Minimal change disease laboratory findings

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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

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, 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. Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.

Immunofluorescence

Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.

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.