Nephritic syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian

Overview

Laboratory work-up must be directed to first identify the exact diagnosis of nephritic syndrome by ruling out common etiologies, and to monitor disease progression and renal function. Work-up might be different from one individual to another based on the patient's presentation and medical history and physical examination findings.

Laboratory Findings

Initial Work-Up

Blood Work-up

• Complete blood count (CBC)

• Serum electrolytes

• Serum creatinine

• Blood urea nitrogen (BUN)

• Erythrocyte sedimentation rate (ESR) and C-reactive protein

Findings associated with glomerulonephritis include anemia, leukocytosis, and electrolyte disturbances such as hyperkalemia. Creatinine and BUN are required to monitor renal function, calculate eGFR, and possible renal deterioration.

Inflammatory markers, such as CRP and ESR, may or may not be elevated in acute glomerulonephritis. They may be helpful in the diagnosis of systemic illnesses, such as malignancies or vasculitides.

Urinalysis

A urinalysis is always recommended in acute glomerulonephritis, looking for:

• Hematuria

• Proteinuria

• RBC casts

• Urine culture

Further Work-Up

A more extensive work-up may be necessary for patients who present with symptoms of signs consistent with secondary glomerulonephritis. Work-up includes, but is not limited to:

• Complement levels

• Blood culture

• Streptozyme test (ASO titer)
• Streptococcal antigens, such as nephritis-associated protease (NAPR), DNase, streptolysin O, streptokinase, and hyaluronidase
• ANA profile
• c-ANCA and p-ANCA
• HBV and HCV serologies