Recommended initial testing for patients being evaluated for glomerular disease 24-hour urine collection - Quantify proteinuria. Spot PC (protein/creatinine ratio) is not recommended for this purpose because it is unreliable in individual patients 166, 85, 87—891. 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 Serum albumin - Assess severity of the disruption of the GFB, and whether protein nutrition and hepatic albumin synthesis are adequate. LDH - Assess for hemolysis, or damage to muscles or viscera. Reticulocyte count/platelet count - Assess for increased or decreased red cell production. Assess for thrombotic microangiopathy. 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 [901. C3, C4 - Test for disorders that activate the classical or alternative complement pathways. Hepatitis B surface antigen, hepatitis C antibody, and HIV (if risk factors for HIV are present) - These infections are common causes of glomerular disease. ANA - Screen for autoimmune disorders. ANCA - Screen for ANCA-related vasculitis. Rheumatoid factor - Screen for cryoglobulinemias (types 2 and 3), and certain autoimmune disorders #glomerular #testing #workup #diagnosis #glomerulonephritis #nephrotic #nephritic #nephrology
