Nephrology

512 Investigations Nephritic-Nephrotic Syndrome

  • Investigations Nephritic-Nephrotic Syndrome  

    Ward investigation

    • Ward test of urine (blood, protein, pH, glucose) at least daily
    • Accurate Fluid Balance chart, particularly urine volume 
    • (Weigh nappies if necessary)
    • Daily body weight - 0600
    • Lying Blood Pressure, recording 1-4 hourly as necessary

    Biochemistry

    Plasma Urea, Creatinine,  Electrolytes,  Calcium,  Phosphate,  Alkaline Phosphatase,  Proteins,  Cholesterol,  Uric Acid.

    Urine Protein Excretion

    Either

    • Urine Protein and Creatinine concentrations,  preferably on an early morning urine sample.  (Normal < 30 mg protein/mmol creatinine for children over 3 years)
    • Timed Over-night Protein Excretion. (Normal <4mg/hr/m2, Nephrotic >40 mg/hr/m2)
    • 24 hr urine protein excretions have been replaced by the above methods  

    Creatinine clearance is rarely measured nowadays and has been replaced by 51Cr EDTA or DTPA clearances in selected cases.  For most purposes, a sufficiently accurate estimate of creatinine clearance can be calculated from the Schwartz formula:  Creatinine Clearance (ml/min/1.73m2) = 40 x Height (cm) / Serum Creatinine (umol/l)

    Nuclear Medicine

    DTPA or 51CrEDTA clearances (selected cases only)

    Haematology

    • FBE, film
    • ESR
    • PTT
    • Prothrombin / INR
    • Fibrinogen

    Bacteriology

    Urine microscopy and culture ( Mid- stream or Bag specimen initially, not SPA as haematuria cannot be interpreted in SPA specimens). Phase contrast microscopy for red cell morphology (glomerular or non-glomerular morphology)

    Virology (selected cases only)

    • Hepatitis B Surface Antigen
    • Hepatitis C and CMV antibodies
    • HIV antibodies

    Immunology

    • Serum Complement ( C3 and C4) Immunoglobulins
    • Anti- Double Stranded DNA 
    • ANF
    • ASO Titre
    • Anti- streptococcal DNase B titre
    • Anti-Neutrophil Cytoplasmic Antibody (ANCA)