Minimal change disease laboratory findings: Difference between revisions

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Revision as of 16:39, 5 April 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian

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

Elevated hematocrit due to volume contraction
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

Urine

24-hour urinary analysis is indicated in the work-up of minimal change disease.

Elevated urinary specific gravity
Proteinuria that might reach nephrotic range
High urinary protein-creatinine ratio
Microscopic hematuria
Lipid-laden cells

References

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 ==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===
-*Elevated hematocrit due to volume contraction
+*Elevated [[hematocrit]] due to volume contraction
 *Serum electrolytes may show pesudohyponatremia, defined as low serum sodium levels due to elevated serum lipids
-*Hypocalcemia
+*[[Hypocalcemia]]
 *Hypovitaminosis D
-*Normal/elevated serum creatinine
+*Normal/elevated serum [[creatinine]]
-*Hypoalbuminemia
+*[[Hypoalbuminemia]]
-*Abnormal lipid profile (total cholesterol, LDL-C, HDL-C, triglycerides)
+*Abnormal lipid profile (total [[cholesterol]], [[LDL-C]], [[HDL-C]], [[triglyceride]]s)
-*ANA panel is usually normal
+*[[ANA]] panel is usually normal
-*Complement levels are usually normal
+*[[Complement]] levels are usually normal
 ===Urine===
 -hour urinary analysis is indicated in the work-up of minimal change disease.
-*Elevated urinary specific gravity
+*Elevated [[urinary specific gravity]]
-*Proteinuria that might reach nephrotic-range
+*[[Proteinuria]] that might reach [[nephrotic]] range
-*High urinary protein-creatinine ratio
+*High urinary protein-[[creatinine]] ratio
-*Microscopic hematuria
+*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====
-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>
 ==References==