Nephrotic Oedema — RACP Adult Medicine MCQ

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EasyNephrologyNephrotic OedemaRACP Adult Medicine

A 55-year-old man with newly diagnosed nephrotic syndrome (proteinuria 8 g/day, albumin 16 g/L) presents with generalised oedema (periorbital, lower limb, scrotal), ascites, and pleural effusions. Renal function is normal. What is the mechanism of oedema?

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Correct answer: E — Hypoalbuminaemia with reduced oncotic pressure

Generalised oedema with periorbital involvement, massive proteinuria, severe hypoalbuminaemia, ascites, and pleural effusions is nephrotic syndrome. The classic underfill hypothesis: heavy proteinuria → hypoalbuminaemia → reduced plasma oncotic pressure → fluid shift to interstitium. Treatment: sodium restriction, diuretics (furosemide + spironolactone; IV furosemide with IV albumin for diuretic resistance), and treatment of underlying glomerular disease. VTE prophylaxis (albumin <20 g/L increases thrombotic risk).

Reference: KDIGO – 2021 – GN; eTG Nephrology 2024