Membranoproliferative glomerulonephritis laboratory findings: Difference between revisions
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==Overview== | ==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== | ==Laboratory Findings== | ||
=== Urinalysis === | |||
:* Glomerular hematuria; characterized by dysmorphic red blood cells (RBCs) and RBC casts | :* Glomerular hematuria; characterized by dysmorphic red blood cells (RBCs) and RBC casts | ||
:* 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. | :* 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. | ||
:* Hyperlipidemia and low albumin may be seen with nephrotic syndrome. | :* Hyperlipidemia and low albumin may be seen with nephrotic syndrome. | ||
=== CBC with differential: === | |||
* Most often, patients have a normocytic normochromic anemia. | |||
=== Complement profile - === | |||
* MPGN type I | |||
:* C3 levels are low in about half of the patients. | :* 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) | :* 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. | ||
* | * 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 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. | ||
* | * 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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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
Revision as of 19:10, 27 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
- 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
- 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.
- Hyperlipidemia and low albumin may be seen with nephrotic syndrome.
CBC with differential:
- Most often, patients have a normocytic normochromic anemia.
Complement profile -
- MPGN type I
- 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.
- To rule out secondary causes, obtain antinuclear antibodies, hepatitis screens, cryoglobulins, urine, and serum protein electrophoresis.