Membranous glomerulonephritis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2] Jogeet Singh Sekhon, M.D. [3]
Overview
The most efficient and sensitive test is ANA, ds-DNA antibodies specific test that is utilized for diagnosis of membranous glomerulonephritis. The gold standard test for the diagnosis of renal biopsy.
Diagnostic Study of Choice
Gold standard/Study of choice:
- Renal biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis[1]
- The complete blood count, urinalysis, 24 hour urine collection should be performed when:
- The patient presented with signs of proteinurea and hypertension.
- A positive test is detected in the patient.
- Renal biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis.
The diagnostic study of choice for membranous glomerulonephritis is:
- Renal biopsy under light and electron microscopy.[1]
- Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.
- Other tests include
- CBC,
- Urine analysis
- Renal function tests
- Serum ANA
- Serum complement profile
- Antistreptolysin-O titres
- Hepatitis B and Hepatitis C
- Blood cultures
- Serum and urine electrophoresis
- These tests must be performed when a patient presents with anorexia, malaise, edema, secondary hypertension and oliguria.
Diagnostic Test:
- Renal biopsy is confirmatory of membranous glomerulonephritis.[1]
| Stage | Glomerular Basement Membrane | Immunofluorescence | Electron Microscopy |
|---|---|---|---|
| Stage 1 | Normal or slightly thickned BM | Fine granular IgG, C3 | Scattered small subepithelial electron dense deposits no foot effacement |
| Stage 2 | Moderately thickened BM with spikes and vacuolization | Granular IgG, C3 | Diffuse spikes due to subepithelial deposits, diffuse foot process effacement |
| Stage 3 | Moderately thickened BM residual spikes and vacuoles | Chain like appearance IF, coarsely granular IgG, C3 | Intramembraneous deposits, spikes, neomembrane formation and diffuse foot process effacement |
| Stage 4 | Markedly thick GBM, few spikes, vacoules and glomerulosclerosis | Focal IgG, C3 | Sclerotic GBM, few deposits and lacunae |
Sequence of Diagnostic Studies
The urinalysis and comprehensive chemistry panel should be performed when:[2]
- The patient presented with signs of hypertension and proteinurea
- Complete blood count
- Urinaylsis
- A positive ANA, anti dsDNA suggest the diagnosis of membranous glomerulonephritis
- To confirm the diagnosis we do renal biopsy
Diagnostic Criteria
- There are no established criteria for the diagnosis of membranous glomerulonephritis.
References
- ↑ 1.0 1.1 1.2 De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC (February 2017). "A Proposal for a Serology-Based Approach to Membranous Nephropathy". J. Am. Soc. Nephrol. 28 (2): 421–430. doi:10.1681/ASN.2016070776. PMC 5280030. PMID 27777266.
- ↑ Qin W, Beck LH, Zeng C, Chen Z, Li S, Zuo K, Salant DJ, Liu Z (June 2011). "Anti-phospholipase A2 receptor antibody in membranous nephropathy". J. Am. Soc. Nephrol. 22 (6): 1137–43. doi:10.1681/ASN.2010090967. PMC 3103733. PMID 21566055.