Discuss the causes, symptoms and dietary management of nephrotic syndrome.

1. 1 · Open in two lines. Nephrotic syndrome is a kidney disorder in which leaky glomeruli lose large amounts of protein in urine. It causes low albumin, oedema and high lipids.
2. 2 · Draw the chain. [Flow: leaky glomeruli → proteinuria → low albumin → fluid leaks into tissues → oedema; liver makes more lipoproteins → high cholesterol]
3. 3 · Causes and symptoms.
   • Minimal change disease, diabetes, lupus, other glomerular diseases.
   • Frothy urine, puffy face, swollen legs, ascites, tiredness.
4. 4 · Compare with nephritis. Nephritis: blood in urine, high BP, oliguria. Nephrotic: protein loss, oedema, high lipids.
5. 5 · Diet principles. Energy 35 kcal/kg, protein 0.8-1 g/kg good quality, sodium under 2 g, low saturated fat and cholesterol, fluid limit only if severe oedema, calcium and vitamin D.
6. 6 · Foods and menu. Include and avoid lists; a low-salt menu.
7. 7 · Close in one line. Salt control and the right amount of protein ease oedema while drugs treat the kidney.

Scoring tip: Write both the old (high-protein) and current (0.8-1 g/kg) advice and say which is current; examiners reward this.