Consequences of Nephrotic Syndrome

Nephrotic syndrome is defined by heavy proteinuria (>3.5 g/day), hypoalbuminemia, edema, and hyperlipidemia. The massive urinary loss of protein and the compensatory hepatic response drive most of the systemic biochemical abnormalities seen in this condition. The correct answer is statements 1, 2 and 3.

Analysis of Each Statement

• 1. Increased lipoprotein synthesis — Correct. Hypoalbuminemia and reduced plasma oncotic pressure stimulate the liver to increase synthesis of proteins, including lipoproteins (VLDL, LDL, and later HDL abnormalities). Additionally, reduced catabolism of lipoproteins (due to loss of lipoprotein lipase-related cofactors in urine) contributes. The result is the characteristic hyperlipidemia/hypercholesterolemia of nephrotic syndrome.
• 2. Low serum globulin levels — Correct. Along with albumin, several globulin fractions (particularly immunoglobulins, especially IgG) are lost in the urine because the damaged glomerular basement membrane loses its selective permeability. This contributes to hypogammaglobulinemia and the increased susceptibility to infection seen in nephrotic patients.
• 3. Increased serum aldosterone levels — Correct. Hypoalbuminemia lowers intravascular oncotic pressure, causing fluid to shift into the interstitium and reducing effective circulating volume. This activates the renin–angiotensin–aldosterone system (RAAS), raising serum aldosterone and promoting renal sodium and water retention, which worsens edema.
• 4. Increased serum Antithrombin III levels — Incorrect. Antithrombin III is a relatively small molecular weight protein that is lost in the urine along with albumin in nephrotic syndrome. This causes decreased, not increased, serum Antithrombin III levels, which — together with increased hepatic synthesis of clotting factors (fibrinogen, factors V and VIII) and platelet hyperaggregability — produces the well-known hypercoagulable state and increased risk of venous thromboembolism (including renal vein thrombosis) in nephrotic syndrome.

Conclusion

Increased lipoprotein synthesis, low serum globulin levels, and increased serum aldosterone are all genuine consequences of nephrotic syndrome, whereas serum Antithrombin III is characteristically decreased (not increased), which is one of the key contributors to the hypercoagulable state of this syndrome. Therefore, statements 1, 2 and 3 are the correct consequences, confirming the marked answer.