Membranoproliferative glomerulonephritis laboratory findings: Difference between revisions

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{{Membranoproliferative glomerulonephritis}}
{{Membranoproliferative glomerulonephritis}}
{{CMG}}
{{CMG}} {{JSS}}
==Overview==
==Overview==
MPGN laboratory findings include [[urinalysis]], [[renal function tests]], [[Complete blood count|complete blood counts]][[Complement|, complement profile]] and other diagnostic tests for evaluating the cause of MPGN.
==Laboratory Findings==
==Laboratory Findings==


* Urinalysis
=== Urinalysis ===
:* Glomerular hematuria; characterized by dysmorphic red blood cells (RBCs) and RBC casts
:* Glomerular [[hematuria]]; characterized by dysmorphic red blood cells (RBCs) and [[Urinary casts|RBC casts]]<ref name="pmid22435371">{{cite journal| author=Sethi S, Fervenza FC| title=Membranoproliferative glomerulonephritis--a new look at an old entity. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 12 | pages= 1119-31 | pmid=22435371 | doi=10.1056/NEJMra1108178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22435371  }} </ref>
:* Proteinuria is almost always present.
:* [[Proteinuria]] is almost always present.
:* Urine protein creatinine ratio is a good estimate of 24-hour urinary protein excretion.
:* Urine protein creatinine ratio is a good estimate of 24-hour urinary protein excretion.
:* Nephrotic proteinuria is present in approximately 50% of patients.
:* Nephrotic proteinuria is present in approximately 50% of patients.
* Serum chemistries
 
:* Elevated serum creatinine and blood urine nitrogen and a decreased estimated glomerular filtration rate (GFR) are evident in 20-50% of patients at presentation. Patients with a nephritic presentation typically have a decreased GFR.
=== Serum chemistries ===
:* Hyperlipidemia and low albumin may be seen with nephrotic syndrome.
:* Elevated serum [[creatinine]] and blood urine nitrogen and a decreased estimated [[glomerular filtration rate]] (GFR) are evident in 20-50% of patients at presentation. Patients with a [[Nephritic syndrome|nephritic]] presentation typically have a decreased GFR<ref name="pmid7723253">{{cite journal| author=Rennke HG| title=Secondary membranoproliferative glomerulonephritis. | journal=Kidney Int | year= 1995 | volume= 47 | issue= 2 | pages= 643-56 | pmid=7723253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7723253  }} </ref>.
* CBC with differential: Most often, patients have a normocytic normochromic anemia.
:* [[Hyperlipidemia]] and low [[albumin]] may be seen with [[nephrotic syndrome]].
* Complement profile - MPGN type I
 
:* C3 levels are low in about half of the patients.
=== CBC with differential: ===
:* Evidence of activation of the classic pathway of complement (ie, low C4, C2, C1q, B, C3)
* Most often, patients have a [[Anemia|normocytic normochromic anemia]]
======Urine analysis======
*May show [[proteinuria]]
======Renal function tests======
*Serum [[creatinine]] and [[Blood urea nitrogen|BUN]] might be elevated
======Complement profile======
*C3, C4 and CH50 levels for [[Complement|classic complement pathway]]
*AH50 levels for alternate complement pathway
*C3 nephritic factor levelsj<ref name="pmid2662048">{{cite journal| author=Bourke E, Campbell WG, Piper M, Check IJ| title=Hypocomplementemic proliferative glomerulonephritis with C3 nephritic-factor-like activity in multiple myeloma. | journal=Nephron | year= 1989 | volume= 52 | issue= 3 | pages= 231-7 | pmid=2662048 | doi=10.1159/000185648 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2662048  }}</ref>
======Serum ANA======
*Postive serum [[Antinuclear antibodies|ANA]] means autoimmune disease etiology
======Blood culture======
*Chronic bacterial infections
=====Sequence of Diagnostic Studies=====
The urinalysis and comprehensive chemistry panel should be performed when:<ref name="pmid21566055">{{cite journal |vauthors=Qin W, Beck LH, Zeng C, Chen Z, Li S, Zuo K, Salant DJ, Liu Z |title=Anti-phospholipase A2 receptor antibody in membranous nephropathy |journal=J. Am. Soc. Nephrol. |volume=22 |issue=6 |pages=1137–43 |date=June 2011 |pmid=21566055 |pmc=3103733 |doi=10.1681/ASN.2010090967 |url=}}</ref>
*The patient presented with signs of hypertension and proteinurea
*Complete blood count
*Urinaylsis
*A positive [[ANA]], anti [[DsDNA virus|dsDNA]] suggest the diagnosis of membranous glomerulonephritis
*To confirm the diagnosis we do [[renal biopsy]]
=== Complement profile - ===
* MPGN type I<ref name="pmid18408474">{{cite journal| author=Alpers CE, Smith KD| title=Cryoglobulinemia and renal disease. | journal=Curr Opin Nephrol Hypertens | year= 2008 | volume= 17 | issue= 3 | pages= 243-9 | pmid=18408474 | doi=10.1097/MNH.0b013e3282f8afe2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18408474  }} </ref>
:* [[C3-convertase|C3]] levels are low in about half of the patients.
:* Evidence of activation of the classic pathway of [[complement]] (ie, low C4, C2, C1q, B, C3)
:* Terminal complement components C3, C5, C8, and C9 may be low or within the reference range.
:* Terminal complement components C3, C5, C8, and C9 may be low or within the reference range.
:* NFc (C4NeF) or NFt may be present.
:* NFc (C4NeF) or NFt may be present.
* Complement profile - MPGN type II
* MPGN type II
:* C3 levels are low in 70-80% of patients.
:* C3 levels are low in 70-80% of patients.
:* Early and terminal complement components are within the reference range.
:* Early and terminal [[Complement|complemen]]<nowiki/>t components are within the reference range.
:* NFa (C3NeF) is present in more than 70% of patients.
:* NFa (C3NeF) is present in more than 70% of patients.
* Complement profile - MPGN type III
* MPGN type III
:* C3 levels are decreased in 50% of patients.
:* C3 levels are decreased in 50% of patients.
:* C1q and C4 levels are within the reference range.
:* C1q and C4 levels are within the reference range.
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:* NFa is absent and NFt is present in 60-80% of patients.
:* NFa is absent and NFt is present in 60-80% of patients.
:* Antistreptolysin-O (ASO) titers may be elevated in as many as 50% of patients at presentation.
:* Antistreptolysin-O (ASO) titers may be elevated in as many as 50% of patients at presentation.
* To rule out secondary causes, obtain antinuclear antibodies, hepatitis screens, cryoglobulins, urine, and serum protein electrophoresis.
* To rule out secondary causes, obtain [[antinuclear antibodies]], [[hepatitis]] screens, [[Cryoglobulinemia|cryoglobulin]]<nowiki/>s, urine, and serum protein electrophoresis.


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Nephrology]]
[[Category:Nephrology]]

Latest revision as of 20:21, 6 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Jogeet Singh Sekhon, M.D. [2]

Overview

MPGN laboratory findings include urinalysis, renal function tests, complete blood counts, complement profile and other diagnostic tests for evaluating the cause of MPGN.

Laboratory Findings

Urinalysis

  • Glomerular hematuria; characterized by dysmorphic red blood cells (RBCs) and RBC casts[1]
  • Proteinuria is almost always present.
  • Urine protein creatinine ratio is a good estimate of 24-hour urinary protein excretion.
  • Nephrotic proteinuria is present in approximately 50% of patients.

Serum chemistries

CBC with differential:

Urine analysis
Renal function tests
Complement profile
Serum ANA
  • Postive serum ANA means autoimmune disease etiology
Blood culture
  • Chronic bacterial infections
Sequence of Diagnostic Studies

The urinalysis and comprehensive chemistry panel should be performed when:[4]

  • The patient presented with signs of hypertension and proteinurea
  • Complete blood count
  • Urinaylsis
  • A positive ANA, anti dsDNA suggest the diagnosis of membranous glomerulonephritis
  • To confirm the diagnosis we do renal biopsy

Complement profile -

  • C3 levels are low in about half of the patients.
  • Evidence of activation of the classic pathway of complement (ie, low C4, C2, C1q, B, C3)
  • Terminal complement components C3, C5, C8, and C9 may be low or within the reference range.
  • NFc (C4NeF) or NFt may be present.
  • MPGN type II
  • C3 levels are low in 70-80% of patients.
  • Early and terminal complement components are within the reference range.
  • NFa (C3NeF) is present in more than 70% of patients.
  • MPGN type III
  • C3 levels are decreased in 50% of patients.
  • C1q and C4 levels are within the reference range.
  • Terminal complement components are low, especially if C3 is markedly depressed.
  • NFa is absent and NFt is present in 60-80% of patients.
  • Antistreptolysin-O (ASO) titers may be elevated in as many as 50% of patients at presentation.

References

  1. ↑ Sethi S, Fervenza FC (2012). "Membranoproliferative glomerulonephritis--a new look at an old entity". N Engl J Med. 366 (12): 1119–31. doi:10.1056/NEJMra1108178. PMID 22435371.
  2. ↑ Rennke HG (1995). "Secondary membranoproliferative glomerulonephritis". Kidney Int. 47 (2): 643–56. PMID 7723253.
  3. ↑ Bourke E, Campbell WG, Piper M, Check IJ (1989). "Hypocomplementemic proliferative glomerulonephritis with C3 nephritic-factor-like activity in multiple myeloma". Nephron. 52 (3): 231–7. doi:10.1159/000185648. PMID 2662048.
  4. ↑ Qin W, Beck LH, Zeng C, Chen Z, Li S, Zuo K, Salant DJ, Liu Z (June 2011). "Anti-phospholipase A2 receptor antibody in membranous nephropathy". J. Am. Soc. Nephrol. 22 (6): 1137–43. doi:10.1681/ASN.2010090967. PMC 3103733. PMID 21566055.
  5. ↑ Alpers CE, Smith KD (2008). "Cryoglobulinemia and renal disease". Curr Opin Nephrol Hypertens. 17 (3): 243–9. doi:10.1097/MNH.0b013e3282f8afe2. PMID 18408474.

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