Membranoproliferative glomerulonephritis diagnostic study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
Renal biopsy is considered the gold standard diagnostic test for MPGN.Light, electron and immunoflourescnce microscopy are performed.Other diagnostic tests are doen to look for the cause of the disease. | |||
== Diagnostic study of choice == | == Diagnostic study of choice == | ||
=== Study of choice === | === Study of choice === | ||
* Renal biopsy is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis<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>19908070 . | * [[Kidney biopsy|Renal biopsy]] is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis<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>19908070 . | ||
* Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample. | * Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample. | ||
* Other tests include | * Other tests include | ||
** CBC, | ** [[Complete blood count|CBC]], | ||
** Urine analysis | ** Urine analysis | ||
** Renal function tests | ** [[Renal function tests]] | ||
** Serum ANA | ** Serum [[Antinuclear antibodies|ANA]] | ||
** Serum complement profile | ** [[Complement system|Serum complement profile]] | ||
** Antistreptolysin-O titres | ** Antistreptolysin-O titres | ||
** | ** [[Hepatitis B]] and [[Hepatitis C]] | ||
** Blood cultures | ** Blood cultures | ||
** Serum and urine electrophoresis<ref name="pmid25607108">{{cite journal| author=Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP et al.| title=Diagnosis of monoclonal gammopathy of renal significance. | journal=Kidney Int | year= 2015 | volume= 87 | issue= 4 | pages= 698-711 | pmid=25607108 | doi=10.1038/ki.2014.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25607108 }} </ref> | ** Serum and urine [[electrophoresis]]<ref name="pmid25607108">{{cite journal| author=Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP et al.| title=Diagnosis of monoclonal gammopathy of renal significance. | journal=Kidney Int | year= 2015 | volume= 87 | issue= 4 | pages= 698-711 | pmid=25607108 | doi=10.1038/ki.2014.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25607108 }} </ref> | ||
* These tests must be performed when a patient presents with anorexia, malaise, edema, secondary hypertension and oliguria. | * These tests must be performed when a patient presents with [[anorexia]], [[malaise]], [[edema]], [[Chronic hypertension causes|secondary hypertension]] and [[Oliguria|oliguria.]] | ||
=== Diagnostic results === | === Diagnostic results === | ||
====== Light microscopy ====== | ====== Light microscopy ====== | ||
* The findings of glomerulus with increased mesangial cellularity, increase in the mesangial matrix, and thickened peripheral capillary walls are confirmatory for the disease. | * The findings of [[glomerulus]] with increased mesangial cellularity, increase in the [[Mesangial cell|mesangial]] matrix, and thickened peripheral capillary walls are confirmatory for the disease. | ||
====== Electron microscopy ====== | ====== Electron microscopy ====== | ||
| Line 31: | Line 32: | ||
====== Immunoflourescence ====== | ====== Immunoflourescence ====== | ||
* Presence of immunoglbulins or complement in the mesangium depending on the cause. | * Presence of immunoglbulins or [[complement]] in the mesangium depending on the cause. | ||
====== CBC ====== | ====== CBC ====== | ||
* Normocytic normochromic anemia | * [[Anemia|Normocytic normochromic anemia]] | ||
====== Urine analysis ====== | ====== Urine analysis ====== | ||
* May show proteinuria | * May show [[proteinuria]] | ||
====== Renal function tests ====== | ====== Renal function tests ====== | ||
* Serum creatinine and BUN might be elevated | * Serum [[creatinine]] and [[Blood urea nitrogen|BUN]] might be elevated | ||
====== Complement profile ====== | ====== Complement profile ====== | ||
* C3, C4 and CH50 levels for classic complement pathway | * C3, C4 and CH50 levels for [[Complement|classic complement pathway]] | ||
* AH50 levels for alternate 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> | * 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 ====== | ====== Serum ANA ====== | ||
* Postive serum ANA means autoimmune disease etiology | * Postive serum [[Antinuclear antibodies|ANA]] means autoimmune disease etiology | ||
====== Blood culture ====== | ====== Blood culture ====== | ||
Revision as of 19:20, 26 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:
Overview
Renal biopsy is considered the gold standard diagnostic test for MPGN.Light, electron and immunoflourescnce microscopy are performed.Other diagnostic tests are doen to look for the cause of the disease.
Diagnostic study of choice
Study of choice
- Renal biopsy is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis[1]19908070 .
- Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.
- Other tests include
- CBC,
- Urine analysis
- Renal function tests
- Serum ANA
- Serum complement profile
- Antistreptolysin-O titres
- Hepatitis B and Hepatitis C
- Blood cultures
- Serum and urine electrophoresis[2]
- These tests must be performed when a patient presents with anorexia, malaise, edema, secondary hypertension and oliguria.
Diagnostic results
Light microscopy
- The findings of glomerulus with increased mesangial cellularity, increase in the mesangial matrix, and thickened peripheral capillary walls are confirmatory for the disease.
Electron microscopy
- Immune deposits in the mesangium and subendothelial space.
Immunoflourescence
- Presence of immunoglbulins or complement in the mesangium depending on the cause.
CBC
Urine analysis
- May show proteinuria
Renal function tests
- Serum creatinine and BUN might be elevated
Complement profile
- C3, C4 and CH50 levels for classic complement pathway
- AH50 levels for alternate complement pathway
- C3 nephritic factor levelsj[3]
Serum ANA
- Postive serum ANA means autoimmune disease etiology
Blood culture
- Chronic bacterial infections
Diagnostic criteria
There is no established diagnostic criteria for membranoproliferative glomerulonephritis
References
- ↑ 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.
- ↑ Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP; et al. (2015). "Diagnosis of monoclonal gammopathy of renal significance". Kidney Int. 87 (4): 698–711. doi:10.1038/ki.2014.408. PMID 25607108.
- ↑ 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.