Minimal change disease laboratory findings: Difference between revisions
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*Complement levels are usually normal | *Complement levels are usually normal | ||
===Urinary Findings=== | ===Urinary Findings=== 24-hour urinary analysis is indicated in the work-up of minimal change disease. | ||
*Elevated urinary specific gravity | *Elevated urinary specific gravity | ||
*Proteinuria that might reach nephrotic-range | *Proteinuria that might reach nephrotic-range | ||
Revision as of 06:14, 25 November 2013
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Laboratory Findings
Blood Work-Up
- Elevated hematocrit due to volume contraction
- Serum electrolytes may show pesudohyponatremia, 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)
- ANA panel is usually normal
- Complement levels are usually normal
===Urinary Findings=== 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
===Imaging=== Imaging in nephrotic syndrome is usually unremarkable.
Kidney Biopsy
A kidney biopsy is not routinely performed as soon as nephrotic syndrome is found during lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012[1], an initial attempt using corticosteroids should be performed before a renal biopsy is performed.
Light Microscopy
A renal biopsy of minimal change disease shows no abnormalities on light microscopy. Lipid-laden cells may be seen in proximal tubular epithelium. Additional features of focal segmental glomerulosclerosis, such as mesangial prominence, interstitial fibrosis, and tubular atrophy, or glomerular tip lesions of FSGS, may be seen in patients who have complicated disease.[2] Those with acute renal injury may have histological features of focal flattening of the proximal tubular epithelium.[2]
Immunofluorescence
Renal biopsy is often unremarkable under immunofluorescence, with the exception of few cases that stain positively for IgM antibodies and C3.[2]
Electron Microscopy
Electron-microscopy is required for the diagnosis of minimal change disease. It shows effacement (fusion) of podocytes, which are visceral epithelial cells, with slit-pore membrane obliteration between podocyte foot processes. However, podocyte effacement is not specific and should not be considered pathognomonic of the disease.[2]
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 D'Agati V (2003). "Pathologic classification of focal segmental glomerulosclerosis". Semin Nephrol. 23 (2): 117–34. doi:10.1053/snep.2003.50012. PMID 12704572.