Membranoproliferative glomerulonephritis laboratory findings

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

Laboratory Studies

• Urinalysis

• Glomerular hematuria; characterized by dysmorphic red blood cells (RBCs) and RBC casts
• 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.
• 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

• 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.

• Complement profile - 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.

• Complement profile - 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.