Histopathological Pattern of Glomerulonephritis: Experience from BIRDEM General Hospital, Dhaka, Bangladesh (original) (raw)
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IP innovative publication pvt. ltd, 2019
Introduction: Glomerulonephropathies (GNs) have high burden of morbidity and mortality worldwide. The distribution GNs varies significantly due to several factors. Materials and Methods: This retrospective clinico-pathological study estimates the biopsy-proven distribution of primary and secondary GNs and detects the predominant patterns among adult patients who underwent renal biopsy at Nephrology Centre, King Abdul-Aziz Specialist Hospital, Taif City, Kingdom of Saudi Arabia (KSA) from 2008 to 2013 with comparing data to other KSA studies and to other countries. Analysis of possible contributing factors for variation is provided. Relevant patients’ data were collected from hospital records. Renal biopsies stained with H&E, Periodic Acid Schiff (PAS), Gomori Methenamine Silver (GMS), Masson Trichrome (MT) and immunofluorescence (IF) were examined and categorized according to the World Health Organization (WHO) classification of glomerular diseases. Comparisons to other studies were set. Results: Primary and secondary GNs comprised 59.4% and 40.6%. Focal segmental glomerulosclerosis (FSGS) was the commonest primary GN (29.3%), followed by minimal change disease (MCD, 22%) then membranous glomerulonephropathy (MGN, 19.5%). IgA nephropathy was the least frequent (IgAN, 2.4%). Lupus nephritis (LN) was the commonest secondary GN (75%), followed by diabetic and vascular nephropathies (DN, 17.9% ; VN, 7.1%). Spatial and temporal variations in GNs distribution existed locally and worldwide. Conclusion:Factors including selection criteria; biopsy rate and indications; local facilities; demographic distribution; racial, ethnic and genetic differences; and prevalence of etiological factors contribute to the variations of GNs distribution. National renal biopsy registry is recommended for obtaining correct distribution of GNs leading to proper prevention and treatment.
Journal of Nephropharmacology, 2016
Introduction: The frequency of primary glomerular diseases is variable from one part of the world to the other. Data published from India has shown wide range of variation in the different regions of the country. Objectives: This study reports the frequency of primary glomerulonephritis (GN) in adults in the Rayalaseema region of south India. Materials and Methods: The study is based on prospective evaluation of renal biopsies done during 2 years 4 months period (May 2010-August 2012). A total of 137 cases of primary GN were studied by light microscopy and immunofluorescence (IF). The patients age range between 15-74 years. Results: Most frequent primary GN was membranous nephropathy (MN) constituting 35.8%, followed by minimal change disease (MCD) at 16.7%. Conclusion: This study demonstrates that MN is the most common primary GN encountered in the adults, the second more frequent is MCD. This result is in contrast to previous reports from India where IgA nephropathy (IgAN) and MCD...
Idiopathic Membranous Glomerulonephritis in Patients with Type 2 Diabetes Mellitus
Hong Kong Journal of Nephrology, 2005
The occurrence of membranous glomerulonephritis (MGN) in patients with type 2 diabetes mellitus (DM) is a rare event and of pathogenetic interest. We report two males (52 and 64 years old) with type 2 DM and nephrotic syndrome of recent onset. Renal biopsy was performed because of the unusual clinical pictures: microscopic hematuria; heavy proteinuria without evidence of diabetic retinopathy; and, in one case, a sudden onset of renal failure. Renal biopsy disclosed pure MGN without glomerulosclerosis. In both cases, clinical history, physical examination and biologic assessment failed to reveal the cause; MGN was thus considered idiopathic. Treatment, including glycemic control and angiotensin-II receptor blockers, led to resolution of proteinuria in one case. We suggest that renal biopsies should be performed in diabetic patients with a sudden onset of renal failure, proteinuria without retinopathy, or other evidence of microvascular disease. [Hong Kong J Nephrol 2005;7(1):
Hong Kong Journal of Nephrology, 2010
Published studies from different centers in Saudi Arabia have reported contradicting results regarding glomerular lesions. In this retrospective study, we report our experience in King Fahd Hospital of the University at Al-Khobar in the Eastern province, including a description of the morphologic and clinical characteristics of primary and secondary glomerular disease. The study included 233 renal biopsies obtained from patients presenting with glomerular manifestations over a period of 23 years , investigated by light microscopy, immunofluorescence (149 cases) and electron microscopy (34 cases). One hundred and eighty-seven cases (80.3%) were primary glomerulonephritides. Minimal change glomerulopathy was the most common type of primary glomerulonephritis found (29.4% of primary glomerulonephritides), followed by mesangioproliferative glomerulonephritis (19.8%), and focal/segmental glomerulosclerosis (15.5%). Membranoproliferative glomerulonephritis was found in 9.6% of cases, membranous glomerulopathy in 8.6%, IgA nephropathy in 6.4%, end-stage glomerulopathy in 5.9%, crescentic glomerulonephritis in 3.2%, and IgM nephropathy in 1.6%. Of the secondary glomerulonephritides (46 cases constituting 19.7% of the biopsies), lupus nephritis was the most frequently diagnosed disease (71.7% of secondary glomerulonephritides). Diabetic glomerulosclerosis was found in 10.9% of cases, amyloidosis in 6.5%, and Alport syndrome in 4.3%. Wegener's granulomatosis, Henoch-Schönlein purpura nephritis and hypertensive nephrosclerosis each represented 2.2% of cases (one case each). Other than a significantly higher incidence of minimal change glomerulopathy and lupus nephritis (p < 0.001) and a significantly lower prevalence of membranoproliferative glomerulonephritis (p = 0.029), our results are generally comparable to those reported by the Saudi registry for glomerulopathy and in some neighboring countries. Ageand sex-adjusted analyses revealed that minimal change glomerulopathy and lupus nephritis were also the most prevalent primary and secondary glomerulopathies in the pediatric age group (below 15 years) as well as in adults, females and males. [Hong Kong J Nephrol 2010;12(1):20-30]
The spectrum of glomerular diseases in a single center: A clinicopathological correlation
Indian Journal of Nephrology, 2013
We report the spectrum of biopsy-proven glomerular disease (GD) in a single center in Eastern India. Medical records of 666 patients with biopsy-proven GD over a period of 2 years from July 2010 to July 2012 were retrospectively analyzed. The clinical, laboratory, and histological data were recorded. All biopsy specimens were examined by the same pathologist with light and immunofluorescence microscopy. Electron microscopic analysis was performed only in selected cases. Histologic spectrum of various GDs was studied along with its correlation with the clinical and laboratory parameters. The clinical diagnosis was nephrotic syndrome (NS) in 410 (61.56%), rapidly progressive renal failure/glomerulonephritis in 130 (19.52%), subnephrotic proteinuria/asymtomatic urinary abnormalities in 52 (7.81%), acute kidney injury/acute nephritic syndrome in 40 (6.01%), and macroscopic hematuria in 4 (0.6%) patients. Male: Female ratio was 1.05; 27.92% (n = 186) were < 18 years, 68.47% (n = 456) were 18-59 years, and 3.6% (n = 24) were ≥ 60 years of age. The most common GD was minimal change disease (MCD) (20.12%, n = 134); others were focal segmental glomerulosclerosis (FSGS) (18.02%, n = 15.32%), lupus nephritis (LN) (15.32%, n = 102), membranous nephropathy (MN) (12.01%, n = 80), and IgA nephropathy (IgAN) (8.11%, n = 54). Primary GD was present in 79.13% (n = 527) and common histologies were MCD (25.42%), FSGS (22.58%), MN (14.42%), and IgAN (10.25%). Secondary GD was present in 20.87% (n = 139), with the most common being LN (73.38%, n = 102). Among the NS (n = 410), the most common GD was MCD (31.46%), followed by FSGS (25.6%), MN (15.58%), LN (7.8%), IgAN (6.09%), and membranoproliferative glomerulonephritis (4.88%). FSGS was the most common primary GD in adults, MCD in children, and MN in the elderly patients. The spectrum of GD varies according to the area of study and changes over time. A biopsy registry is needed for documenting this variation.
Membranoproliferative glomerulonephritis complicating diabetic nephropathy
Prilozi, 2005
BACKGROUND Renal diseases other than diabetic nephropathy can be found in diabetic patients who have undergone renal biopsy. Various forms of primary and secondary glomerular diseases were reported, but membranoproliferative glomerulonephritis was rare. METHODS Analyzing data at our Department for the past three years, we noted 18 patients with primary membranoproliferative glomerulonephritis and 4 associated with diabetic nephropathy. RESULTS Nodular glomerulosclerosis with diffuse membranoproliferative glomerulonephritis was registered in two patients and a diffuse form of diabetic nephropathy with a combination of segmental and diffuse changes characteristic of membranoproliferative glomerulonephritis in the other two patients. CONCLUSIONS Analyzing what can be common for these two diseases we can conclude that they are at least three disorders: 1. hyperperfusion injury, hallmark for the diabetic nephropathy, but also with the highest incidence in membranoproliferative glomerulon...
Biopsy proven renal diseases at PNS SHIFA, Karachi, Pakistan: Clinicopathological correlations
To determine the clinicopathological and the mean of segmentally sclerosed glomeruli, correlations of biopsy proven renal disease 0.94±1.55 (range: 0-7). Overall, global (BPRD) from a tertiary care naval hospital in glomerulosclerosis (GS) was found in 31(66%) Karachi, Pakistan. biopsies, and segmental glomerulosclerosis (SS) Methodology: All the adequate native renal in 19 (40.4%) biopsies. Arteriolosclerosis (AS) biopsies (RBs) in adult patients (>18 years) was present in 12 (25.5%) biopsies and hyaline performed at our hospital from 2008 to 2012 were arteriolosclerosis in 11(23.4%). Fibrointimal retrospectively analyzed. These were studied by thickening of arteries was found in 13 (27.6%) light microscopy and immunofluorescence. cases. A variable degree of interstitial fibrosis and Results: A total 47 cases met the inclusion tubular atrophy (IFTA) was found in 41 (87.2%) criteria. The mean age was 33.23±12.11 years. cases and interstitial inflammation in 16 (34%) Nephrotic syndrome (NS) was the most frequent cases. Acute tubular necrosis (ATN) was found in indication, followed by renal failure (RF). Focal 5 (10.6%) cases. segmental glomerulosclerosis (FSGS) was the Conclusion: This study provides the most common cause of NS, followed by clinicopathological correlates of RBs in patients membranous GN (MN) while chronic sclerosing with medical renal diseases. Our data are more or GN was the most common cause of RF. The mean less similar to those recently reported from around total number of glomeruli included in all RBs was the world.
The changing pattern of adult primary glomerular disease
Nephrology Dialysis Transplantation, 2009
Background. Published biopsy series have shown geographical and temporal variations in the patterns of primary glomerulonephritis (GN). IgA nephropathy is the most common type of GN in most European studies, but there is evidence suggesting that focal segmental glomerulosclerosis (FSGS) is increasingly common in the USA in all ethnic groups. We report the analysis of 30 years of native renal biopsies and the temporal pattern of primary glomerular disease in a single United Kingdom (UK) region. Methods. All 1844 adult native kidney biopsies for 30 years (1976-2005 inclusive) were analysed. The data were divided into three 10-year time frames, and trends in the biopsy rate and diagnosis of primary glomerular disease were considered. Results. Biopsy rates increased significantly from 2.02 to 7.08 per hundred thousand population per year (php/year) (χ 2 = 55.9, P < 0.001), and the mean patient age at biopsy rose from 33 to 49 years over the study period (F = 58, P < 0.001). Primary GN was documented in 49% of biopsies; the most common diagnoses within this group were IgA nephropathy (38.8%), membranous nephropathy (29.4%), minimal change disease (9.8%), membranoproliferative GN type 1 (9.6%) and FSGS (5.7%). There was a significant increase in the proportion of IgA nephropathy (χ 2 = 9.6, P = 0.008) and a decrease in membranous nephropathy (χ 2 = 7.2, P = 0.03) over time. The population incidence of FSGS was low and unchanged at 0.18 php/ year from 1986 to 2005. Conclusions. Consistent with several other European studies, IgA nephropathy was the most common primary glomerular disease in this UK region. The diagnosis of FSGS was uncommon with no evidence of a rise in incidence.