Rapidly progressive glomerulonephritis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Laboratory Findings

Blood Work-Up

• Complete blood count (CBC)

• Serum electrolytes

• Creatinine and blood urea nitrogen

• Lactate dehydrogenase (LDH)

• Creatine phosphokinase (CPK)

• Liver function tests

• Erythrocyte sedimentation rate and C-reactive protein (CRP)

• Antinuclear antibody (ANA)

• Anti-GBM antibodies

• ANCA

• Cryoglobulins

• HBV and HCV titers

• Complement C3 and C4 levels

• Serum protein electrophoresis

Laboratory findings

• Anemia , mostly due to impaired production of erythropoietin by kidneys. or GI bleeding.
• Eosinophilia is usually seen in patients with Churg-Strauss disease.
• Patients with RPGN may show formation of immune complexes and cryoglobulins.
• Complement C3 levels is usually low in immune-complex mediated RPGN.
• The presence of ANCA and anti-GBM is variable.
• ANCA-associated glomerulonephritis have high levels of ANCA, it is associated with disease activity.

• ESR and CRP may be elevated and indicate inflammation and activity of the disease.

Urine Work-Up

• Urinalysis
• Urinary protein electrophoresis
• Patients with RPGN do not usually have a full-blown picture of nephrotic syndrome; Nephrotic syndrome only occurs in less than 30% of cases.
• Proteinuria, if present, is usually mild to moderate. Hematuria of glomerular type with dysmorphic red blood cells is usually present on urinalysis and associated with red cell casts.
• Mild to moderate leukocyturia may be seen and other casts, such as epithelial cell leukocyte, or fatty casts. Urinary findings in RPGN are important features that not only favor diagnostic work-up, but also follow-up and therapeutic effectiveness.