How is it Diagnosed?
Nephrotic syndrome is diagnosed based on a characteristic constellation of clinical and
laboratory findings. Patients typically present with generalized edema, particularly
periorbital swelling, ascites, and peripheral edema. A detailed history may reveal recent
infections or allergies, and physical examination confirms fluid accumulation without
signs of cardiac or hepatic disease.
Urinalysis is the cornerstone of diagnosis, revealing heavy proteinuria—typically more
than 3.5 grams per day in adults or a protein-to-creatinine ratio >2 mg/mg in children. A
dipstick test usually shows 3+ or 4+ protein. Spot urine protein/creatinine ratio is a
convenient alternative to 24-hour urine collection.
Blood tests show hypoalbuminemia (serum albumin <2.5 g/dL), hyperlipidemia, and
possibly elevated serum creatinine if renal function is impaired. Serum cholesterol and
triglycerides are often markedly increased.
Further evaluation may include renal ultrasound to rule out structural abnormalities. In
secondary or atypical cases, serologic tests for autoimmune diseases (e.g., ANA, antidsDNA), infections (e.g., hepatitis B/C, HIV), or other systemic conditions may be
conducted. A kidney biopsy is recommended in adults and select pediatric cases to
determine the underlying histopathology (e.g., minimal change disease, focal segmental
glomerulosclerosis).
Accurate diagnosis enables targeted treatment and monitoring to prevent relapses and
long-term renal complications.