This web page has eight sections.  To go to any desired section, click on the section title below.

Blood tests	Urine Tests	Imaging Tests	Tuberculosis Test (if never before tested)
cANCA/pANCA	Urine Creatinine	X-ray/CT Scan/MRI as appropriate Note 5	[Must be done before starting immunosuppressives] Note 1
anti-PR-3/anti-MPO	Blood & Protein	Echo Cardiogram  Note 4
Erythrocyte Sedimentation Rate (ESR or SED)	Blood and protein by dipstick (After remission)	Ultra-sound as appropriate
High Sensitivity C Reactive Protein (CRP)	24 hr. creatinine clearance (Best measure of kidney function)	Baseline bone scan
Eosinophilic Cationic Protein (ECP) Note 3	Urine Microscopic	18F FDG PET/CT Note 2
Complete blood count (CBC) with differential		Endoscopic exams as appropriate
Blood Chemistry Panel		MRA (large vessel)   DSA (medium & small              vessel)
Eotaxin 3   Note 3
IL-6 and Fibrinogen Note 6
Immunoglobulin E (IgE)

Note 1 - If TB test is positive, the patient must receive appropriate long term antibiotic treatment.

Note 2 - For large and medium size vessel vasculitides, PET/CT investigations can be performed using a whole-body PET/CT scanner (LSO Hi-REZ Biograph 16, Siemens, Erlangen, Germany) with LSO-detector (PET) and 16-slice multi slice CT (MSCT). The tracer used to detect hypermetabolic areas is [18F]-FDG (fluorodeoxyglucose).  PET/CT is a sensitive and specific method for the diagnosis of large vessel vasculitis. PET/CT allows the diagnosis of disease activity and vessel stenosis in the same session.

Note 3 - Possibly useful for evaluating Churg-Strauss or other eosinophilic diseases.

Note 4 - Silent heart damage occcurs in some cases of vasculitis.

Note 5 - For CNSV, MRA (magnetic resonance angiogram) is useful for large vessels.  Medium and small vessels can be imaged using DSA (digital subtraction angiogram).  Contrast enhanced MRA may be useful to avoid biopsy of large vessels.

Note 6 - Recent (2008) work suggests IL-6 and fibrinogen levels may track disease activity levels

These are not the only tests but are key to diagnosing and tracking autoimmune vasculitides (AVs), though perhaps no single test alone is sufficient to rule an AV in or out.  For more on the above tests, see the sections below on blood, urine, and on imaging testing.

I - MEDICAL TEST PHASES

There are four phases to medical testing of a AV patient:

  Phase I - Diagnostic tests.

There is a clinical examination, a medical history, and a period of extensive blood, urine, and imaging tests to allow the physician to conclude the patient indeed has AV, and may uncover other diseases, autoimmune or infectious.

There will usually be one or more imaging tests with may be x-ray, computed tomography scan (CT scan) or magnetic resonance imaging (MRI), or ultra-sound.  An echo-cardiogram is needed to detect silent heart damage.

A bone scan may be done as a baseline to record pretreatment bone density.

To have a record of the patient's condition before starting treatment, physicians may chose to have a
series of baseline tests made.  Some baseline information will already be available from the 
Diagnostic Tests done during Phase 1.

Click here to view a file on Baseline Testing

After begining treatment, there will be frequent blood and urine tests, perhaps weekly.

Once the disease starts to come under control, blood and urine testing will be less frequent, perhaps monthly or bi-monthly.

Imaging tests are likely be at longer intervals than the blood and urine tests.

 ------->  IMPORTANT  <---------
Persons taking long-term TNF[alpha]-suppressing drugs such as Enbrel, Remicade, and Humira or Rituxan, should request an annual purified protein derivative (PPD) testing to detect latent TB infections if the patient has been exposed to persons with TB, or traveled.

Once in remission, blood and urine tests may be several months apart unless symptoms indicate a possible relapse.

As long as a person is on prednisone or similar steroids, periodic bone scans should be done, perhaps semi-annually or annually.

Vasculitis patients with lung involvement will have imaging tests at extended intervals, perhaps semi-annual or annually, even in remission.

At least annual clinical examinations is prudent.

AV patients will require lifelong follow-up testing to guard involvements in organs that may be symptom free.

Once in remission, AV patients can and should use inexpensive dipsticks to test urine for blood and protein at least every two weeks.

(Click here to return to index)

• All new or suspected vasculitis patients with lung symptoms should be screened for alpha-1 antitrypsin deficiency (AATD). 
  
• Click here to view a web page about alpha-1 antitrypsin deficiency.

• Since identification of the hepatitis C virus (HCV) in 1989, it has become clear that the chronic infection can be accompanied by a variety of systemic autoreactive phenomena, most notably vasculitis [Feb. 2007 article].
• All known or suspected autoimmune vasculitis patients should perhaps be tested for hepatitis C.
  
• This virus replicates very rapidly, turning over billions of times each day and chronically stimulating the immune system.
• In approximately half of patients, this chronic immune stimulation leads to the development of autoreactivity and the appearance of rheumatoid factor (RF) in serum.
• Some patients also are found to have cryoglobulins, and a subset develop autoimmune conditions such as cryoglobulinemic vasculitis with symptoms of purpura, glomerulonephritis, peripheral neuropathy, and polyarthritis. B-cell lymphomas also can occur.

• A new (2006) non-invasive test for kidney disease, developed by clinicians at Hammersmith Hospitals NHS Trust and Imperial College London, is providing a simple, safe, cheap and reliable method of detecting kidney disease.
• This new test can accurately measure response to treatment, allowing clinicians to tailor treatments to individual patients
• The test can tell us if a treatment is working, and shows us, before it is too late, if it's necessary to change the medication, without the need to perform a biopsy.
• The test works by identifying the amount of a cytokine molecule called monocyte chemoattractant protein-1 (MCP-1) present in the urine. MCP-1 is produced by the body as a response to inflammation, and attracts white blood cells to the area to combat pathogens.
  

•   A Feb. 2006 study noted that markedly increased numbers of circulating endothelial cells (CECs) discriminate active vasculitis from limited granulomatous disease and remission. 
  
• A cut off value of 20 cells/ml for a positive result yielded 64% specificity and 95% sensitivity for active systemic vasculitis; the positive predictive value was 63% and the negative predictive value 95%.  
  
• These findings add further proof to the concept of CECs as a marker of ANCA associated small vessel vasculitis.
• A more recent study found the level of CECs did not track the disease activity.
  

• Given the wide variety of organs and tissues that can be affected by AVs, clinical examination alone is unlikely to result in a conclusive diagnosis of an AV.
  

III - BLOOD TESTS AND COUNTS

NOTE THAT EACH MEDICAL LABORATORY ESTABLISHES THEIR OWN NORMAL RANGES FOR SOME TESTS WHICH MAY BE DIFFERENT THAN THE VALUES BELOW.

It is important to know the level of inflammation of the blood vessel walls.  Inflammation can be from many causes, other than an autoimmune vasculitis alone.  Two broad measurements of inflammations are the Erythrocyte (Red cell) Sedimentation Rate (ESR or SED), and the C Reactive Protein (CRP).  An abnormally high level of either can indicate inflammation of some type is present, but not what nor where, nor the cause

  A - TYPICAL NORMAL ESR VALUES *  **
 

     * Obviously there are some variations with age, so no precise numbers are true in all cases.

  **Some labs use these formulas: [(age divided by 2)=normal ESR] for males and 
          [(age+10) divided by 2=normal ESR] for women. 

  C - BLOOD CHEMISTRY TESTS:  At the start of the diagnostic process, usually a blood chemistry panel is done to help screen out other diseases that might be causing the symptoms as well as to find what effects the disease has already caused.  At one time, chem  7 or chem 20 test panels were run on patients.  Now it's more common to order organ specific test panels that are both more pertinent and less costly.  For some autoimmune vasculitides, low Hemoglobin, elevated Alkaline Phosphatase and Platelets may correlate with vasculitis activity.

• For a list of blood chemistry tests with a brief explanation, see the table at http://members.aol.com/CatsPajama/bloodval.htm
• Critical values are:  Hematocrit less than18% or more than 54% , Hemoglobin less than 6g/dL or more than18g/dL, WBC less than 2500/mm3 or more than 30000mm3, Platelets less than 20,000/mm3 or more than 1,000,000/mm3
• See also http://www.bloodbook.com/ranges.html#BLOOD for more blood chemistry tests
  

  D - BLOOD COUNTS:  Complete blood counts are also done.  For diagnosing an AV, probably the counts of various white cells is most significant.  Neutrophils are polymorphonuclear leukocytes, one of the several types of white blood cells (WBC).  See the table at the above link for information on blood counts.  It is to be expected the neutrophil counts will be high if WG is active and untreated.  Hign wosinophils counts are associated with Churg-Strauss syndrome, and perhaps some other AVs.

  E - ANCA TEST: 

• The Anti-Neutrophil Cytoplasmic Antibody test)
• This test is somewhat specific for certain autoimmune diseases affecting blood vessels. 
  
• It is done by separating out neutrophils (one type of white  blood  cell) and staining them with a dye that will fluoresce when exposed to ultra-violet light. 
  
• The illuminatedneutrophils are then examined by microscope to determine the character of the fluorescing granules in the neutrophils.

• There are four recognized ANCA immunofluorescence patterns:
  
• C-ANCA - classical cytoplasmic:  A coarse granular cytoplasmic fluorescence with accentuation between the nuclear lobes.
  
• Atypical C-ANCA:  A diffuse (flatter) cytoplasmic fluorescence without accentuation of the interlobular fluorescence or glanular staining.
  
• P-ANCA- perinuclear:  A typical perinuclear fluorescence with some nuclear extension  and granular cytoplasmic fluorescence on formalin-fixed neutrophils.
  
• Atypical" P-ANCA and atypical ANCA which include all other IIF reactivity:  Pronounced nuclear rim fluorescence with the center of nucleus unstained  and non-reactivity with formalin-fixed neutrophils, most commonly a combination of cytoplasmic and perinuclear fluorescence.
  

• Points to consider about ANCA:

• The upper limit of normal cANCA ratio varies from lab to lab.  The upper normal limit for the test result to be considered a“ negatives may be about 1:16 or 1:32.

• The cANCA test is about 90+% accurate for WG for serious cases, but only 50% or so for light cases).  Not all medical labs do the test, so frequently it is a 'send-out' test.  A tentative diagnosis made by positive cANCA is often confirmed by biopsy.

• The related pANCA test if positive may be an indicator for some other autoimmune diseases, e.g., microscopic polyarteritis (MPA), Churg-Strauss syndrome (CSS), polyarteritis nodosa (PAN) or crescentic glomerulonephritis.

• In the case of mixed ANCA, it may require other tests and analysis of symptoms to determine if the cause of the abnormality is Wegener's or some other condition.

• Note that the cANCA and pANCA are immunofluorescent (IIF) tests requiring a human microscopic examination and interpretation.  Results may vary if different individuals are doing the test.  It is best to have these and other tests done at the same lab each time to reduce the possible variations.

• While a positive cANCA is rather diagnostic for Wegener's, some small percentage of Wegener's patients test pANCA positive, rather than cANCA.  Occasionally a Wegener's patient will switch at times from testing positive to one ANCA to the other.

• ANCAs are titrated tests.  Stained blood samples are diluted in steps, progressively until no fluorescence is detected.  Results are reported as the dilution level at which fluorescence ceases.  These are given as 1:256 or 1/256 for example.  The higher the ANCA ratio, the more of the harmful antibodies are present in the patient’s blood.

• ANCA test results can be positive due to conditions other than autoimmune diseases.  Amebiasis, ulcerative colitis,  mesangiocapillary glomerulonephritis with crescents, improperly cleaned glassware,  and both subacute and bacterial endocarditis have been shown to cause transient positive ANCAs.
• The table below shows nneutrophil cytoplasmic antibodies (ANCA) staining patterns and associated target antigen in patients with systemic vasculitides and nonvasculitic disorders

• ANCA test samples can show differing results if submitted to different labs.  An effort to standardize these tests is underway in Europe by the EUVAS group.  False positives or negatives can and do occur due to mishandling or misinterpretation or even effects of medications or other disease conditions.

• In diagnosis both cANCA by immunofluorescence and anti-PR-3 by ELISA (see below) result in greater sensitivity than either test alone, and are both are performed in some labs even if only the cANCA is ordered.

• For more on ANCA tests, see http://www.thedoctorsdoctor.com/diseases/anca.htm


• See also the article, "Methodological update:  How and why should we detect ANCA?"

• ELISAs use particular biological proteins to detect specific biological markers of diseases. 
  
• The anti-PR-3 test relates generally to cANCA.  The anti-MPO test relates loosely to pANCA.

• Anti-PR3 ranges in use in the Mayo Rochester lab are: 
  
• Less than 6.0  EU/mL - negative
• 6.0 to 9.0 EU/mL - ambiguous
• greater than 9.0 - positive

• Anti-MPO ranges in use in the Mayo Rochester lab are:
• Less than 5.0 - negative
• 5.1 to 14.9 - equivocal
• above 14.9 - postive

• An ELISA test for anti-MPO antibodies can be indicative of several autoimmune diseases such as microscopic polyarteritis (MPA), polyarteritis nodosa,  idiopathic necrotizing and crescentic glomerulonephritis as well as in periarteritis with glomerulonephritis.

• The newer Capture [Sandwich] ELISA Test" can be more sensitive in detecting the less usual forms of anti-PR-3.  In particular, the Capture ELISA using the MoAb 12.8 antibody was found to have 96% sensitivity for WG in one study.

• The Immunoblot method is more sensitive to anti-PR3 than IIF, ELISA, or capture ELISA.  It does not quantify the results which must be done by IIF, ELISA, or capture ELISA.

•  It is probably prudent to have an anti-glomerular basement membrane (anti-GBM) test done to assure a seoond autoimmune disease isn't present that could threaten kidneys.
  

• A November 2006 study of autoimmune vasculitis ANCA postive patients found that plasma levels of sIL2R, sCD30 and BAFF were higher in patients than in controls at all time points.

• "Plasma levels of soluble interleukin 2 receptor, soluble CD30, interleukin 10 and B cell activator of the tumour necrosis factor family during follow-up in vasculitis associated with proteinase 3-antineutrophil cytoplasmic antibodies: associations with disease activity and relapse", and, "Plasma levels of sIL2R, sCD30 and IL-10 were higher at diagnosis and relapse than during remission."
• Testing of those proteins and others may be commercialized at some time and be useful for determining AV activity.
• There are some indications that cytokines sICAM-1 and CCR5 may correlate with WG activity.  Tests for these might prove useful  though experience and proof are lacking.

• As vasculitis patients often have silent (asymptomatic) heart damage, it is good that they have their heart function evaluated by electrocardiogram..
• A 2006 study showed that a serum protein,  N-terminal pro-brain natriueuretic peptide (NT-proBNP), can indicate the degree of heart damage. The body releases it when the heart's in trouble. It can not only diagnose the disease, it also correlates with the magnitude of heart failure,

• There are some indications that cytokines sICAM-1, interleukin-6 (IL-6), and CCR5 may correlate with WG activity.  These tests may prove valuable, though experience and proof are lacking.

• It has been suggested that anti-cardiolipin antibodies be tested for when ANCA test return a positive result.  Anti-phospholipid antibodies might also be checked.  These tests are not diagnostic for Wegener's, but may uncover other autoimmune dysfunctions.

• Anti-Endothelial Cell Antibodies (AECA) are found in the blood of 55-80% of Wegener's patients, and may be involved in the etiology of WG though that isn't proven.
• Possibly related, a 2003 paper stated that it had been found that soluble Endothelial protein C receptor (sEPCR) levels in the plasma of patients with WG was shown to correlate with disease activity and to rise prior to clinical relapse.

• There are some indications that the Procalcitonin (PCT) level may be a useful marker both for the differential diagnosis between bacterial infection and inflammation, but this remains unproven.

• ECP is a blood test for eosinophilic cationic protein. These cationic proteins are among the toxic granules that eosinophils release when they are activated. In eosinophilic disease.
  
• The eosinophils infiltrate an organ, inflame it, and the eos degranulate releasing these toxic byproducts of eosinophils.
  
• These proteins are what actually causes the tissue damage.
  
• So by testing for ECP, a physician can tell more of the activity level of eosinophils.
  
•  ECP is currently the best blood test we have to look for active eosinophilic disease.
  
• Sometimes the regular eos count on cbc is normal, but the ECP is high showing they are still active.
  
• ECP is the best test to reflect active Eosinophilia orf Churg-Strauss syndrome.
• It usually has to be sent off to an out of state lab and takes about 2 weeks to come back.

• Pentraxin 3 (PTX3) level is related to vascular inflammation.  Testing for PTX3 levels might be useful in determining vasculitis activity levels.

• A Jan. 2008 paper discusses the possible value of testing for the Cystatin C level as it is more sensitive than the calculated eGFR and so can reveal degradation of kidney function before the estimated glomerular filtration rate (GFR) which is based on the 24 hr. creatinine clearance test.. 
  

  A - URINE CHEMISTRY TESTS

• In remission, dipsticks should be used bi-weekly to check for for blood and/or protein indicating silent kidney involvement.

• Creatinine levels above normal are likely to be evidence of kidney involvement.  (NOTE: It is possible to have creatinine levels within the normal range even while kidneys are spilling blood and portein due to WG damage.)
  

• Urine creatinine can be tested from a single sample.

• Single measurement normal range is 0.4 to 1.5 milligrams per deciliter (mg/dl)

• The more exacting test is the 24 Hour Creatinine Excretion (Clearance) test.  The kilograms refers to body weight.  To convert pounds to kilograms, divide by 2.2.

• Renal function should be assessed by the GFR using estimating equations like the MDRD or Cockroft-Gault formula.

• Low Urine Creatinine:
• Values above decrease with advancing age.
• Low value suggests inadequately collected specimen

• High Urine Creatinine:

•  Indicates probable kidney damage due to WG or another cause.

• Urine chemistry is checked for:

 

Blood Component	Normal Values ##
Nitrite	Negative
PH (Acid/Alkaline)	5.0 to 8.0
Protein #	Negative
Glucose	Normal or negative
Ketones	Negative
Urobilinogen	Normal or negative
Bili Qual	Negative
Blood	Negative
Red Blood Cells	Less than 1 per HPF
White Blood Cells	2 per HPF

##  Measured values can vary from normal due to disease, medications, or medication interactions.

• Cell abnormalities
• White blood cells
• Red blood cells
• Transitional epithelial cells
• Squamous epithelial cells
• Renal tubular epithelial cells

• Fat Globules and Oval Fat Bodies

• Microorganisms
• Yeast
• Bacteria
• Trichomonas vaginalis
• Clinically Significant Casts
• Tamm-Horsfall protein
• Crystals  (Most crystals are not clinically significant)
• Crystals may be counted if abnormal.
• Abnormal crystals may indicate pH problems

• Miscellaneous Elements and Artifacts
• Mucus
• Sperm
• Artifacts                                    (Click here to return to index)

• X-rays, Computed Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) test may be done for sinus, lungs, head, kidneys and others as required.  Color duplex ultrasound (CDU) might prove useful in some cases to identify blood vessel abnormalities.  MRIs of sinuses are frequently false positives as small amounts of mucus may appear as inflammation.
  

• F-18-fluorodeoxyglucose (FDG) accumulates in inflammatory cells due to an increased metabolic rate. FDG positron emission tomography (PET) represents a proven imaging technique in patients with vasculitis.    FDG PET is a useful tool for evaluating the extent of vasculitis and evaluating the effects of treatment of vasculitis.  A recent development of a combined FDG PET and CT uses 18F FDG to better locate and assess disease activity.
  

• CT scans are generally preferable to x-rays because of their considerably greater detail and diagnostic utility, and are not significantly more expensive than x-rays.  There is greater radiation exposure so the number of CT scans should be only those required.

•  MRIs may be done for soft tissues where x-rays and CT scans are not always useful.  MRIs are done in small tubes into which the patient slides and must remain motionless.  Larger machines less likely to cause claustraphobia are available in some locations.
  

• MRIs done with contrast may use gadolinium (gadodiamide).  The gadodiamide agent poses less risks the the odinated contrast agents formerly used.  Poor kidney function probably precludes that particular contrast medium.  A new form of gadolinium encased in carbon buckey balls may prove less toxic than gadodismide.
  

• Tranquillizers or hypnotics may be required for those with claustrophobia. Newer, larger MRI machines may be available where claustrophobia may not be a problem. 
  

• MRA (magnetic resonance angiogram) is particularly useful in identifying large vessel stenoses in the brain.
• DSA (digital subtraction angiography) may be useful in identifying and monitoring smaller blood vessel abnormalities. 
  

• Recently a study showed diffusion-weighted echoplanar MR imaging may be especially useful in diagnosing vasculitis involvement in the brain (Central Nervous System).

• Videostroboscopy may be useful in imaging the trachea and glottus.

• Early diagnosis of Takayasu's arteritis (and perhaps other vasculitides) can be helped by use of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) instead of the more common imaging tests.

• Virtual vascular endoscopy (VVE) uses two- and three-dimensional (3D) data sets from magnetic resonance (MR) or computed tomographic angiography to create endoluminal views of blood vessels.

• A protocol of high-resolution magnetic resonance imaging at 3 T in combination with contrast-enhanced magnetic resonance angiography can help determine blood vessel abnormalities.

• Some things to be aware of:

• Biopsies are usually done under local anesthetic, excepting for open lung biopsies which require a general anesthesia.

• Negative sinus biopsies are notoriously unreliable because it is such a problem to get the correct tissue sampled.

• Kidney biopsies are generally rather trouble free and involve minimal intrusiveness if done by the guided-needle method.

• Lung biopsies may be either by guided-needle or an open-lung surgical method.  The open lung is major surgery and probably to be avoided if possible.

• Some physicians insist on an open lung biopsy.  It might be best to get a second opinion on the necessity for that method before proceeding.

• More than once, a lung granuloma as been incorrectly identified as lung cancer.  It may be prudent to have the tissue sample submitted to a different pathologist in a different hospital for evaluation.

• All patients suspected of having vasculitis with lung or liver involvement should be tested for alpha-1 antitrypsin antibodies (AATD).
  

• It is prudent to check all vasculitis patients for hypothyroidism (Hashimoto's thyroiditis) or other malfunctions of thyroid and associated endocrine glands (pituitary or hypothalamus).
  

• Because AVs can have clinically silent cardiac involvement in about 3 out of 10 patients, echocardiography is appropriate at times. As AVs can involve most any organ, there may be other tests required to identify those affected organs.
• Heart function should be systematically assessed in vasculitis patients, with at least ECG and echocardiography, and more invasive exploratory procedures when the former reveal abnormalities or symptoms become manifest.

• Before starting therapy with Imuran (Azathioprine), liver functions should be tested.

• Routine monitoring of patients taking immunosuppressant drugs
• Monitoring of immune system
• Acute phase reactants
• C-reactive protein
• Erythrocyte sedimentation rate
• Disease-specific auto-antibodies
• Antineutrophil cytoplasmic antibody
• Anti-double-stranded DNA antibody
• Immunoglobulin and complement concentrations
• Organ function and histology
• Neutrophil and lymphocyte counts
• T-cell subsets
• Monitoring of adverse effects
• Haemoglobin
• Platelets
• Lipids
• Blood glucose
• Blood pressure
• Skin cancer surveillance
• Rectal examination
• Pap smear
• Possibly prostate specific antigen
• Bone densitometry
• Cataract screening
• Therapeutic drug monitoring
• Meeting therapeutic targets (where known)
• Defines poor absorption
• Helps assess compliance
  

    ANCA Interpretation
    Frequency Of cANCA, pANCA, Anti-MPO & Anti-PR3 In Vasculitis
    http://www.rdlinc.com/ancachrt.htm

   ANCA Tests:
    Anti-neutrophil cytoplasmic antibodies:
    Current diagnostic potential - 1996
    http://medicine.wustl.edu/~labmed/1996vol4no1.html

   Autoantibody tests:
    Auto-Antibody Patterns vs. Vasculitis- Table - Oct. 2001
    http://www.haps.nsw.gov.au/edrsrch/edinfo/autopat.html

   Blood Test Tables and Interpretations - America-On-Line
    http://members.aol.com/CatsPajama/bloodval.htm

  Complete Blood Count (CBC):
    http://www.healthwise.org/kbase/topic/medtest/hw4260/results.htm

  ELISA (Enzyme-Linked Immunosorbent Assay)
    http://www.uq.edu.au/vdu/ELISA.htm
    http://www.focusonthyroid.com/script/main/art.asp?articlekey=9105&rd=1

  How To Read Laboratory Tests
    Includes table of normal values for blood tests
    http://ighawaii.com/naturally/newsletter/lab.html

  How to convert U.S. concentration levels to the Syst'eme Internationale (SI)
    http://dwjay.tripod.com/conversion.html

  Imaging Tests for WG - Scroll down to Sections 4-9
    Thoracic Imaging of Wegener's Granulomatosis
    http://www.emedicine.com/radio/topic743.htm

 Immunology: Ref. Chart of Tests/Panels - [no longer available]
    Univ. of Washington, Dep't.. of Laboratory Medicine, Immunology Division
    Excellent summary of tests, updated in June 2000
    http://depts.washington.edu/labweb/dept/div/imm/refchart.html

  Lab Tests On-Line:
    Wonderful World of Tests - Links to various on-line lab test information
    http://www.enetis.net/~rbreske/lab.htm

  Rheumatology Laboratory Tests - Last update 1997
    http://www.rheumatology.org/publications/primarycare/number6/hrh0034698.html

 Systemic Rheumatic Diseases - Laboratory Testing
    http://www.postgradmed.com/issues/1998/02_98/ward.htm

 Urinalysis:
   Slides of Microscopic Examination
    http://www.lhsc.on.ca/lab/renal/

 Urinalysis: Informal but expert dissertation - Scroll way down for Urinalysis
    http://www.pathguy.com/lectures/urine.htm