u/Haunting-Bake-7338

19M. My LDL came very high twice: 365.7 and 349 mg/dL. Total cholesterol was 461 then 397.

Also albumin is low: 2.9 then 2.1 g/dL, total protein 5.2 then 3.8, and urine protein is ++. Creatinine is normal at 0.7, eGFR 158. TSH mildly high at 5.97.

Could this be familial hypercholesterolemia, nephrotic syndrome/kidney protein leak, or both? Urine protein/creatinine ratio is pending. Seeing a doctor soon.

19M. Recent labs show a concerning pattern:

- Total cholesterol: 461, repeat 397 mg/dL

- LDL: 365.7, repeat direct LDL 349 mg/dL

- Triglycerides: 229, repeat 161 mg/dL

- Albumin: 2.9, repeat 2.1 g/dL

- Total protein: 5.2, repeat 3.8 g/dL

- Urine protein: ++

- Creatinine: 0.7 mg/dL

- eGFR: 158 mL/min

- TSH: 5.97 with normal total T3/T4

- Glucose and HbA1c normal

- CBC mostly normal

- Liver enzymes normal

Urine protein/creatinine ratio is pending.

Question:

Does this combination of very high LDL + very low albumin/total protein + urine protein suggest nephrotic syndrome or another kidney protein-loss issue, even with normal creatinine/eGFR? Could familial hypercholesterolemia also be possible?

Which specialist should I see first: nephrologist, cardiologist/lipid specialist, or endocrinologist? What tests should I prioritize next?