Minimal change disease laboratory findings

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

Overview

Laboratory findings in minimal change disease include elevated hematocrit, pseudohyponatremia, hypocalcemia, and abnormal lipid panel. Findings of urine analysis include elevated urinary specific gravity, proteinuria that might reach nephrotic range, high urinary protein-creatinine ratio, microscopic hematuria, and lipid-laden cells.

Laboratory Findings

Blood

• Fibrinogen, factors V and VIII, and protein C increases and increased risk of thrombosis due to  hypercoagulability.

• Elevated hematocrit due to volume contraction.
• Serum electrolytes may show pseudohyponatremia, 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) due to
  • Decreased activity of lipoprotein lipase.
  • Decreased LDL receptor activity.
  • Increased urinary loss of HDL and antithrombin III.
• IgG decreased.
• IgA is minimally reduced.
• IgM is increased.

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.
• Gross hematuria.
• Urinary dipstick showing 3+/4+ proteinuria (≥300 mg/dl).
• Urine protein-to-creatinine ratio >200 mg/mmol.
• Urine proteins >3.5 g/d in adults.
• Increased α2-globulin and a reduced γ-globulin fraction.