Membranous glomerulonephritis diagnostic study of choice: Difference between revisions

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__NOTOC__
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{{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.
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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
=== Gold standard/Study of choice: ===
=== Gold standard/Study of choice: ===
* Biopsy is the gold standard test for the diagnosis of membranous glomerulonephritis.
* [[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>
* 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 are: ===
* The complete [[blood count]], [[urinalysis]], 24 hour [[Urine culture|urine]] collection should be performed when:
* ''chemistry panel,'' 
** The patient presented with signs of [[proteinurea]] and [[hypertension]].
* ''complete blood count,'' 
** A positive test is detected in the patient.
* ''urinalysis,'' 
* [[Biopsy|Renal biopsy]] is the gold standard test for the diagnosis of membranous glomerulonephritis.
* ''24 hours urine collection,'' 
'''The diagnostic study of choice for membranous glomerulonephritis is:'''
* ''creatinine clearance,'' 
* [[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>
* ''urine albumin,'' 
** Light microscopy, electron dense microscopy and immunofluorescence are performed on the renal biopsy sample.
* ''ANA,'' 
* Other tests include
* ''anti-doublestandard DNA,'' 
** [[Complete blood count|CBC]],
* ''anti-SM,'' 
** Urine analysis
* ''anti Ro/SSA,'' 
** [[Renal function tests]]
* ''anti La/SSB,'' 
** Serum [[Antinuclear antibodies|ANA]]
*   ''serum C3 and C4 Complement levels.'' 
** [[Complement system|Serum complement profile]]
* ''Chest CT,'' 
** Antistreptolysin-O titres
*  ''Anti PLA2Rantibody''.<small> </small> 
** [[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.]]


===== Diagnostic Test: =====
===== Diagnostic Test: =====
Biopsy is confirmatory 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>
 
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stage
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Glomerular Basement Membrane
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Immunofluorescence
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electron Microscopy
|-
| 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:#DCDCDC;" align="center" + |Stage 2
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM with spikes and vacuolization
| 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:#DCDCDC;" align="center" + |Stage 3
| style="background:#F5F5F5;" align="center" + |Moderately thickened BM residual spikes and vacuoles
| 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
|}
 
===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The urinalysis and comprehensive chemistry panel should be performed when:
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.
 
* A positive ANA, anti dsDNA is detected in the patient, to confirm the diagnosis.
* 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 ===
=== Diagnostic Criteria ===
*There are no established criteria for the diagnosis of membranous glomerulonephritis.
*There are no established criteria for the diagnosis of membranous glomerulonephritis.


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

Membranous glomerulonephritis Microchapters

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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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