**Question:** All of the following decreases in nephrotic syndrome except

A. Proteinuria
B. Hyperlipidaemia
C. Hypoalbuminaemia
D. Edema

**Core Concept:** Nephrotic syndrome is a clinical condition characterized by nephrotic range proteinuria (more than 3.5 g/day), hypoalbuminaemia (low serum albumin), hyperlipidaemia, and edema due to increased permeability of glomerular capillaries.

**Why the Correct Answer is Right:** The correct answer, **A. Proteinuria**, is not affected by nephrotic syndrome. Proteinuria is the excessive excretion of proteins in the urine, which is a primary feature of nephrotic syndrome. The other options are all consequences or secondary features of nephrotic syndrome, but proteinuria itself is not reduced or corrected by any of the listed options.

**Why Each Wrong Option is Incorrect:**

**Option A (Hyperlipidaemia):** Hyperlipidaemia is a common feature of nephrotic syndrome, which is characterized by increased levels of lipids in the blood, particularly triglycerides and cholesterol. Various factors contribute to hyperlipidaemia in nephrotic syndrome, including increased lipoprotein synthesis, reduced lipoprotein clearance, and increased lipoprotein lipase activity.

**Option B (Hypoalbuminaemia):** Hypoalbuminaemia is a direct consequence of nephrotic range proteinuria, as albumin is predominantly lost in the urine due to increased permeability of glomerular capillaries. Hypoalbuminaemia is caused by low serum albumin levels (proteinuria leads to decreased synthesis and increased catabolism).

**Option C (Edema):** Edema, also known as swelling, is a common manifestation of nephrotic syndrome, resulting from the loss of proteins, particularly albumin, in the urine. Edema can be generalized, facial, or localized, depending on the extent of proteinuria and the degree of intravascular volume expansion.

**Option D (Increased glomerular filtration rate):** Nephrotic syndrome is characterized by increased glomerular filtration rate (GFR) due to the increased permeability of glomerular capillaries, which leads to increased proteinuria. This results in a compensatory mechanism to maintain the plasma protein levels by increasing the GFR.

**Why Proteinuria does not decrease despite treatment:** Treatment options like corticosteroids or immunosuppressants may help to reduce proteinuria in some cases, but proteinuria does not decrease in all patients, and its persistence does not necessarily negate the diagnosis of nephrotic syndrome. Proteinuria is a significant hallmark of nephrotic syndrome, and its reduction or resolution is not the primary goal of treatment. Treatment focuses on addressing the underlying cause, alleviating symptoms, and preventing complications.

**Core Concept:** Nephrotic syndrome is caused by various conditions, including primary glomerular diseases (e.g., minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy), secondary glomerular diseases (e.g., glomerulonephritis, amyloidosis,