<s>[INST] context: NEPHROTIC SYNDROME:-

 Characterised by massive proteinuria, hypoalbuminemia and edema, hyperlipidemia is often associated.

Some patients show hematuria and hypertension.

Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl).
The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin-angiotensin-aldosterone axis and ADH secretion that enhances sodium and water retention.

Hypoalbuminemia also induces hepatic synthesis of beta-lipoproteins resulting in hypercholesterolemia.
 
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.

Steroid sensitive nephrotic syndrome:-

MCNS 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. 

 Lab 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.

Low serum calcium level.
Steroid-resistant nephrotic syndrome:-

Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and Wilms a tumour (WT1) genes. [/INST] question: Which is seen in nephrotic syndrome | options: A: Low serum calcium B: Raised AT-III C: Low lipid D: Platelet activation | answer: A </s>