Nephrotic syndrome, protein urea and edema. Background: Nephrotic syndrome is a clinical syndrome defined by massive proteinuria responsible for hypo-albuminemia, with resulting hyperlipidemia, edema, and various complications. Aim of the study: to see the clinical presentation of cases of nephrotic syndrome in IRAQI patients and the possible causes of relapses Material and Methods: Forty children with nephrotic syndrome admitted to Al-Mansour Teaching Hospital. A full physical examination was done to each patient and all undergo the following investigations: Urinalysis, urine culture, serum cholesterol, total serum protein, serum protein electrophoresis and chest roentgenogram. Renal biopsy was done only for one patient. The treatment received and the outcome of these cases were recorded. Results: The symptoms of associated infections (fever, cough, abdominal pain, vomiting and diarrhea) were more frequent among the patients with relapse than the newly diagnosed patients. The most obvious sign in all nephrotic patients was edema. Ascites found in (55.5%) of newly diagnosed cases , and in (31.8 %) of patients with relapses , Hypertension (blood pressure more than 95 % for age and sex) .(55.5 %) of patients with relapse who had hypertension , were frequent relapses. Abdominal tenderness was more common among the patients with relapse. Discussion: The peak age incidence in this study was between 1-5 years and there was decreases in incidence below on and above 10 years of age. Edema was found as a symptom and sign. Localized edema in the periorbital area or in the legs at presentation was found only in small number of the patients (15%) this may be due to the delay in the consultation until the edema becomes generalized (table 4 and 5). Generalized edema was the most common presenting symptom in nephrotic patients and oliguria was the next common symptom. Conclusion: Generalized edema was the most common presenting symptom in nephrotic patients and oliguria was the next common symptom.