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: Pathology
All of the following are decreased in nephrotic syndrome, except ? 
Select and explain. 
A. Serum transferrin, B. Serum fibrinogen, C. Serum ceruloplasmin, D. Serum albumin
B: Serum fibrinogen
Answer: B: Serum fibrinogen 
Explanation: Ans. is 'b' i.e., Serum Fibrinogen Fibrinogen level is increased in nephrotic syndrome d/t increased hepatic synthesis of fibrinogen. The largest propoion of protein lost in urine is albumin. Sometimes, globulins can also be excreted - - Immunoglobulin excretion increases the susceptibility of infection. Other proteins which are decreased - Transferrin - Microcytic hypochromic anemia. Cholecalciferol binding protein - hypocalcemia Thyroxine binding globulin - decreased thyroxine level. Antithrombin III - hypercoagulability Ceruloplasmin Causes of Hvpercoagulability in nephrotic syndrome Loss of antithrombin III Increased synthesis of fibrinogen by liver. Altered activity of protein C and S Increased platelet aggregability. Hypercoagulability can cause renal vein thrombosis.