Which protein increases up to ten-fold in nephrotic syndrome?

• A. A2-MG
• B. Haptoglobin
• C. Ceruloplasmin
• D. Albumin

Answer: (A)

In nephrotic syndrome the liver compensates for heavy loss of albumin by ramping up production of other plasma proteins, especially acute‑phase reactants. Alpha-2 macroglobulin is a major liver-produced protein that increases markedly in this state, often reaching about ten times its normal level. Its large size means it’s less prone to urinary loss than albumin, so its concentration in blood rises noticeably as part of the hepatic response. While other acute‑phase proteins like haptoglobin or ceruloplasmin can increase as well, the most pronounced rise among these options is seen with alpha-2 macroglobulin. Meanwhile, albumin decreases due to urinary loss, not increases.