Which tests are performed in the workup of pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

In order to establish the presence of nephrotic syndrome, laboratory tests should confirm (1) nephrotic-range proteinuria, (2) hypoalbuminemia, and (3) hyperlipidemia. Therefore, initial laboratory testing should include the following:

  • Urinalysis

  • Urine protein quantification (preferably first-morning urine protein/creatinine ratio)

  • Serum albumin measurement

  • Lipid panel

The following tests should be performed to determine whether the nephrotic syndrome is primary/idiopathic (INS) or secondary and—if INS has been determined—whether signs of chronic kidney disease or extra-renal disease exclude the possibility of minimal change nephrotic syndrome (MCNS):

  • Complete blood cell (CBC) count

  • Complete metabolic panel that includes serum electrolytes, calcium, phosphorus, albumin, blood urea nitrogen (BUN), creatinine, aspartate aminotransferase (AST), and alanine aminotransferase (ALT)

  • Ionized calcium (because the total calcium level will be low in patients with hypoalbuminemia)

  • Testing for human immunodeficiency virus (HIV)

  • Testing for hepatitis B and C viruses

  • Complement studies (C3, C4)

  • Antinuclear antibody (ANA), anti–double-stranded DNA antibody (in selected patients)

Other tests and procedures in selected patients may include the following:

  • Genetic studies

  • Kidney ultrasonography

  • Chest radiography

  • Mantoux test

  • Kidney biopsy

See Workup for more detail.


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