nExplanation: NEPHROTIC SYNDROME:-\n\nCharacterised by massive proteinuria, hypoalbuminemia and oedema, hyperlipidemia is often associated.\nSome patients show hematuria and hypertension.\nHeavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl).\n\nThe resultant fall in plasma oncotic pressure leads to interstitial oedema and hypovolemia. This stimulates the renin-angiotensin-aldosterone axis and ADH secretion that enhances sodium and water retention.\nHypoalbuminemia also induces hepatic synthesis of beta-lipoproteins resulting in hypercholesterolemia.\n\xa0\nThe main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy.\nSteroid-sensitive nephrotic syndrome:-\nMCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non-specific obliteration of epithelial foot processes. Immunofluorescence studies show deposits of occasional mesangial IgM.\xa0\nLab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia imparts a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated.\nLow serum calcium level.\nSteroid-resistant nephrotic syndrome:-\n\nHomozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and Wilms a tumour (WT1) genes.', 'role': 'assistant'}]