Erythrocyte sedimentation rate in renal disease
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
The erythrocyte sedimentation rate (ESR) is elevated (greater than 25 mm/h by the Westergren method) in almost all patients with the nephrotic syndrome or end-stage renal disease [1-3]. Two-thirds of patients have an ESR above 60 mm/h, while 20 percent have extreme elevations to above 100 mm/h, a level usually associated with disorders such as infection, cancer (particularly if metastatic), or collagen vascular diseases such as temporal arteritis . (See "Acute phase reactants".) The elevation in ESR is not affected by hemodialysis as the pre- and post-dialysis values are similar .
It is likely that plasma factors, particularly increased levels of fibrinogen, are responsible for the elevation in ESR. Anemia and hypocalcemia do not appear to play a role and the ESR is not lowered by dialysis. A direct relation between the degree of proteinuria and the ESR has been noted in patients with glomerular disease in which the ESR was approximately 10 times the daily rate of protein excretion . How this might occur is not clear.
The frequent elevation in ESR in renal insufficiency or the nephrotic syndrome is important clinically, because this finding alone is not an indication to evaluate a patient for an underlying systemic disorder. This issue becomes important in a condition such as membranous nephropathy in which a minority of patients has an associated malignancy. Occult malignancy should be excluded if the patient has some suggestive finding such as weight loss, heme-positive stools, or unexplained anemia, but not an isolated increase in ESR. (See "Causes and diagnosis of membranous nephropathy".)
- The erythrocyte sedimentation rate (ESR) is elevated in almost all patients with the nephrotic syndrome or end-stage renal disease.
- This finding alone is not an indication to evaluate a patient for an underlying systemic disorder.
- Bathon J, Graves J, Jens P, et al. The erythrocyte sedimentation rate in end-stage renal failure. Am J Kidney Dis 1987; 10:34.
- Shusterman N, Kimmel PL, Kiechle FL, et al. Factors influencing erythrocyte sedimentation in patients with chronic renal failure. Arch Intern Med 1985; 145:1796.
- Arik N, Bedir A, Günaydin M, et al. Do erythrocyte sedimentation rate and C-reactive protein levels have diagnostic usefulness in patients with renal failure? Nephron 2000; 86:224.
- Sox HC Jr, Liang MH. The erythrocyte sedimentation rate. Guidelines for rational use. Ann Intern Med 1986; 104:515.
- Liverman PC, Tucker FL, Bolton WK. Erythrocyte sedimentation rate in glomerular disease: association with urinary protein. Am J Nephrol 1988; 8:363.