LabMed

Nephrotic Syndrome

At a Glance

Nephrotic syndrome is included in the differential diagnosis of patients with peripheral edema. Nephrotic syndrome is characterized by:

  1. pitting-edema

  2. hypoalbuminia

  3. proteinuria (in adults: ≥3.5 g/24 hours)

  4. hyperlipidemia (increased cholesterol and/or triglycerides)

What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?

The clinician should measure serum albumin, 24-hour urine protein excretion, and a fasting lipid profile. It would also be prudent to evaluate renal function overall by performing a urinalysis and measuring creatinine, estimated glomerular filtration rate, and blood urea nitrogen (BUN). (Table 1)

What Lab Results Are Absolutely Confirmatory?

A 24-hour urinary protein excretion is absolutely confirmatory.

What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?

Urine protein electrophoresis can help identify the type of proteinuria: glomerular, tubular, combined glomerular and tubular, overflow, or non-selective proteinuria.

The differential diagnosis of the nephrotic syndrome is very broad and includes:

  • glomerular diseases (e.g., minimal change nephropathy, focal and segmental glomerulosclerosis, and hyalinosis, membranous glomerulopathy, proliferative glomerulonephritis, membranoproliferalite glomerulonephritis (GN), cresentic GN, mesangial proliferative GN, and focal and segmental proliferative glomerulonephritis)

  • various secondary disorders (e.g., infectious: acute post-streptococcal glomerulonephritis, infectious mononucleosis; drugs: organic gold, Hg, penicillamine, antivenom, antitoxins, contrast media; neoplasia: Hodgkin disease, lymphomas, leukemias, carcinoma, melanoma, Wilm’s tumor; multisystem diseases: SLE, HSP, vasculitis, Goodpasteur’s syn, dermatomyositis, amyloidosis, sarcoidosis, Sjogren’s syn; hereditary disorders: diabetes mellitus, Alport syndrome, sickle cell disease, Fabry disease, congenital nephrotic syn)

  • miscellaneous causes (e.g., preeclamptic toxemia, renovascular hypertension, and chronic interstitial nephritis)

References

Winter, WE, Harris, NS, Winter, WE. "Urine protein electrophoresis". Multiple Myeloma and Related Serum Protein Disorders: An Electrophoretic Guide. Demos Medical Publishing. 2012. pp. pp83-116.

(Provides an up-to-date review of causes and patterns of proteinuria.)

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