NEPHROTIC SYNDROME EXAM QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026
Questions 1–15: Definitions, Epidemiology, and Classification
Question 1
What is the definition of nephrotic syndrome?
A. Proteinuria <1 g/day, hypoalbuminaemia, oedema
B. Haematuria, hypertension, renal failure
C. Proteinuria >3.5 g/1.73m²/day (or >50 mg/kg/day in children),
hypoalbuminaemia (<30 g/L), oedema, and often hyperlipidaemia
D. Isolated haematuria
*Rationale: Nephrotic syndrome is defined by heavy proteinuria (≥3.5
g/day/1.73m²), hypoalbuminaemia (serum albumin <30 g/L), peripheral oedema,
and hyperlipidaemia. The triad of proteinuria, hypoalbuminaemia, and oedema is
essential. Hyperlipidaemia is common but not universal.*
Question 2
What is the distinction between nephrotic syndrome and nephritic syndrome?
A. Nephritic syndrome has heavier proteinuria
B. Nephrotic syndrome: heavy proteinuria, hypoalbuminaemia, oedema,
hyperlipidaemia; Nephritic syndrome: haematuria, hypertension, oliguria, red
cell casts, mild-to-moderate proteinuria
C. They are the same
D. Nephritic syndrome has worse oedema
Rationale: Nephrotic syndrome is primarily a disorder of the glomerular filtration
barrier, causing massive protein loss. Nephritic syndrome is characterised by
,glomerular inflammation (haematuria, red cell casts, hypertension, oliguria) with
variable proteinuria.
Question 3
What is the most common cause of nephrotic syndrome in children (ages 2-10
years)?
A. Focal segmental glomerulosclerosis (FSGS)
B. Minimal change disease (MCD)
C. Membranous nephropathy (MN)
D. IgA nephropathy
*Rationale: Minimal change disease (MCD) accounts for 70-90% of nephrotic
syndrome in children aged 2-10 years. It typically presents with sudden onset of
oedema, heavy proteinuria, and is highly responsive to corticosteroids. FSGS is
more common in adults and African-American children.*
Question 4
What is the most common cause of nephrotic syndrome in adults (Caucasian
populations)?
A. Minimal change disease (MCD)
B. Focal segmental glomerulosclerosis (FSGS) and membranous nephropathy
(MN) (approximately equal)
C. Diabetic nephropathy
D. IgA nephropathy
*Rationale: In Caucasian adults, the most common primary glomerular causes of
nephrotic syndrome are FSGS and membranous nephropathy (each ~30-40%).
Minimal change disease accounts for 10-15% of adult nephrotic syndrome.
Diabetic nephropathy is the most common secondary cause globally.*
Question 5
What is the most common secondary cause of nephrotic syndrome in adults
worldwide?
,A. Systemic lupus erythematosus (SLE)
B. Diabetes mellitus (diabetic nephropathy)
C. Amyloidosis
D. Preeclampsia
Rationale: Diabetes mellitus is the leading secondary cause of nephrotic syndrome
globally, due to diabetic nephropathy (nodular glomerulosclerosis, Kimmelstiel-
Wilson nodules). Other secondary causes: SLE (lupus nephritis), amyloidosis
(primary or secondary), preeclampsia, HIV-associated nephropathy (HIVAN), and
drugs (NSAIDs, gold, penicillamine).
Question 6
What is the annual incidence of nephrotic syndrome in adults?
A. 1-2 per 100,000
B. 3-5 per 100,000
C. 10-20 per 100,000
D. 50-100 per 100,000
*Rationale: The annual incidence of primary nephrotic syndrome is approximately
3-5 per 100,000 adults. Minimal change disease has a higher incidence in children
(2-3 per 100,000 children). Prevalence is higher in certain ethnic groups (e.g., FSGS
in African-Americans).*
Question 7
What is the triad of nephrotic syndrome complications?
A. Hypertension, hyperkalaemia, metabolic acidosis
B. Thrombosis (hypercoagulable state), infection (encapsulated organisms),
acute kidney injury (AKI)
C. Anaemia, thrombocytopenia, leucopenia
D. Hypocalcaemia, hyperphosphataemia, secondary hyperparathyroidism
Rationale: Nephrotic syndrome predisposes to: (1) venous and arterial thrombosis
(loss of anticoagulant factors in urine, high fibrinogen, platelet
hyperaggregability), (2) infection (loss of immunoglobulins, complement factors),
and (3) acute kidney injury (prerenal, ATN, or renal vein thrombosis).
, Question 8
What is the histological hallmark of minimal change disease (MCD) on light
microscopy?
A. Glomerular sclerosis
B. Crescents
C. Normal glomeruli (no changes on light microscopy)
D. Thickened basement membrane
Rationale: Minimal change disease is so named because light microscopy shows
normal or near-normal glomeruli. The diagnosis is made by electron microscopy,
which shows diffuse effacement (flattening) of podocyte foot processes. There is
no immune complex deposition.
Question 9
What is the characteristic finding on electron microscopy in minimal change
disease?
A. Subepithelial immune deposits
B. Diffuse effacement (flattening) of podocyte foot processes
C. Subendothelial immune deposits
D. Mesangial electron-dense deposits
Rationale: The pathognomonic finding in MCD is diffuse effacement of podocyte
foot processes (loss of the normal interdigitating architecture) on electron
microscopy. No immune deposits are seen. This is reversible with corticosteroid
treatment.
Question 10
What is the characteristic histology of focal segmental glomerulosclerosis (FSGS)?
A. Diffuse glomerular involvement
B. Sclerosis (scarring) of some (focal) glomeruli, involving only part (segmental)
of the glomerular tuft
C. Thickened capillary loops
D. Crescent formation
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026
Questions 1–15: Definitions, Epidemiology, and Classification
Question 1
What is the definition of nephrotic syndrome?
A. Proteinuria <1 g/day, hypoalbuminaemia, oedema
B. Haematuria, hypertension, renal failure
C. Proteinuria >3.5 g/1.73m²/day (or >50 mg/kg/day in children),
hypoalbuminaemia (<30 g/L), oedema, and often hyperlipidaemia
D. Isolated haematuria
*Rationale: Nephrotic syndrome is defined by heavy proteinuria (≥3.5
g/day/1.73m²), hypoalbuminaemia (serum albumin <30 g/L), peripheral oedema,
and hyperlipidaemia. The triad of proteinuria, hypoalbuminaemia, and oedema is
essential. Hyperlipidaemia is common but not universal.*
Question 2
What is the distinction between nephrotic syndrome and nephritic syndrome?
A. Nephritic syndrome has heavier proteinuria
B. Nephrotic syndrome: heavy proteinuria, hypoalbuminaemia, oedema,
hyperlipidaemia; Nephritic syndrome: haematuria, hypertension, oliguria, red
cell casts, mild-to-moderate proteinuria
C. They are the same
D. Nephritic syndrome has worse oedema
Rationale: Nephrotic syndrome is primarily a disorder of the glomerular filtration
barrier, causing massive protein loss. Nephritic syndrome is characterised by
,glomerular inflammation (haematuria, red cell casts, hypertension, oliguria) with
variable proteinuria.
Question 3
What is the most common cause of nephrotic syndrome in children (ages 2-10
years)?
A. Focal segmental glomerulosclerosis (FSGS)
B. Minimal change disease (MCD)
C. Membranous nephropathy (MN)
D. IgA nephropathy
*Rationale: Minimal change disease (MCD) accounts for 70-90% of nephrotic
syndrome in children aged 2-10 years. It typically presents with sudden onset of
oedema, heavy proteinuria, and is highly responsive to corticosteroids. FSGS is
more common in adults and African-American children.*
Question 4
What is the most common cause of nephrotic syndrome in adults (Caucasian
populations)?
A. Minimal change disease (MCD)
B. Focal segmental glomerulosclerosis (FSGS) and membranous nephropathy
(MN) (approximately equal)
C. Diabetic nephropathy
D. IgA nephropathy
*Rationale: In Caucasian adults, the most common primary glomerular causes of
nephrotic syndrome are FSGS and membranous nephropathy (each ~30-40%).
Minimal change disease accounts for 10-15% of adult nephrotic syndrome.
Diabetic nephropathy is the most common secondary cause globally.*
Question 5
What is the most common secondary cause of nephrotic syndrome in adults
worldwide?
,A. Systemic lupus erythematosus (SLE)
B. Diabetes mellitus (diabetic nephropathy)
C. Amyloidosis
D. Preeclampsia
Rationale: Diabetes mellitus is the leading secondary cause of nephrotic syndrome
globally, due to diabetic nephropathy (nodular glomerulosclerosis, Kimmelstiel-
Wilson nodules). Other secondary causes: SLE (lupus nephritis), amyloidosis
(primary or secondary), preeclampsia, HIV-associated nephropathy (HIVAN), and
drugs (NSAIDs, gold, penicillamine).
Question 6
What is the annual incidence of nephrotic syndrome in adults?
A. 1-2 per 100,000
B. 3-5 per 100,000
C. 10-20 per 100,000
D. 50-100 per 100,000
*Rationale: The annual incidence of primary nephrotic syndrome is approximately
3-5 per 100,000 adults. Minimal change disease has a higher incidence in children
(2-3 per 100,000 children). Prevalence is higher in certain ethnic groups (e.g., FSGS
in African-Americans).*
Question 7
What is the triad of nephrotic syndrome complications?
A. Hypertension, hyperkalaemia, metabolic acidosis
B. Thrombosis (hypercoagulable state), infection (encapsulated organisms),
acute kidney injury (AKI)
C. Anaemia, thrombocytopenia, leucopenia
D. Hypocalcaemia, hyperphosphataemia, secondary hyperparathyroidism
Rationale: Nephrotic syndrome predisposes to: (1) venous and arterial thrombosis
(loss of anticoagulant factors in urine, high fibrinogen, platelet
hyperaggregability), (2) infection (loss of immunoglobulins, complement factors),
and (3) acute kidney injury (prerenal, ATN, or renal vein thrombosis).
, Question 8
What is the histological hallmark of minimal change disease (MCD) on light
microscopy?
A. Glomerular sclerosis
B. Crescents
C. Normal glomeruli (no changes on light microscopy)
D. Thickened basement membrane
Rationale: Minimal change disease is so named because light microscopy shows
normal or near-normal glomeruli. The diagnosis is made by electron microscopy,
which shows diffuse effacement (flattening) of podocyte foot processes. There is
no immune complex deposition.
Question 9
What is the characteristic finding on electron microscopy in minimal change
disease?
A. Subepithelial immune deposits
B. Diffuse effacement (flattening) of podocyte foot processes
C. Subendothelial immune deposits
D. Mesangial electron-dense deposits
Rationale: The pathognomonic finding in MCD is diffuse effacement of podocyte
foot processes (loss of the normal interdigitating architecture) on electron
microscopy. No immune deposits are seen. This is reversible with corticosteroid
treatment.
Question 10
What is the characteristic histology of focal segmental glomerulosclerosis (FSGS)?
A. Diffuse glomerular involvement
B. Sclerosis (scarring) of some (focal) glomeruli, involving only part (segmental)
of the glomerular tuft
C. Thickened capillary loops
D. Crescent formation
