Which of the following is not found in nephrotic syndrome-irrelevant

Nephrotic syndrome Nephrotic syndrome is characterised by very heavy proteinuria (>3.5 g/24 hrs), hypoalbuminaemia and oedema . Blood volume may be normal, reduced or increased. Renal sodium retention is an early and universal feature . The diseases that cause nephrotic syndrome all affect the glomerulus , either directly, by damaging podocytes, or indirectly, by causingscarring or deposition of exogenous material such as amyloid into the glomerulus. Investigation of nephrotic syndrome usually involves renal biopsy, although non-invasive tests may also be helpful in suggesting the underlying cause . In children, minimal change disease is by far the most common cause of nephrotic syndrome and therefore renal biopsy is not usually required unless the patient fails to respond to high-dose glucocoicoid therapy. Similarly, most patients with diabetes presenting with nephrotic syndrome will have diabetic nephropathy, and so renal biopsy is usually not performed unless the course of the disease is atypical (rapidly increasing proteinuria or rapid decline in renal function). Management of nephrotic syndrome should be directed at the underlying cause. In addition, nephrotic syndrome is associated with a number of complications , which may require suppoive management unless the nephrosis is expected to resolve rapidly, such as in glucocoicoid-responsive minimal change disease. Ref Harrison20th edition pg 297