Focal segmental glomerulosclerosis laboratory findings

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Work

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Initial lab-work up should be directed first towards finding a possible etiology for FSGS. HIV testing in patients with new-onset FSGS, especially those with collapsing variant, is a must in all patient. Additionally, monitoring of disease progression by serum creatinine and proteinuria is equally important.

Work-Up

General work-up includes blood work-up, urinalysis, renal ultrasound, and renal biopsy with electron microscopy for the diagnosis and management of FSGS. Genetic testing is currently not recommended.^[1]

Blood Work-Up

A comprehensive lab work-up is necessary for all patients with FSGS. Common causes of secondary FSGS, such as HIV, HBV, HCV, and systemic lupus erythematosus (SLE), should also be ruled out:

Complete blood count (CBC)
Serum electrolytes
Serum albumin
Lipid profile
Serum creatinine
Blood urea nitrogen (BUN)
CD4 count and HIV test (necessary for all patients with FSGS, especially collapsing variant)
DNA/PCR for parvovirus B19
CMV test
Serum complement C3 and C4
ANA profile
Titers of antibodies specific for systemic diseases, such as anti-dsDNA
c-ANCA and p-ANCA
Serum protein electrophoresis

Other necessary tests to rule out secondary etiologies, as suggested by history and physical exam

Urinalysis

Urinalysis with microalbuminuria and urinary creatinine
Urine culture
Urinary protein electrophoresis

Renal Ultrasound

Routine renal ultraound is recommended in patients with FSGS to monitor kidney size and echogenicity.^[1]

Renal Biopsy & Electron Microscopy

Renal biopsy and electron microscopy are required for the diagnosis and management of FSGS.^[1]

Laboratory Findings

Blood

Anemia
Hypoalbuminemia
Abnormal lipid profile
Increased serum creatinine

Urine

Proteinuria
No/microscopic/macroscopic hematuria
Dysmorphic red blood cells
Fatty casts

References

↑ ^1.0 ^1.1 ^1.2 Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH; et al. (2013). "KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis". Am J Kidney Dis. 62 (3): 403–41. doi:10.1053/j.ajkd.2013.06.002. PMID 23871408.

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[pmid23871408-1] 1.0 ^1.1 ^1.2 Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH; et al. (2013). "KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis". Am J Kidney Dis. 62 (3): 403–41. doi:10.1053/j.ajkd.2013.06.002. PMID 23871408.

[1]