Nephrotic syndrome laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings
For the diagnosis of nephrotic syndrome[1]:
- 24-hour urine collection shows proteinuria > 3.5g/24 hrs
- Urine dipstick confirms proteinuria
- Urine protein/creatinine ratio > 3
When nephrotic syndrome is diagnosed (proteinuria > 3.5 g/24 hrs), the following laboratory evaluation is needed[1]:
- Low serum albumin levels
- Serum chemistry panel is generally normal. Pseudohyponatremia due to hyperlipidemia may be present.
- Abnormal lipid panel
- Normal/elevated plasma creatinine levels
Other tests may be necessary to rule-out secondary etiologies of nephrotic syndrome[1]:
- Fasting plasma glucose
- Antinuclear antibody (ANA) panel
- Hepatic enzymes
- Serologic tests for HBV and HCV
- HIV screening test
- Rheumatoid factor
- Cryoglobulins
- Complement C3 and C4 levels
- VDRL or RPR
- Serum and urine protein electrophoresis
Renal Biopsy
Renal biopsy is usually recommende for patients with nephrotic syndrome. Renal biopsy provides diagnostic and prognostic benefit. However, guidelines that define the timing and the circumstances to perform renal biopsy are not present. In minimal change disease, the most common primary cause of nephrotic syndrome in children, and in diabetic nephropathy, the most common secondary cause of nephrotic syndrome in adults, renal biopsy is not generally recommended and is not routinely performed.[1]