Minimal change disease laboratory findings: Difference between revisions

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__NOTOC__
__NOTOC__
{{Minimal change disease}}
{{Minimal change disease}}
{{CMG}}; {{AE}} {{VKG}}
==Overview==
Laboratory findings in minimal change disease include elevated [[hematocrit]], [[pseudohyponatremia]], [[hypocalcemia]], and abnormal lipid panel.  Findings of urine analysis include elevated [[urinary specific gravity]], [[proteinuria]] that might reach [[nephrotic]] range, high urinary protein-[[creatinine]] ratio, microscopic [[hematuria]], and lipid-laden cells.
==Laboratory Findings==
==Laboratory Findings==
===Blood===
===Blood===
*Elevated hematocrit due to volume contraction
* [[Fibrinogen]], factors V and VIII, and [[protein C]] increases and increased risk of thrombosis due to  hypercoagulability.<ref name="pmid279404604">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref><ref name="pmid22344511">{{cite journal |vauthors=Kerlin BA, Ayoob R, Smoyer WE |title=Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease |journal=Clin J Am Soc Nephrol |volume=7 |issue=3 |pages=513–20 |date=March 2012 |pmid=22344511 |pmc=3302669 |doi=10.2215/CJN.10131011 |url=}}</ref>
*Serum electrolytes may show pesudohyponatremia, defined as low serum sodium levels due to elevated serum lipids
*Hypocalcemia
*Hypovitaminosis D
*Normal/elevated serum creatinine
*Hypoalbuminemia
*Abnormal lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides)
*ANA panel is usually normal
*Complement levels are usually normal


*Elevated [[hematocrit]] due to volume contraction.<ref name="pmid279404605">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref>
*Serum electrolytes may show [[pseudohyponatremia]], defined as low serum sodium levels due to elevated serum lipids.
*[[Hypocalcemia]].
*Hypovitaminosis D.
*Normal/elevated serum [[creatinine]].
*[[Hypoalbuminemia]].
*Abnormal [[lipid profile]] (total [[cholesterol]], [[LDL-C]], [[HDL-C]], [[triglyceride]]s) due to<ref name="pmid279404606">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref>
**Decreased activity of [[lipoprotein lipase]].
**Decreased [[LDL]] receptor activity.
**Increased urinary loss of [[HDL]] and [[antithrombin III]].
*[[IgG]] decreased.
*[[IgA]] is minimally reduced.<ref name="pmid24527245">{{cite journal |vauthors=Oberweis BS, Mattoo A, Wu M, Goldfarb DS |title=Minimal change disease and IgA deposition: separate entities or common pathophysiology? |journal=Case Rep Nephrol |volume=2013 |issue= |pages=268401 |date=2013 |pmid=24527245 |pmc=3914242 |doi=10.1155/2013/268401 |url=}}</ref>
*[[IgM]] is increased.
===Urine===
===Urine===
24-hour urinary analysis is indicated in the work-up of minimal change disease.              
* 24-hour urinary analysis is indicated in the work-up of [[minimal change disease]].<ref name="pmid27940460">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref><ref name="VivarelliMassella2017">{{cite journal|last1=Vivarelli|first1=Marina|last2=Massella|first2=Laura|last3=Ruggiero|first3=Barbara|last4=Emma|first4=Francesco|title=Minimal Change Disease|journal=Clinical Journal of the American Society of Nephrology|volume=12|issue=2|year=2017|pages=332–345|issn=1555-9041|doi=10.2215/CJN.05000516}}</ref>              
*Elevated urinary specific gravity
*Proteinuria that might reach nephrotic-range
*High urinary protein-creatinine ratio
*Microscopic hematuria
*Lipid-laden cells
 
===Imaging===
Imaging in nephrotic syndrome is usually unremarkable.
 
===Kidney Biopsy===
A kidney biopsy is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012<ref name="pmid23871408">{{cite journal| author=Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH et al.| title=KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. | journal=Am J Kidney Dis | year= 2013 | volume= 62 | issue= 3 | pages= 403-41 | pmid=23871408 | doi=10.1053/j.ajkd.2013.06.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871408  }} </ref>, an initial attempt using corticosteroids should be performed before a renal biopsy is performed.
 
====Light Microscopy====
A renal biopsy of minimal change disease shows no abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular epithelium. Additional features of focal segmental glomerulosclerosis, such as mesangial prominence, interstitial fibrosis, and tubular atrophy, or glomerular tip lesions of FSGS, may be seen in patients who have complicated disease.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572  }} </ref> Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572  }} </ref>
 
====Immunofluorescence====
Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.<ref name="pmid12704572">{{cite journal| author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. | journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 | doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572  }} </ref>


====Electron Microscopy====
*Elevated [[urinary specific gravity]].
Electron-microscopy is required for the diagnosis of minimal change disease. It shows effacement (fusion) of podocytes, which are visceral epithelial cells, with slit-pore membrane obliteration between podocyte foot processes.  However, podocyte effacement is not specific and should not be considered pathognomonic of the disease.<ref name="pmid12704572">{{cite journal|author=D'Agati V| title=Pathologic classification of focal segmental glomerulosclerosis. |journal=Semin Nephrol | year= 2003 | volume= 23 | issue= 2 | pages= 117-34 | pmid=12704572 |doi=10.1053/snep.2003.50012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12704572  }} </ref>
*[[Proteinuria]] that might reach [[nephrotic]] range.
*High urinary protein-[[creatinine]] ratio.
*Microscopic [[hematuria]].
*Lipid-laden cells.
*Gross [[hematuria]].<ref name="pmid279404602">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref>
*Urinary dipstick showing 3+/4+ [[proteinuria]] (≥300 mg/dl).<ref name="pmid279404603">{{cite journal |vauthors=Vivarelli M, Massella L, Ruggiero B, Emma F |title=Minimal Change Disease |journal=Clin J Am Soc Nephrol |volume=12 |issue=2 |pages=332–345 |date=February 2017 |pmid=27940460 |pmc=5293332 |doi=10.2215/CJN.05000516 |url=}}</ref>
*Urine protein-to-[[creatinine]] ratio >200 mg/mmol.
*Urine [[Protein|proteins]] >3.5 g/d in adults.<ref name="pmid17699450">{{cite journal |vauthors=Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, D'Agati V, Appel G |title=Adult minimal-change disease: clinical characteristics, treatment, and outcomes |journal=Clin J Am Soc Nephrol |volume=2 |issue=3 |pages=445–53 |date=May 2007 |pmid=17699450 |doi=10.2215/CJN.03531006 |url=}}</ref>
*Increased ''α''2-[[globulin]] and a reduced ''γ''-[[globulin]] fraction.


==References==
==References==
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[[Category:Disease]]
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[[Category:Kidney diseases]]
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Latest revision as of 14:39, 13 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Laboratory findings in minimal change disease include elevated hematocrit, pseudohyponatremia, hypocalcemia, and abnormal lipid panel. Findings of urine analysis include elevated urinary specific gravity, proteinuria that might reach nephrotic range, high urinary protein-creatinine ratio, microscopic hematuria, and lipid-laden cells.

Laboratory Findings

Blood

Urine

References

  1. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  2. ↑ Kerlin BA, Ayoob R, Smoyer WE (March 2012). "Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease". Clin J Am Soc Nephrol. 7 (3): 513–20. doi:10.2215/CJN.10131011. PMC 3302669. PMID 22344511.
  3. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  4. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  5. ↑ Oberweis BS, Mattoo A, Wu M, Goldfarb DS (2013). "Minimal change disease and IgA deposition: separate entities or common pathophysiology?". Case Rep Nephrol. 2013: 268401. doi:10.1155/2013/268401. PMC 3914242. PMID 24527245.
  6. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  7. ↑ Vivarelli, Marina; Massella, Laura; Ruggiero, Barbara; Emma, Francesco (2017). "Minimal Change Disease". Clinical Journal of the American Society of Nephrology. 12 (2): 332–345. doi:10.2215/CJN.05000516. ISSN 1555-9041.
  8. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  9. ↑ Vivarelli M, Massella L, Ruggiero B, Emma F (February 2017). "Minimal Change Disease". Clin J Am Soc Nephrol. 12 (2): 332–345. doi:10.2215/CJN.05000516. PMC 5293332. PMID 27940460.
  10. ↑ Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, D'Agati V, Appel G (May 2007). "Adult minimal-change disease: clinical characteristics, treatment, and outcomes". Clin J Am Soc Nephrol. 2 (3): 445–53. doi:10.2215/CJN.03531006. PMID 17699450.

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