DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150317

Spectrum of glomerular diseases – clinico-pathologic observations from a state run tertiary care centre

Umesha Lingaraju, Shyam S. Varma, Satishkumar M.M., Leelavathi V., Shreedhar C.G.

Abstract


Background: Renal biopsy is an accurate tool for the diagnosis of glomerular disorders. This study was done to evaluate the histo-pathological spectrum of GDs at our centre and analyze its clinico-pathological correlation.

Methods: All renal biopsies performed for suspected glomerular diseases at our institute over a period of 2 years from Jan 2013 to Jan 2015 were analyzed (n= 597). Biopsies were performed under ultrasound guidance and processed for light microscopy and immunofluorescence.

Results: Among the total biopsies done, 597 (69.49%) had biopsy proven GD .The mean age of the patients included was 37.96 ± 15.58 years. M:F ratio was 2.3 : 1. The most common clinical syndrome was nephrotic syndrome (44.38%). PGDs were more common than SGDs The most common GD presenting as NS was FSGS (29.8%). Among patients with nephrotic syndrome, FSGS, MCD, and MGN predominated. DN was the commonest SGD, followed by Lupus nephritis. NDRD was reported in 33 patients (5.52%).Crescentic GN was seen in 11.89% cases majority presenting as RPGN. IgAN comprised 40.42% of the immune complex crescentic GNs. Amyloidosis was diagnosed in 1.84% of biopsies.

Conclusion: Histo-pathological examination with LM and IF techniques and correlation with clinical, biochemical and serological markers as done in this study, have proved useful for the accurate diagnosis of glomerular diseases. It also provides important epidemiological information towards setting up a renal biopsy registry.

 


Keywords


Glomerular disorders, Renal biopsy, Spectrum, Histopathology

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References


Chávez Valencia V, et al: Epidemiology of glomerular disease in adults: A database review; Gacetamedica de mexico 2014;150,403-8.

Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013;380:2095–128.

Ferraz, Fabio HumbertoRibeiroPaes et al. Profile of glomerular diseases in a public hospital of Federal District, Brazil. J Bras Nefrol. 2010;32(3):249-56.

Gesualdo L, DiPalma AM, Morrone LF, Strippoli GF, Schena FP. Italian Immunopathology Group, Italian Society of Nephrology. The Italian experience of the national registry of renal biopsies. Kidney Int. 2004;66:890-4.

Hanko JB, Mullan RN, O'Rourke DM, McNamee PT, Maxwell AP, Courtney AE. The changing pattern of adult primary glomerular disease. Nephrol Dial Transplant. 2009;24:3050.

Floege J, Feehally J. Introduction to glomerular disease: Clinical presentations. In: Floege J, Johnson RJ, Feehally J. editors. Comprehensive Clinical Nephrology. 4th ed. St. Louis, Missouri: Saunders; 2010; 193.

PA James; 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20.

Sharp VJ, Barnes KT, Erickson BA. Assessment of asymptomatic microscopic hematuria in adults. Am Fam Physician. 2013;88:747–54.

Gupta K, Iskandar SS, Daeihagh P, et al. Distribution of pathologic findings in individuals with nephrotic proteinuria according to serum albumin. Nephrol Dial Transplant. 2008;23(5):1595-9.

Lafayette RA, Perrone RD, Levey AS. Laboratory evaluation of renal function, in Schrier RW (ed): Diseases of the Kidney and Urinary Tract. Philadelphia, Lippincott, Williams and Wilkins, 2001, ed 7, pp 333-369.

V. Golay, M. Trivedi, A. Abraham, A. Roychowdhary, R. Pandey. The spectrum of glomerular diseases in a single center: A clinic pathological correlation. Indian J Nephrol. 2013;23(3):168–75.

Pecse et al; Worldwide distribution of glomerular diseases: the role of renal biopsy registries. Nephrol Dial Transplant. 2010;25(2):334-6.

Chugh KS, Sakhuja V. Glomerular diseases in the tropics. Am J Nephrol. 1990;10:437–50.

Kristin Meliambro, Monica Schwartzman, Paolo Cravedi, and Kirk N. Campbell, “The Impact of Histologic Variants on FSGS Outcomes,” International Scholarly Research Notices, vol. 2014, Article ID 913690, 7 pages, 2014. doi:10.1155/2014/913690.

Swaminathan S, Leung N, Lager DJ, Melton LJ, 3rd, Bergstralh EJ, Rohlinger A, et al. Changing incidence of glomerular disease in Olmsted County, Minnesota: A 30-year renal biopsy study. Clin J Am Soc Nephrol. 2006;1:483–7.

Balakrishnan N, John GT, Korula A. Spectrum of biopsy proven renal disease and changing trends at a tropical tertiary care centre 1990-2001. Indian J Nephrol. 2003;13:29–35.

Das U, Dakshinamurty KV, Prayaga A. Pattern of biopsy-proven renal disease in a single center of south India: 19 years experience. Indian J Nephrol. 2011;21:250–7.

Floege J, Feehally J. Introduction to glomerular disease: Clinical presentations. In: Floege J, Johnson RJ, Feehally J. editors. Comprehensive Clinical Nephrology. 4th ed. St. Louis, Missouri: Saunders; 2010. p. 194.

Churg J, Bernstein J, Glassock R. Renal disease: classification and atlas of glomerular diseases. New York, Tokyo: Igaku-Shoin 1995.

Arias LF, Paulo S. Glomerular diseases in a Hispanic population: review of a regional renal biopsy database Enfermedadesglomerulares en unapoblaciónhispánica: resultados de un registro regional de biopsiasrenales. Med J. 2009;127(3):140-4.

RiyamI DA. The Spectrum of Glomerular Diseases on Renal Biopsy: Data From A Single Tertiary Center In Oman. Oman Med J. 2013;28(3):213–5.

Ghani AA, Al Waheeb S, Al Sahow A, Hussain N. Renal biopsy in patients with type 2 diabetes mellitus: indications and nature of the lesions. Annals of Saudi Medicine. 2009;29(6):450-3.

Pham TT, Sim JJ, Kujubu DA, et al. Prevalence of non-diabetic renal disease in diabetic patients. Am J Nephrol. 2007;27:322-8.

Das U, Dakshinamurty KV, Prayaga A, Uppin MS. Nondiabetic kidney disease in type 2 diabetic patients: A single center experience. Indian J Nephrol. 2012;22:358–62.

Abdalah E, Waked E. Incidence and clinical outcome of renal amyloidosis: a retrospective study. Saudi J Kidney Dis Transpl. 2013;24(5):950–8.

Chugh KS, Datta BN, Singhal PC, Jain SK, Sakhuja V, Dash SC. Pattern of renal amyloidosis in Indian patients. Postgrad Med J. 1981;57:31–5.

Narasimhan B, Chacko B, John GT, Korula A, Kirubakaran MG, Jacob CK. Characterization of kidney lesions in Indian adults: Towards a renal biopsy registry. J Nephrol. 2006;19:205–10.

Mubarak M; Pattern of renal diseases observed in native renal biopsies in adults in a single centre in Pakistan. Nephrology. 2011;16:87-92.

Alwahaibi NY, Alhabsi TA, Alrawahi SA. Pattern of glomerular diseases in Oman; A study based on light microscopy and immunoflurescence. Saudi J Kidney Dis Transpl. 2013;24:387-91.