Focal segmental glomerulosclerosis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]
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]
Kidney biopsy is the gold standard to establish the diagnosis of FSGS and determine the subtype of FSGS (see the histological variants of FSGS above). Kidney biopsy will reveal the presence of sclerosis in parts (segmental) of some (focal) glomeruli by light microscopy and diffuse (more than 80 percent) effacement of the foot processes by electron microscopy.
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.