Which feature is NOT typically a feature of nephrotic syndrome?

• A. Heavy proteinuria
• B. Hematuria with RBC casts
• C. Edema
• D. Hypoalbuminemia

Answer: (B)

Nephrotic syndrome is defined by heavy protein loss through the kidneys, which drives low blood albumin, leading to swelling (edema), and the liver ramps up lipoprotein production causing high cholesterol and lipid in the urine. Hematuria with red blood cell casts, on the other hand, signals inflammation of the glomeruli and is characteristic of nephritic processes like glomerulonephritis. While nephrotic syndrome can have some blood in the urine, the presence of RBC casts reflects a glomerular inflammatory injury rather than the noninflammatory protein leakage that defines nephrotic syndrome. So the feature that doesn’t fit nephrotic syndrome is hematuria with RBC casts. The other features—heavy proteinuria, hypoalbuminemia, and edema—are hallmark components of nephrotic syndrome.