Membranous glomerulonephritis diagnostic study of choice: Difference between revisions
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===== Diagnostic Test: ===== | ===== Diagnostic Test: ===== | ||
* [[Biopsy|Renal biopsy]] is confirmatory of membranous glomerulonephritis<ref name="pmid27777266">{{cite journal |vauthors=De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC |title=A Proposal for a Serology-Based Approach to Membranous Nephropathy |journal=J. Am. Soc. Nephrol. |volume=28 |issue=2 |pages=421–430 |date=February 2017 |pmid=27777266 |pmc=5280030 |doi=10.1681/ASN.2016070776 |url=}}</ref> | * [[Biopsy|Renal biopsy]] is confirmatory of membranous glomerulonephritis<ref name="pmid27777266">{{cite journal |vauthors=De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC |title=A Proposal for a Serology-Based Approach to Membranous Nephropathy |journal=J. Am. Soc. Nephrol. |volume=28 |issue=2 |pages=421–430 |date=February 2017 |pmid=27777266 |pmc=5280030 |doi=10.1681/ASN.2016070776 |url=}}</ref> | ||
{| class="wikitable" | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Glomerular Basement Membrane | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunofluorescence | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electron Microscopy | |||
|- | |||
| style="background:#DCDCDC;" align="center" + |Stage 1 | |||
| style="background:#F5F5F5;" align="center" + |Normal or slightly thickned BM | |||
| style="background:#F5F5F5;" align="center" + |Fine granular IgG, C3 | |||
| style="background:#F5F5F5;" align="center" + |Scattered small subepithelial electron dense deposits no foot effacement | |||
|- | |||
| style="background:#DCDCDC;" align="center" + |Stage 2 | |||
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM with spikes and vacuolization | |||
| style="background:#F5F5F5;" align="center" + |Granular IgG, C3 | |||
| style="background:#F5F5F5;" align="center" + |Diffuse spikes due to subepithelial deposits, diffuse foot process effacement | |||
|- | |||
| style="background:#DCDCDC;" align="center" + |Stage 3 | |||
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM residual spikes and vacuoles | |||
| style="background:#F5F5F5;" align="center" + |Chain like appearance IF, coarsely granular IgG, C3 | |||
| style="background:#F5F5F5;" align="center" + |Intramembraneous deposits, spikes, neomembrane formation and diffuse foot process effacement | |||
|- | |||
| style="background:#DCDCDC;" align="center" + |Stage 4 | |||
| style="background:#F5F5F5;" align="center" + |Markedly thick GBM, few spikes, vacoules and glomerulosclerosis | |||
| style="background:#F5F5F5;" align="center" + |Focal IgG, C3 | |||
| style="background:#F5F5F5;" align="center" + |Sclerotic GBM, few deposits and lacunae | |||
|} | |||
===== Sequence of Diagnostic Studies ===== | ===== Sequence of Diagnostic Studies ===== | ||
Revision as of 16:41, 19 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]
Overview
The most efficient and sensitive test is ANA, ds-DNA antibodies specific test that is utilized for diagnosis of membranous glomerulonephritis. The gold standard test for the diagnosis of renal biopsy
Diagnostic Study of Choice
Gold standard/Study of choice:
- Renal biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis[1]
- The complete blood count, urinalysis, 24 hour urine collection should be performed when:
- The patient presented with signs of proteinurea and hypertension
- A positive test is detected in the patient
- Renal biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis
The diagnostic study of choice for membranous glomerulonephritis is:
- Renal biopsy under light and electron microscopy[1]
Diagnostic Test:
- Renal biopsy is confirmatory of membranous glomerulonephritis[1]
| Stage | Glomerular Basement Membrane | Immunofluorescence | Electron Microscopy |
|---|---|---|---|
| Stage 1 | Normal or slightly thickned BM | Fine granular IgG, C3 | Scattered small subepithelial electron dense deposits no foot effacement |
| Stage 2 | Moderately thickened BM with spikes and vacuolization | Granular IgG, C3 | Diffuse spikes due to subepithelial deposits, diffuse foot process effacement |
| Stage 3 | Moderately thickened BM residual spikes and vacuoles | Chain like appearance IF, coarsely granular IgG, C3 | Intramembraneous deposits, spikes, neomembrane formation and diffuse foot process effacement |
| Stage 4 | Markedly thick GBM, few spikes, vacoules and glomerulosclerosis | Focal IgG, C3 | Sclerotic GBM, few deposits and lacunae |
Sequence of Diagnostic Studies
The urinalysis and comprehensive chemistry panel should be performed when:[2]
- The patient presented with signs of hypertension and proteinurea
- A positive ANA, anti dsDNA is detected in the patient, to confirm the diagnosis
Diagnostic Criteria
- There are no established criteria for the diagnosis of membranous glomerulonephritis
References
- ↑ 1.0 1.1 1.2 De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC (February 2017). "A Proposal for a Serology-Based Approach to Membranous Nephropathy". J. Am. Soc. Nephrol. 28 (2): 421–430. doi:10.1681/ASN.2016070776. PMC 5280030. PMID 27777266.
- ↑ 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.