<prompt> The following are the hallmarks of nephrotic syndrome in children exceptGross hematuriaHypoalbuminemia 2.5 gdLSevere proteinuria 2 gmm2dayEdema  <response>: NEPHROTIC SYNDROME:-Characterised by massive proteinuria, hypoalbuminemia and oedema, hyperlipidemia is often associated.Some patients show hematuria and hypertension.Heavy proteinuria more than 1gmetre squareday is the underlying abnormality leading to hypoalbuminemia serum albumin below 2.5gdl.The resultant fall in plasma oncotic pressure leads to interstitial oedema and hypovolemia. This stimulates the renin-angiotensin-aldosterone axis and ADH secretion that enhances sodium and water retention.Hypoalbuminemia also induces hepatic synthesis of beta-lipoproteins resulting in hypercholesterolemia. The main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy.Steroid-sensitive nephrotic syndrome:-MCNS accounts for 80 cases of nephrotic syndrome. Electron microscopy shows non-specific obliteration of epithelial foot processes. Immunofluorescence studies show deposits of occasional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia imparts a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated.Low serum calcium level.Steroid-resistant nephrotic syndrome:-Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocinNPHS2, nephrinNPHS1 and Wilms a tumour WT1 genes. 