Membranous glomerulonephritis diagnostic study of choice: Difference between revisions

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{{Membranous glomerulonephritis}}
{{Membranous glomerulonephritis}}
{{CMG}}; {{AE}} {{SAH}}
{{CMG}}; {{AE}} {{SAH}} {{JSS}}
== Overview ==
== Overview ==


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* [[Biopsy|Renal 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.
'''The diagnostic study of choice for membranous glomerulonephritis is:'''
'''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>  
* [[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.]]


===== Diagnostic Test: =====
===== Diagnostic Test: =====

Revision as of 19:09, 31 July 2018

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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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