A 55-year-old man with nephrotic syndrome (massive proteinuria, serum albumin 1.8 g/dL, generalized edema) has reduced effective arterial blood volume despite total body sodium overload. Which hormonal profile is most consistent with the 'underfill' mechanism of edema formation in this patient?
- A Suppressed renin, suppressed aldosterone, elevated ANP
- B Elevated renin, elevated aldosterone, elevated ADH ✓
- C Suppressed renin, elevated aldosterone, suppressed ADH
- D Elevated renin, suppressed aldosterone, suppressed ADH
Correct answer: B. Elevated renin, elevated aldosterone, elevated ADH
Explanation
In the underfill theory of nephrotic edema, reduced effective arterial volume activates the RAAS axis (elevated renin and aldosterone) and stimulates ADH secretion, causing sodium and water retention. The distractor A represents the overfill theory (primary sodium retention with suppressed RAAS and elevated ANP), which occurs in some patients but underfill is the dominant mechanism in most nephrotic adults.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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