A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

Nephrotic syndrome in toddlers is characterized by massive proteinuria and systemic edema. Knowledge of fluid shifts, oncotic pressure, and renal pathophysiology is necessary to identify clinical manifestations resulting from the leakage of albumin into the urine and subsequent fluid retention. Choice A rationale While a child with a chronic illness might be irritable, irritability is a non-specific finding and can occur with many pediatric conditions. It does not specifically point to the glomerular changes or protein loss seen in nephrotic syndrome. Choice B rationale Increased abdominal girth is a classic sign of ascites, which occurs in nephrotic syndrome due to hypoalbuminemia. Low serum albumin levels decrease plasma oncotic pressure, causing fluid to shift from the intravascular space into the peritoneum. Choice C rationale Constipation is not a primary clinical indicator of nephrotic syndrome. The condition focuses on renal protein loss and fluid distribution; bowel habits are typically not the diagnostic focus unless related to severe generalized edema affecting the GI tract. Choice D rationale Nephrotic syndrome usually leads to decreased urinary output or oliguria as the body retains sodium and water in response to low intravascular volume. Increased urinary output would be inconsistent with the pathophysiological fluid retention seen in this disorder..