Membranoproliferative glomerulonephritis diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
Renal biopsy is considered the gold standard diagnostic test for MPGN.Light, electron and immunoflourescnce microscopy are performed.Other diagnostic tests are doen to look for the cause of the disease.
Renal biopsy is considered the gold standard diagnostic test for MPGN.


== Diagnostic study of choice ==
== Diagnostic study of choice ==


=== Study of choice ===
=== Study of choice ===
* [[Kidney biopsy|Renal biopsy]] is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis<ref name="pmid22435371">{{cite journal| author=Sethi S, Fervenza FC| title=Membranoproliferative glomerulonephritis--a new look at an old entity. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 12 | pages= 1119-31 | pmid=22435371 | doi=10.1056/NEJMra1108178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22435371  }} </ref>19908070 .
* [[Kidney biopsy|Renal biopsy]] is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis<ref name="pmid22435371">{{cite journal| author=Sethi S, Fervenza FC| title=Membranoproliferative glomerulonephritis--a new look at an old entity. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 12 | pages= 1119-31 | pmid=22435371 | doi=10.1056/NEJMra1108178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22435371  }} </ref>.
* Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.
** Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.
* Other tests include
** [[Complete blood count|CBC]],
** Urine analysis
** [[Renal function tests]]
** Serum [[Antinuclear antibodies|ANA]]
** [[Complement system|Serum complement profile]]
** Antistreptolysin-O titres
** [[Hepatitis B]] and [[Hepatitis C]]
** Blood cultures
** Serum and urine [[electrophoresis]]<ref name="pmid25607108">{{cite journal| author=Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP et al.| title=Diagnosis of monoclonal gammopathy of renal significance. | journal=Kidney Int | year= 2015 | volume= 87 | issue= 4 | pages= 698-711 | pmid=25607108 | doi=10.1038/ki.2014.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25607108  }} </ref> 
* These tests must be performed when a patient presents with [[anorexia]], [[malaise]], [[edema]], [[Chronic hypertension causes|secondary hypertension]] and [[Oliguria|oliguria.]]


=== Diagnostic results ===
=== Diagnostic results ===
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====== Immunoflourescence ======
====== Immunoflourescence ======
* Presence of immunoglbulins or [[complement]] in the mesangium depending on the cause.
* Presence of immunoglobulins or [[complement]] in the mesangium depending on the cause.
 
====== CBC ======
* [[Anemia|Normocytic normochromic anemia]]
 
====== Urine analysis ======
* May show [[proteinuria]]
 
====== Renal function tests ======
* Serum [[creatinine]] and [[Blood urea nitrogen|BUN]] might be elevated
 
====== Complement profile ======
* C3, C4 and CH50 levels for [[Complement|classic complement pathway]]
* AH50 levels for alternate complement pathway
* C3 nephritic factor levelsj<ref name="pmid2662048">{{cite journal| author=Bourke E, Campbell WG, Piper M, Check IJ| title=Hypocomplementemic proliferative glomerulonephritis with C3 nephritic-factor-like activity in multiple myeloma. | journal=Nephron | year= 1989 | volume= 52 | issue= 3 | pages= 231-7 | pmid=2662048 | doi=10.1159/000185648 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2662048  }} </ref> 
 
====== Serum ANA ======
* Postive serum [[Antinuclear antibodies|ANA]] means autoimmune disease etiology
 
====== Blood culture ======
* Chronic bacterial infections
 
===== Sequence of Diagnostic Studies =====
The urinalysis and comprehensive chemistry panel should be performed when:<ref name="pmid21566055">{{cite journal |vauthors=Qin W, Beck LH, Zeng C, Chen Z, Li S, Zuo K, Salant DJ, Liu Z |title=Anti-phospholipase A2 receptor antibody in membranous nephropathy |journal=J. Am. Soc. Nephrol. |volume=22 |issue=6 |pages=1137–43 |date=June 2011 |pmid=21566055 |pmc=3103733 |doi=10.1681/ASN.2010090967 |url=}}</ref>
 
* The patient presented with signs of hypertension and proteinurea
* Complete blood count
* Urinaylsis
* A positive [[ANA]], anti [[DsDNA virus|dsDNA]] suggest the diagnosis of membranous glomerulonephritis
* To confirm the diagnosis we do [[renal biopsy]]
 
=== Diagnostic criteria ===
There is no established diagnostic criteria for membranoproliferative glomerulonephritis


== References ==
== References ==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 20:19, 6 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Jogeet Singh Sekhon, M.D. [2] Syed Ahsan Hussain, M.D.[3]

Overview

Renal biopsy is considered the gold standard diagnostic test for MPGN.

Diagnostic study of choice

Study of choice

  • Renal biopsy is the gold standard diagnostic test for the diagnosis of membranoproilferative glomerulonephritis[1].
    • Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.

Diagnostic results

Light microscopy
  • The findings of glomerulus with increased mesangial cellularity, increase in the mesangial matrix, and thickened peripheral capillary walls are confirmatory for the disease.
Electron microscopy
  • Immune deposits in the mesangium and subendothelial space.
Immunoflourescence
  • Presence of immunoglobulins or complement in the mesangium depending on the cause.

References

  1. ↑ Sethi S, Fervenza FC (2012). "Membranoproliferative glomerulonephritis--a new look at an old entity". N Engl J Med. 366 (12): 1119–31. doi:10.1056/NEJMra1108178. PMID 22435371.
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