investigation
Last reviewed 01/2018
Purpose of investigations in nephrotic syndrome (NS) is- (1) confirm the clinical diagnosis;
- (2) seek a possible cause;
- (3) assess renal function; and
- (4) identify biochemical disorders related to the nephrotic state e.g. hypercoagulability, hypovolaemia, hyperlipidaemia
Finding of heavy proteinuria (3-4+) on dipstick and oedema in a child in the developed world usually means a diagnosis of NS. Proteinuria needs to be quantified as the protein: creatinine ratio or per litre of urine
- proteinuria is usually measured on first morning spot voids
- microscopic haematuria may be present in up to 25% of children with steroid-sensitive NS and should not be a contraindication to empirical steroid therapy
- recommended investigations in a child (2)
- urine dipstick analysis (protein and blood)
- first morning urine for protein:creatinine ratio
- urine for microscopy, sensitivity and culture
- serum electrolytes, albumin, triglyceride and cholesterol, calcium
- FBC
- haemoglobin and packed cell volume
- complement C3 and C4 levels
- varicella zoster serology
- hepatitis B and C serology
- ASO titre, anti-DNAse B, lupus antibody serology (ANA, ENA, ds- DNA), ANCA if atypical presenting features
Reference:
- (1) Lancet (1995); 346 (8969):148-52.
- (2) Dolon MN, Gill D. Management of nephrotic syndrome. Paediatrics and Child Health 2002:369-374.