Which of the following is NOT typical of nephrotic syndrome?

• A. Hematuria With Red Blood Cell Casts
• B. Lipiduria With Oval Fat Bodies
• C. Fatty Casts
• D. Proteinuria

Answer: (D)

Nephrotic syndrome is defined by heavy proteinuria with lipiduria, oval fat bodies, and fatty casts, often accompanied by hypoalbuminemia and edema. The presence of lipid in the urine and the characteristic lipid-containing casts reflect the loss of proteins and lipids due to increased glomerular permeability.

Hematuria with red blood cell casts signals bleeding and inflammation within the glomeruli, which is more characteristic of nephritic syndromes. While some overlap can occur, red blood cell casts are not typical features of nephrotic syndrome. Proteinuria, lipiduria with oval fat bodies, and fatty casts align with nephrotic pathology, whereas hematuria with RBC casts points toward nephritic processes.