Investigation of Nephrotic Syndrome (NS)

Investigation of Nephrotic Syndrome (NS)

Laboratory Tests

1. Urine Tests*

a. Physical colour and appearance

b. Urine specific gravity

i. Concentration of all chemical particles in the urine

c. Microscopic appearance

i. Look at cells, urine crystals, mucus, etc

ii. Identify bacteria or other microorganisms

d. Chemical appearance

i. Dipstick tests

e. Normal results

i. Colour: colourless to dark yellow

ii. USUALLY, glucose, ketones, proteins, bilirubin are not detectable

iii. Hemoglobin, nitrites, RBC, WBC are not normally found in urine

f. NS results

i. Protein in urine > 100mg/dL (value as high as 1000mg/L are common)

ii. Blood in urine

2. Blood Tests

a. Low levels of the protein albumin (hypoalbuminemia)

i. Below normal range of 3.5~4.5 g/dL

b. Decreased levels of blood protein overall

i. Cause an increase in blood cholesterol & triglycerides

c. Serum creatinine and blood urea nitrogen (BUN)

i. Assess overall kidney function

ii. Normal adult serum creatinine level is ~ 1mg/dL

3. Kidney biopsy

a. Detects underlying cause and extent of disease

Imaging studies (no routine imaging for patients with NS)

1. Ultrasound

a. Normal to slightly enlarged kidney

b. Determine whether patient possesses 2 kidneys

i. 1 kidney à prone to developing focal glomerulosclerosis

ii. Contraindication to kidney biopsy

c. Demonstrate their echogenicity

i. Increased echogenicity à intrarenal fibrosis (chronic disease with reduced kidney function)

Other tests

1. Infants with NS, genetic testing for NPHS1 & NPHS2 mutation

2. In adults, tests for hepatitis B, C, HIV, or sysphilis

References:

http://www.mayoclinic.com/health/nephrotic-syndrome/DS01047/DSECTION=tests-and-diagnosis

http://emedicine.medscape.com/article/244631-diagnosis

http://www.nlm.nih.gov/medlineplus/ency/article/000490.htm

http://www.nephroticsyndrome.com/app/investigations.asp