Laboratory Tests for Glomerulonephropathy Workup

Initial Laboratory Assessment

The National Kidney Foundation recommends serum creatinine and blood urea nitrogen (BUN) to assess kidney function and establish baseline renal status 1, 2
The American Society of Nephrology suggests estimated glomerular filtration rate (eGFR) using creatinine-based equations (CKD-EPI preferred) to quantify kidney function 1, 3
Complete urinalysis with microscopy is recommended to evaluate for hematuria, proteinuria, red blood cell casts, and dysmorphic red blood cells which suggest glomerular disease 4, 5
Urine protein quantification via 24-hour urine collection for total protein and protein electrophoresis, or protein-to-creatinine ratio (PCR) from a first morning sample is advised 5, 3
The National Institute of Diabetes and Digestive and Kidney Diseases recommends albumin-to-creatinine ratio (ACR) to assess for albuminuria, particularly important in early detection of glomerular disease 6, 7

A complete blood count (CBC) is recommended to evaluate for anemia, thrombocytopenia, or leukocytosis 4
The European Renal Association suggests comprehensive metabolic panel including electrolytes, acid-base status, and liver function tests 1, 2
Antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) are recommended for lupus nephritis 1, 5
Complement levels (C3, C4) are advised to evaluate for hypocomplementemic glomerulonephritis 5, 3
Anti-neutrophil cytoplasmic antibodies (ANCA) are recommended for ANCA-associated vasculitis 1, 2
Anti-glomerular basement membrane (anti-GBM) antibodies are suggested for Goodpasture's syndrome 1, 2
Anti-phospholipase A2 receptor antibodies (anti-PLA2R) are recommended for primary membranous nephropathy 1, 2
Serum and urine protein electrophoresis with immunofixation are advised to detect monoclonal proteins 6, 7
Serum free light chain assay is recommended to evaluate for monoclonal gammopathy of renal significance (MGRS) 6, 7

Hepatitis B, C, and HIV serologies are recommended for infection-associated glomerulonephritis 5
Blood cultures are advised if infection-related glomerulonephritis is suspected 8
Cryoglobulins are recommended for cryoglobulinemic glomerulonephritis 5
Anti-streptolysin O (ASO) titers are suggested if post-streptococcal glomerulonephritis is suspected 4
Genetic testing (APOL1, COL4A3, COL4A4, COL4A5) is recommended for hereditary forms of glomerulonephritis 1, 2

Kidney biopsy is recommended when rapid decline in kidney function occurs, hematuria with proteinuria and/or reduced eGFR is present, or diagnosis remains unclear after initial workup 1, 5, 6, 3, 4

The International Society of Nephrology advises against relying solely on dipstick urinalysis without microscopic examination, as it can miss important findings such as dysmorphic RBCs and cellular casts 5, 3
Using random "spot" urine collections for protein quantification instead of first morning or 24-hour collections is discouraged 5, 3
Overlooking monoclonal gammopathies in older adults with unexplained proteinuria or kidney dysfunction is a common pitfall 6, 7
Failing to repeat abnormal tests to confirm persistence of findings before invasive procedures is advised against 5
Neglecting family history, which may suggest hereditary forms of glomerulonephritis, is a common mistake 1, 2