A patient presents with generalized edema, low albumin, high cholesterol, and urinary protein with oval fat bodies and fatty casts. What is the presumptive diagnosis?

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The main idea is recognizing nephrotic syndrome from a cluster of findings: edema, low serum albumin, high cholesterol, and heavy proteinuria with lipid-rich urine. When the kidneys leak large amounts of protein, albumin drops in the blood, lowering oncotic pressure and causing fluid to accumulate as edema. The liver then makes more lipids, leading to hyperlipidemia. The heavy protein loss also produces lipid-containing urine, yielding oval fat bodies and fatty casts. This combination—edema with hypoalbuminemia, hyperlipidemia, and marked proteinuria with lipiduria—is classic for nephrotic syndrome. In contrast, nephritic syndrome would feature hematuria and hypertension with fewer lipids in the urine, dehydration wouldn’t explain fatty casts, and acute tubular necrosis presents with different casts (muddy brown) and clinical signs.