BACKGROUND:Little is known about the nature and the course of IgA nephropathy (IgAN) in Arab countries. The aim of this work was to study the spectrum of clinical presentation and histopathological findings at our institution.DESIGN AND SETTING:Retrospective review, all renal biopsies at the Mubarak Al Kabeer Hospital between January 2000 and December 2004.METHODS:Cases of IgA nephropathy were selected, and their medical records and biopsy findings were reviewed.RESULTS:Eighty patients (9.2% of all native kidney biopsies) were diagnosed to have IgAN nephropathy. Sixty-nine biopsies were included in the study;11 were excluded. Forty-three (62.3%) patients were male and 26 (37.7) patients were female. Fifty (72.5%) patients were below the age of 40 years. Mean (SD) duration of follow-up was 3.6 (1.3) years. The first presentation included nephritic-range proteinuria (49.3%) and renal impairment (50.7%). During the follow-up period, 56 (81.2%) patients were stable or improved. Hass classification of biopsies showed 36.2% had class I, 27.5% had class II, 13.0% had class III, 5.8% had class IV, and 17.4% had class V IgAN. Females had milder forms of the disease than males. Macroscopic hematuria and renal impairment at presentation were seen more in patients with class IV and V IgAN. The presenting serum creatinine and uric acid values were higher in those with Hass classes III to V. Deterioration of renal function during the follow-up period was more significant in the presence of hypertension, renal impairment, or macroscopic hematuria at the time of biopsy .CONCLUSION:The prevalence of IgAN in Kuwait is about 9.2%. Renal impairment or macroscopic hematuria at presentation was seen in patients with more aggressive renal lesions and contributed to poor outcome.

9LNS VTOYPd MTZ[^d bL^ []P[L]PO Md N`__TYR [L]LQQTY MWZNV^ TY_Z *$ X ^PN_TZY^ LYO ^_LTYTYR ) ^WTOP^ bT_S [P]TZOTN LNTO FNSTQQ# ) ^WTOP^ QZ] SPXL_ZcdWTY LYO PZ# TY# ( ^WTOP QZ] >ZYP^ XP_SPYLXTYP ^TWaP] LYO ( ^WTOP QZ] _]TNS]ZXP% =XX`YZ[P]ZcTOL^P ^_LTYTYR bL^ LW^Z [P]$ QZ]XPO ]Z`_TYPWd ZY LWW ^WTOP^ QZ] =R;# =R5# =RA LYO 7*% 5Y_TMZOTP^ bP]P Q]ZX 8LVZ# LYO _T_]L_TZY bL^ [P]$ QZ]XPO LNNZ]OTYR _Z _SP WPLQWP_^ bT_S _SP LY_TMZOd aT$ LW^% 9WPN_]ZY XTN]Z^NZ[d !9A" bL^ YZ_ ]Z`_TYPWd OZYP TY LWW NL^P^ TY _SP TY^_T_`_TZY2 SZbPaP]# TY ^PWPN_PO NL^P^# 9A bL^ [P]QZ]XPO LYO _SP QTWX^ bP]P ]P_]TPaPO LYO ]PaTPbPO LWZYR bT_S _SP 9A ]P[Z]_% B`XP]TNLW aL]TLMWP^ L]P Pc[]P^^PO L^ XPLY !^_LY$ OL]O OPaTL_TZY"% GSP ]PWL_TZY^ST[^ bT_STY LYO MP_bPPY _SP NWTYTNLW LYO _SP ST^_Z[L_SZWZRTNLW aL]TLMWP^ bP]P ZM$ _LTYPO `^TYR _SP NST$^\`L]P _P^_ Z] :T^SP] PcLN_ []ZM$ LMTWT_d _P^_ QZ] NL_PRZ]TNLW aL]TLMWP^ LYO YZY[L]LXP_]TN ALYY$JST_YPd H _P^_ LYO ?]`^VLW$JLWWT^ _P^_ QZ] NZY_TY`Z`^ aL]TLMWP^% " WP^^ _SLY %', bL^ NZY^TOP]PO _Z MP ^_L_T^_TNLWWd ^TRYTQTNLY_% F_L_T^_TNLW LYLWd^T^ bL^ [P]$ QZ]XPO `^TYR FDFF QZ] JTYOZb^ aP]^TZY (-!FDFF# =YN%# 7STNLRZ# =@"% F:GIAHG 8`]TYR _SP ,$dPL] [P]TZO# (,., ]PYLW MTZ[^TP^ bP]P [P]QZ]XPO bT_S /.( MTZ[^TP^ ZY YL_TaP VTOYPd^ LYO .'+ ZY _]LY^[WLY_PO VTOYPd^% 9TRS_d [L_TPY_^ !]P[]P$ PY_TYR 0%) ZQ _SP YL_TaP VTOYPd MTZ[^TP^# ,%( ZQ _SP _Z_LW MTZ[^TP^" bP]P QZ`YO _Z SLaP =R5 YP[S]Z[L_Sd LNNZ]OTYR _Z _SP MTZ[^d ]P^`W_^% 9WPaPY [L_TPY_^ bP]P PcNW`OPO Q]ZX _SP ^_`Od MPNL`^P ZQ XT^^TYR OL_L Z] _SP , " LYO NWL^^ I !), " =R5B _SLY TY [L_TPY_^ bT_S NWL^^ = !/ " =R5B !D3%',"% EPYLW TX[LT]XPY_ L_ []P^PY_L_TZY bL^ ^PPY XZ]P TY [L_TPY_^ bT_S NWL^^ =I !., " LYO NWL^^ I !0( " =R5B _SLY TY _SZ^P bT_S NWL^^ = !)/ " =R5B !D3%''("% GSP WPaPW^ ZQ []P^PY_TYR ^P]`X N]PL_TYTYP LYO `]TN LNTO bP]P STRSP] TY _SZ^P bT_S G8IGG>DC ALYd ]P[Z]_^ ZQ RWZXP]`WZYP[S]T_T^ L^^ZNTL_PO bT_S XP^LYRTLW =R5 OP[Z^T_^ SLaP MPPY [`MWT^SPO ^TYNP _SP Z]TRTYLW ]P[Z]_ ZY =R5B Md 6P]RP] LYO L[LY(( LYO =_LWd#() _SP TYNTOPYNP SL^ ]LYRPO Q]ZX ((%. _Z +*%* ZQ _SP _Z_LW Y`XMP] ZQ ]PYLW MTZ[$ TP^% A`NS WZbP] TYNTOPYNP^ SLaP MPPY ]P[Z]_PO TY _SP HYT_P^ F_L_P^#(* 9YRWLYO(+ LYO 7LYLOL#(, bT_S _SP TY$ NTOPYNP ]LYRTYR Q]ZX )%' _Z /%, TY _SP^P NZ`Y_]TP^% 6P]RP](-^`RRP^_PO _SL_ _SP STRSP] ]P[Z]_PO TYNTOPYNP ZQ _ST^ OT^PL^P TY NP]_LTY NZ`Y_]TP^ NZX[L]PO _Z Z_S$ P]^ XLd ]PQWPN_ _SP []LN_TNP Z...

Introduction: Granulomatous interstitial nephritis (GIN) is a rare histological diagnosis that can be the first manifestation of systemic disease. It has been associated with medications, infections, sarcoidosis, crystal deposits, paraproteinemia and Wegnere's granulomatosis. It can also be seen in an idiopathic form. Case report: A 37 year-old female patient presented to our nephrology service with lethargy and weight loss of three months duration. Her past medical history and clinical examination were not remarkable. She had impaired renal function tests and hypercalcemia associated with elevated angiotensin converting enzyme levels and sonographically normal kidneys. Extensive investigations revealed no other organ involvement and no evidence of infection or malignancy. Renal biopsy showed extensive interstitial non-necrotizing granulomata. Accordingly, she was diagnosed as a case of isolated renal sarcoidosis and started on steroid therapy. Within one month of treatment, she recovered normal renal function. Steroids were successfully tapered after another six months, and she shows no evidence of recurrence 24 months after steroid withdrawal. Conclusion: The possibility of isolated renal sarcoidosis should be considered in any case of impaired kidney function and hypercalcemia even in the absence of systemic manifestation. The finding of non-caseating interstitial granulomata in renal biopsy supports this diagnosis.