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Investigation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:

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