Rapidly progressive glomerulonephritis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ali Poyan Mehr, M.D. [2] Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3], Amandeep Singh M.D.[4],

Ahmed Elsaiey, MBBCH [5]

Overview

Rapid diagnosis of rapidly progressive glomerulonephritis is very crucial to save kidneys function

Diagnostic study of choice:

Renal biopsy:

• Renal biopsy will provide the most accurate reslt.
• Renal biopsy will give accurate information about the extent of the disease and therapy can be planned accordingly.

results of Renal biopsy:

• Light microscopy reveals
  • Diffuse inflammation in glomeruli with rupture and damage to glomerular basement membrane.
  • Crescents are present in the Bowmans space.
  • Renal vessels can show transmural vasculitis, with necrosis and lymphocyte infiltrates.
  • Tubular necrosis may also be present.
  • Interstitial granulomas in the glomeruli indicate Wegener’s granulomatosis.

Immunoflourescence

• In type I RPGN- diffuse and linear deposition of IgG along the GBM.
• In ttype II RPGN- diffuse and irregular deposition of IgG and C3 in the mesangial matrix.
• In type III RPGN- no finding.
• Electron microscopy
• In type I and type III, no electron dense deposits are seen.
  • In type II RPGN, subepithelial electron dense deposits indiacting the presence of immune complexes are seen.

Serologic studies

• Complete blood cell count (CBC) withdifferential,
  • Anemia can be seen in patienst with renal failure or gastrointestinal tract bleeding.
  • Eosinophilia greater than 13% suggest Churg-Strauss disease.
• Serum electrolytes
• BUN(blood urea nitrogen)
• Serum creatinine
• Lactate dehydrogenase (LDH)
• Creatine phosphokinase (CPK),
• The most common abnormality is an increased serum creatinine level
• Urinalysis with microscopy: Proteinuria equal to or greater than 2-3 g in 24 hours.
• Microscopic hematuria
• Red cell casts indicates glomerular inflammation
• Erythrocyte sedimentation, elevated with active disease.
• C-reactive protein: levels are elevated and correspond with disease activity.
• Antinuclear antibody (ANA).High ANA titer is present in systemic lupus erythematosus.

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