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.
||SLE and other connective tissue diseases
|Serum and urine electrophoresis
Results next day
||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
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
(Last updated October 9th 2014)