How to Diagnose Childhood Nephrotic Syndrome

Nephrotic syndrome is caused by loss of large amount of plasma protein due to the increased permeability of glomerular filtration memebrane. It is a common glomerular disease in children and its incidence is next to that of acute nephritis with age 3 to 5 the peak age.

Similar with adult nephrotic syndrome, the typical symptoms of childhood nephrotic syndrome are also three highs and one low---massive proteinuria, edema, hyperlipidemia, hypoalbuminemia. Those that have the above four symptoms can be diagnosed as NS with massive proteinuria and hypoalbuminemia the must conditions.

The tests and examinations that need to be done for diagnosing NS in children mainly include routine urine test, plasma protein, serum cholesterol and kidney function.

1. Routine urine test. It is the most effective diagnostic method of childhood nephrotic syndrome and it is done to check weather the protein in urine exceeds the normal range. The urine protein qualitative is usually more than +++. Urine protein of 50mg/kg or urine total protein/creatinine of 3mg/mg indicates kidney diseases. Urinary protein electrophoresis can help know the selectivity of the proteinuria.

2. Plasma protein. It is the further test which can help exam weather the protein concentration in the blood is lower than the normal level. The total protein in plasma is reduced and the decrease of albumin is especially obvious. When the serum albumin is lower than 30g/L it can be diagnosed as hypoalbuminemia in NS. Immune globubin IgG and IgA is generally low and IgM is sometimes high.

3. Serum cholesterol. Hyperlipidemia is one complication of childhood NS. The examination of serum cholesterol can help better understand the children’s illness conditions and make more accurate diagnosis. The cholesterol is higher than 5.7 mmol/l. The triglycerides, low density lipoprotein and very-low density lipoprotein will increase and high-density lipoprotein is usually normal.

4. Kidney function test. Often kidney function test is in the normal range and there can be temporary increase of urea nitrogen and the renal tubular function is usually normal.

5. Routine blood test. Sometimes there is obvious pressure increase of hemoglobin and red blood cell. Children suffering from long term disease usually have small cell anemia and increased platelet.

Besides, other tests include serum complement determination, high condensation state and the formation of thrombosis.

Usually renal biopsy is not needed; however it should be done for those that are not sensitive to glucocorticoid or not minimal change nephropathy.