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nephrotic syndrome


ED Mx of the adult with suspected acute nephrotic syndrome

  • CXR
  • ECG
  • FBE, U&E, LFTs, glucose as initial investigations and consider venous blood gas and ketones in diabetic
  • FWT urine looking for protein, blood, casts
    • normal urinary albumin is less than 25mg/dL
    • early morning spot urine protein:creatinine ratio (typically > 3-3.5mg protein to mg creatinine
  • start strict fluid balance chart
  • daily weigh
  • avoid transfusing with serum albumin as likely to just leak out into urine
  • blood pressure control eg. GTN patch, oral ACE inhibitors
  • if fluid overloaded consider starting low dose bd frusemide - consider iv rather than oral as GIT absorption may be impaired and diuretic efficacy is impaired BUT risk of otoxicity is higher than usual
  • once nephrotic syndrome confirmed by low serum albumin and high urinary protein:
    • MSU m/c/s including phase contrast micro, protein:CRN ratio
      • normal urinary albumin:CRN ratio is < 2.5mg/mmol CRN
    • 24hr urine for protein, free light chains, protein electrophoresis, Bence-Jones proteins
    • CT KUB and/or renal USS
    • discuss with nephrology and consider sending bloods for:
      • HbA1c (if diabetic)
      • Hb electrophoresis
      • serum light chains
      • Ca, Phosphate, Mg, TSH
      • coagulation profile
      • HIV, HepB/C if at risk
      • uric acid, CK, fasting lipids
    • admit under nephrology
nephrotic_syndrome.txt · Last modified: 2022/08/05 22:54 by gary1

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