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Glomerulonephritis Associated with Nonstreptococcal Infection Workup

  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Apr 28, 2015
 

Laboratory Studies

See the list below:

  • Urinalysis: This may reveal hematuria, pyuria, red blood cell casts, and proteinuria. Findings are very helpful for determining if glomerulonephritis (GN) is primarily of a nephrotic or nephritic type.
  • CBC count: The neutrophil count may be elevated in patients with an acute bacterial infection. Eosinophilia may be observed in patients with GN associated with SBE or a parasitic infection. Depending on the duration of disease and severity of renal dysfunction, anemia may be observed due to chronic kidney disease.
  • BUN and creatinine: BUN and serum creatinine levels are commonly elevated in patients with infection-related GN. However, levels may be normal early in the course of these disorders.
  • Electrolytes: Hyperkalemia or evidence of metabolic acidosis may be observed if the patient presents with chronic renal insufficiency.
  • Liver function tests: The aspartate aminotransferase level is commonly elevated in patients with hepatitis-associated GN.
  • Rheumatoid factor: The results commonly are positive in patients with GN associated with bacterial endocarditis.[12]
  • Serum complement levels (C3, C4, CH50): Complement levels commonly are low in patients with infection-related GN, more so in those with certain diseases. Low complement levels indicate an immune complex disease and are not necessarily diagnostic because they can be present in patients with other immune complex diseases (eg, lupus nephritis).
  • Hepatitis panel (hepatitis B surface antigen, hepatitis C antibody): Hepatitis is a common cause of infection-related GN.
  • Cryoglobulins: These are commonly present in patients who have GN associated with hepatitis C.
  • VDRL test: Findings are positive in patients with GN associated with syphilis.
  • HIV testing: This should be performed on all patients with GN and risk factors for HIV infection.
  • Viral titers (cytomegalovirus, parvovirus B19, mumps, varicella, Epstein-Barr virus, Hantavirus): Depending on the clinical presentation, drawing blood for viral titers may be important in order to help identify the cause of the GN.
  • Stool for ova and parasites: This should be performed if the patient has been in areas endemic to diseases such as schistosomiasis or filariasis.
  • Antistreptolysin-O titer, antineutrophil cytoplasmic antibodies, antiglomerular basement membrane antibody, serum protein electrophoresis, and urine protein electrophoresis: Depending on the clinical presentation, these tests may be performed as part of the evaluation to help identify the cause of the GN.
  • Other evaluations: In appropriate clinical circumstances, peripheral blood smears to test for malaria may be helpful.
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Imaging Studies

See the list below:

  • Renal ultrasound: This is routinely obtained in patients presenting with abnormal renal function to help rule out obstructive causes of nephropathy, and findings demonstrate certain anatomic abnormalities. It is also useful to confirm the presence of 2 functioning kidneys prior to performing percutaneous renal biopsy.
  • CT scan of the chest, abdomen, or pelvis: This may be indicated if visceral abscess is suggested.
  • Echocardiogram: A transthoracic echocardiogram should be performed if bacterial endocarditis is a possible cause. If findings are inconclusive, a transesophageal echocardiogram is indicated to help rule out valvular vegetations.
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Procedures

See the list below:

  • Kidney biopsy and other biopsies: These may be helpful depending on the clinical presentation.
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Histologic Findings

Depending on the cause, a number of different renal lesions may be seen, as follows:

  • Syphilis - Membranous or diffuse proliferative GN
  • Hepatitis B - Membranous, membranoproliferative, or mesangial proliferative GN
  • Hepatitis C - Membranoproliferative GN (most common), membranous GN (also seen)
  • HIV - Focal segmental glomerulosclerosis (classic lesion), membranoproliferative GN or minimal change disease (less common)
  • Parvovirus B19 - Focal segmental glomerulosclerosis
  • Hantavirus - Mesangial GN
  • Schistosomiasis - Mesangial proliferative GN, focal segmental glomerulosclerosis, membranoproliferative GN, or membranous GN
  • Leishmaniasis - Mesangial or focal proliferative GN
  • Hydatid - Mesangiocapillary GN, membranous GN
  • Toxoplasmosis - Mesangioproliferative GN
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Contributor Information and Disclosures
Author

James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, Central Society for Clinical and Translational Research

Disclosure: Partner received salary from Alexion for employment.

Coauthor(s)

Quresh T Khairullah, MBBS, MD 

Quresh T Khairullah, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ajay K Singh, MB, MRCP, MBA Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

References
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  12. Takeshima E, Morishita Y, Ogura M, Ito C, Saito O, Takemoto F, et al. A case of diffuse endocapillary proliferative glomerulonephritis associated with polymyalgia rheumatica. Case Rep Nephrol Urol. 2012 Jul. 2(2):158-64. [Medline]. [Full Text].

  13. Tang S, Lai FM, Lui YH, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int. 2005 Oct. 68(4):1750-8. [Medline].

  14. Jefferson JA, Johnson RJ. Treatment of hepatitis C-associated glomerular disease. Semin Nephrol. 2000 May. 20(3):286-92. [Medline].

  15. Atta MG, Gallant JE, Rahman MH, et al. Antiretroviral therapy in the treatment of HIV-associated nephropathy. Nephrol Dial Transplant. 2006 Oct. 21(10):2809-13. [Medline].

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