Recommended initial testing for patients being evaluated for glomerular disease
1) 24-hour urine collection - Quantify proteinuria. Spot PC (protein/creatinine ratio) is not recommended for this purpose because it is unreliable in individual patients. Measuring albuminuria is useful in monitoring low-level glomerular proteinuria. However. once the total proteinuria exceeds 500 mg/day, albuminuria is about 60-80% of the total proteinuria. So, proteinuria provides the same information as albuminuria, and is less expensive
2) Serum albumin - Assess severity of the disruption of the GFB, and whether protein nutrition and hepatic albumin synthesis are adequate.
3) LDH - Assess for hemolysis, or damage to muscles or viscera.
4) Reticulocyte count/platelet count - Assess for increased or decreased red cell production. Assess for thrombotic microangiopathy.
5) C3, C4 - Test for disorders that activate the classical or alternative complement pathways.
6) SPEP+free light chains - Screen for monoclonal gammopathy (SPEP+free light chains), or hypogammaglobulinemia, hypergammaglobulinemia (SPEP). Serum or urine for immunofixation is not recommended for routine screening because it is much more expensive than SPEP+free light chains, which are sensitive and specific for detection of monoclonal gammopathy
7) Hepatitis B surface antigen, hepatitis C antibody, and HIV (if risk factors for HIV are present) - These infections are common causes of glomerular disease.
8) ANA - Screen for autoimmune disorders.
9) ANCA - Screen for ANCA-related vasculitis.
10) Rheumatoid factor - Screen for cryoglobulinemias (types 2 and 3), and certain autoimmune disorders.

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Dr. Gerald Diaz @GeraldMD · 4 years ago
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief πŸ‡΅πŸ‡­ πŸ‡ΊπŸ‡Έ - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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