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Renal disease

This section deals with clinical conditions associated with renal disease which are covered by the Immunology department. For each clinical condition, the relevant immunological tests are listed together with a short explanation of their use

Acute renal presentations

Immunological processes are implicated in many renal diseases. In several situations, diagnosing and treating immunological processes can halt or reverse renal impairment. For this reason the following tests may be offered on an urgent basis, provided an urgent request is made by phone.

Immunological test Clinical condition Turnaround time
ANCA Vasculitis Same day
Anti glomerular basement membrane

Goodpasture's disease

Same day

ANA SLE and other connective tissue diseases Same day
Serum and urine electrophoresis


Results next day

C3, C4 Immune complex nephritis Results next day

Chronic renal presentations

The same tests are also useful for the diagnosis of chronic renal disease.

Cryoglobulinaemia may also be excluded in some patients with chronic renal failure. This test requires very careful specimen handling and it may be helpful to screen for cryoglobulinaemia by doing C4; if C4 is normal, cryoglobulinaemia is very unlikely. C3 nephritic factor can cause membranoproliferative disease. The laboratory can refer samples to a laboratory that measures C3 nef directly, but this is a complex test with delayed results. We recommend checking C3 first; if C3 is normal, C3 nef is very unlikely to be present.

Some of these tests are also used to monitor renal disease (ANCA, C4). In SLE, monitoring anti-DNA antibody levels and complement C4 is more useful than monitoring ANA.

The half life of IgG antibodies is about three weeks, so most forms of immunosuppressive treatment will not produce rapid changes in autoantibodies and repeat sampling more than every six weeks is probably unhelpful.

The exceptions are plasmapheresis and administration of high dose IVIg, which cause rapid and clinically meaningful fluctuations in autoantibody level. In these situations, more frequent testing of ANCA or anti-GBM is appropriate.

Patient information is available from the National Kidney Federation.


(Last updated October 9th 2014)