Membranoproliferative glomerulonephritis laboratory findings: Difference between revisions
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=== Urinalysis === | === 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<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> | ||
:* 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. | ||
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=== Serum chemistries === | === 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<ref name="pmid7723253">{{cite journal| author=Rennke HG| title=Secondary membranoproliferative glomerulonephritis. | journal=Kidney Int | year= 1995 | volume= 47 | issue= 2 | pages= 643-56 | pmid=7723253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7723253 }} </ref>. | ||
:* Hyperlipidemia and low albumin may be seen with nephrotic syndrome. | :* Hyperlipidemia and low albumin may be seen with nephrotic syndrome. | ||
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=== Complement profile - === | === Complement profile - === | ||
* MPGN type I | * MPGN type I<ref name="pmid18408474">{{cite journal| author=Alpers CE, Smith KD| title=Cryoglobulinemia and renal disease. | journal=Curr Opin Nephrol Hypertens | year= 2008 | volume= 17 | issue= 3 | pages= 243-9 | pmid=18408474 | doi=10.1097/MNH.0b013e3282f8afe2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18408474 }} </ref> | ||
:* 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) | ||
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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[1]
- 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[2].
- 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[3]
- 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.
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.
- ↑ Rennke HG (1995). "Secondary membranoproliferative glomerulonephritis". Kidney Int. 47 (2): 643–56. PMID 7723253.
- ↑ Alpers CE, Smith KD (2008). "Cryoglobulinemia and renal disease". Curr Opin Nephrol Hypertens. 17 (3): 243–9. doi:10.1097/MNH.0b013e3282f8afe2. PMID 18408474.