investigations for nephrotic syndrome

Nephrotic syndrome

Urine

 Dipstick (haematuria, proteinuria)
- Nephrotic range proteinuria will be apparent by 3+ or 4+
readings on the dipstick. A 3+ reading is 300 mg/dL of
urinary protein or more.

 24 hour collection (protein excretion, creatinine clearance)
- In healthy individuals, there are no more than 150 mg of
total protein in a 24-hour urine collection.
- The normal adult serum creatinine level is approximately
1 mg/dL, whereas that of a child aged 5 years will
be about 0.5 mg/dL. Values higher than this
indicate reduced kidney function.

 Microscopy (RBCs, casts)
- Waxy casts mark proteinuric renal disease. By use of a
polarizing microscope, one can see oval fat bodies and
also fatty casts. These point to the nephrotic
syndrome. They occur because of glomerular filtration
of lipoproteins, the uptake of these by the tubular cells
that then fall off into the urine. Viewed by polarizer,
the oval fat bodies and fatty casts cause a "Maltese
cross" appearance.

Blood
 FBC + Haematocrit (to check for hypovolaemia)
 U&E (creatinine , albumin )
 Liver Function Test
 Erythrocyte sedimentation rate, ESR
 CRP
 Cholesterol (raised cholesterol confirms diagnosis)
 Serum electrophoresis (Calcium and magnesium)
 complement (C3,C4) & Immunoglobulins (IgG & C3 reduced if nephrotic syndrome due to inflammatory condition, 25% have raised IgE)
 Autoantibodies (ANA, NACA, anti-dsDNA)
 HBV serology (Hep B)

Imaging
 On chest radiographs, pleural effusions (collection of fluid in the membranous covering of lungs) are not uncommon and their presence correlates directly with the degree of edema and indirectly with the serum albumin concentration. Ascites is common.
 Renal sonography usually reveals normal to slightly enlarged kidneys

Renal biopsy
 For childhood nephrotic syndrome, a renal biopsy is indicated for the following:
- Congenital nephrotic syndrome
- Children older than 8 years at onset
- Steroid resistance
- Frequent relapses or steroid dependency
- Significant nephritic manifestations
 Adult nephrotic syndrome of unknown origin may require a renal biopsy for diagnosis.
 A renal biopsy is not indicated in adults when nephrotic syndrome is due to an obvious cause, such as diabetes mellitus. Thus, a subject with diabetes, diabetic retinopathy, and the nephrotic syndrome may well have diabetic nephropathy and not need to undergo kidney biopsy.

Type 1 DM

 Fasting blood sugar test
A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

 Plasma HCO3- and arterial pH may be low, ketones may be present in urine.