Membranous glomerulonephritis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Membranous glomerulonephritis}}
{{Membranous glomerulonephritis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{SAH}} {{JSS}}
== Overview ==
== Overview ==
* The page name should be '''"[Disease name] diagnostic study of choice"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
 
* '''Goal:'''
The most efficient and sensitive test is [[ANAPC2|ANA]], ds-[[DNA]] [[antibodies]] specific test that is utilized for diagnosis of membranous glomerulonephritis. The [[gold standard test]] for the diagnosis of [[renal]] [[biopsy]].
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
**To describe the gold standard test for the diagnosis of [disease name].
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
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* Remember to follow the same format and capitalization of letters as outlined in the template below.
* You should include the name of the disease in the first sentence of every subsection.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
=== Gold standard/Study of choice: ===
* [[Biopsy|Renal biopsy]] is the gold standard test for the diagnosis of membranous glomerulonephritis<ref name="pmid27777266">{{cite journal |vauthors=De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC |title=A Proposal for a Serology-Based Approach to Membranous Nephropathy |journal=J. Am. Soc. Nephrol. |volume=28 |issue=2 |pages=421–430 |date=February 2017 |pmid=27777266 |pmc=5280030 |doi=10.1681/ASN.2016070776 |url=}}</ref>


===== Template statements =====
* The complete [[blood count]], [[urinalysis]], 24 hour [[Urine culture|urine]] collection should be performed when:
** The patient presented with signs of [[proteinurea]] and [[hypertension]].
** A positive test is detected in the patient.
* [[Biopsy|Renal biopsy]] is the gold standard test for the diagnosis of membranous glomerulonephritis.
'''The diagnostic study of choice for membranous glomerulonephritis is:'''
* [[Biopsy|Renal biopsy]] under light and electron microscopy.<ref name="pmid27777266">{{cite journal |vauthors=De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC |title=A Proposal for a Serology-Based Approach to Membranous Nephropathy |journal=J. Am. Soc. Nephrol. |volume=28 |issue=2 |pages=421–430 |date=February 2017 |pmid=27777266 |pmc=5280030 |doi=10.1681/ASN.2016070776 |url=}}</ref>
** 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]]
* These tests must be performed when a patient presents with [[anorexia]], [[malaise]], [[edema]], [[Chronic hypertension causes|secondary hypertension]] and [[Oliguria|oliguria.]]


=== Gold standard/Study of choice: ===
===== Diagnostic Test: =====
* Biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis.
* [[Biopsy|Renal biopsy]] is confirmatory of membranous glomerulonephritis.<ref name="pmid27777266">{{cite journal |vauthors=De Vriese AS, Glassock RJ, Nath KA, Sethi S, Fervenza FC |title=A Proposal for a Serology-Based Approach to Membranous Nephropathy |journal=J. Am. Soc. Nephrol. |volume=28 |issue=2 |pages=421–430 |date=February 2017 |pmid=27777266 |pmc=5280030 |doi=10.1681/ASN.2016070776 |url=}}</ref>
* The following result of [biopsy] is confirmatory of [membranous glomerulonephritis]:
** Result 1
** Result 2
* 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.
* Biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis.
* The diagnostic study of choice for membranous glomerulonephritis is chemistry panel, complete blood count, urinalysis, 24 hours urine collection, creatinine clearance, urine albumin, ANA, anti-doublestandard DNA, anti-SM, anti Ro/SSA, anti La/SSB,  serum C3 and C4 Complement levels. Chest CT, Anti PLA2Rantibody.
* There is no single diagnostic study of choice for the diagnosis of [disease name].  
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
{| class="wikitable"
{|
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Glomerular Basement Membrane
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunofluorescence
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electron Microscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
| style="background:#DCDCDC;" align="center" + |Stage 1
| style="background:#F5F5F5;" align="center" + |Normal or slightly thickned BM
| style="background:#F5F5F5;" align="center" + |Fine granular IgG, C3
| style="background:#F5F5F5;" align="center" + |Scattered small subepithelial electron dense deposits no foot effacement
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background:#DCDCDC;" align="center" + |Stage 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM with spikes and vacuolization
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |Granular IgG, C3
| style="background:#F5F5F5;" align="center" + |Diffuse spikes due to subepithelial deposits, diffuse foot process effacement
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background:#DCDCDC;" align="center" + |Stage 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM residual spikes and vacuoles
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background:#F5F5F5;" align="center" + |Chain like appearance IF, coarsely granular IgG, C3
| style="background:#F5F5F5;" align="center" + |Intramembraneous deposits, spikes, neomembrane formation and diffuse foot process effacement
|-
| style="background:#DCDCDC;" align="center" + |Stage 4
| style="background:#F5F5F5;" align="center" + |Markedly thick GBM, few spikes, vacoules and glomerulosclerosis
| style="background:#F5F5F5;" align="center" + |Focal IgG, C3
| style="background:#F5F5F5;" align="center" + |Sclerotic GBM, few deposits and lacunae
|}
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
===== Sequence of Diagnostic Studies =====
The following result of [investigation name] is confirmatory of [disease name]:
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>
* Result 1
* Result 2


===== Sequence of Diagnostic Studies =====
* The patient presented with signs of hypertension and proteinurea
The [name of investigation] should be performed when:
* Complete blood count
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* Urinaylsis
* A positive [test] is detected in the patient, to confirm the diagnosis.
* A positive [[ANA]], anti [[DsDNA virus|dsDNA]] suggest the diagnosis of membranous glomerulonephritis
* To confirm the diagnosis we do [[renal biopsy]]


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*There are no established criteria for the diagnosis of membranous glomerulonephritis.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 


==References==
==References==
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[[Category:Nephrology]]
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Latest revision as of 22:41, 29 July 2020

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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 diagnostic study of choice for membranous glomerulonephritis is:

Diagnostic Test:
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. ↑ 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.
  2. ↑ 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.

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