A Global Evolutionary Trend of the Frequency of Primary Glomerulonephritis over the Past Four Decades

Woo, Keng Thye; Chan, Choong Meng; Lim, Cynthia Ciwei; Choo, Jason; Chin, Yok Mooi; Teng, Esther Wei Ling; Mok, Irene; Kwek, Jia Liang; Loh, Alwin Hwai Liang; Choong, Hui Lin; Tan, Hwee Leong; Lee, Grace S L; Lee, Evan; Wong, Kok‐Seng; Tan, Puay Hoon; Foo, Marjorie

doi:10.1159/000500142

Cited by 31 publications

(28 citation statements)

References 46 publications

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“…Cross-sectional results from the DANYRBI have previously been published [ 28 ]. Detailed reviews of previously published incidence studies are available [ 12 , 16 ]. Comparison between the studies is difficult due to differences in histological classification, non-inclusion of secondary GN, and subdivision of the results into cohorts and/or age groups.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the studies do not have a defined background population, and thus express relative frequencies rather than absolute incidence. Two large reviews of the studies have been published [ 12 , 16 ]. The studies are characterized by considerable regional heterogeneity, but in general document a falling frequency of mesangioproliferative GN (MesPGN) and membranous GN (MGN), and an increase in focal segmental glomerulosclerosis (FSGS).…”

Section: Introductionmentioning

confidence: 99%

“…Only three studies have presented long-term studies with recent data [ 12 , 15 , 17 ]. The existence of a national, comprehensive renal biopsy registry in Denmark since 1985 permits an evaluation of changes in absolute GN incidence over a long period of time.…”

Section: Introductionmentioning

confidence: 99%

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Increased incidence and improved prognosis of glomerulonephritis: a national 30-year study

Heaf

Sørensen

Hansen

2020

Clinical Kidney Journal

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Background While there are many cross-sectional studies of glomerulonephritis (GN) incidence, changes in incidence over time, particularly in the 21st century have received less attention. Similarly, little is known about temporal changes in GN prognosis. The presence in Denmark of comprehensive registries for renal biopsy results, end-stage renal disease (ESRD), comorbidity and mortality permit these questions to be addressed. Methods Data for all renal biopsies in Denmark between 1985 and 2014 were extracted from the Danish Renal Biopsy Registry and Patobank registries. The date of first dialysis or transplantation was extracted from the Danish Nephrology Registry for those patients developing ESRD. Dates of death and presence of chronic comorbid conditions at date of biopsy were extracted from the National Patient Registry. The incidence of GN, adjusted to the 2013 European standard population, was calculated. ESRD incidence and mortality were calculated, both in absolute terms and after correction for age, comorbidity and presence of renal tubulointerstitial fibrosis. Results The incidence rose from 33.3 patients per million (ppm)/year in 1985–94 to 46.5 ppm in 2005–14. The increase could in part be related to changes in renal biopsy policy. Large increases in Anti-neutropil cytoplasmic antibody (ANCA) vasculitis (ANCAV) (3.1–7.7 ppm/year) and focal segmental glomerulosclerosis (FSGS) (1.5–5.7 ppm/year) incidence were noted. The biopsy-proven prevalence of GN in 2014 was 748 ppm of which 155 ppm were being treated with dialysis or transplantation. Adjusted ESRD incidence fell by 25% during the study period, mortality by 62% and combined ESRD/mortality by 46%. The fall in ESRD incidence was limited to minimal change GN, FSGS, membranous GN and lupus nephritis, while reductions in mortality, and the combination of ESRD and/or death, were seen for nearly all GN diagnoses. Conclusions This study suggests that the incidence of GN has generally increased between 1985 and 2014, but some of the increase may be related to changes in renal biopsy policy. Major increases in FSGS and ANCAV incidence have occurred. The prognosis of GN, both as regards ESRD and mortality, has improved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increased incidence and improved prognosis of glomerulonephritis: a national 30-year study

Heaf

Sørensen

Hansen

2020

Clinical Kidney Journal

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“…IgA nephropathy (IgAN), the most common form of primary glomerulonephritis worldwide, is characterized by the dominant or co-dominant presence of immunoglobulin A (IgA) by immunofluorescence microscopy in the glomerular mesangium [1]. However, the exact mechanism of IgAN remains obscure, it is thought to be an immune-related disease with overproduction of galactose-deficient IgA1 which was influenced by genetic variation at the C1GALT1, ST6GALNAC2 and C1GALT1C1 gene [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

IgG deposits in the mesangium and capillary loops predict poor renal outcome in patients with IgA nephropathy: a single-center retrospective study

et al. 2020

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Background: Glomerular IgG deposition in patients with IgA nephropathy (IgAN) has been shown to be associated with poor renal survival; however, most published studies to date are too small-scale and inconsistent to provide guidance for clinical practice. Methods: Based on renal biopsy findings, 742 patients were divided into the following groups: (i) IgA deposition alone (IgA) vs IgA þ IgG deposition (IgA þ IgG) and (ii) IgG co-deposition confined to the mesangium vs mesangium þ capillary loops (CLs). The clinicopathological variables at biopsy and renal outcome were assessed. Results: Of the 742 patients, 182 had IgG co-deposition and 51 had IgG deposits in the mesangium þ CLs. Patients with IgG co-deposition were associated with severe clinical and pathological lesions, especially those with a location of IgG deposits in the mesangium þCLs. Kaplan-Meier analysis revealed that a lower renal cumulative survival rate was present in both patients with IgG co-deposition and those with a location of IgG deposits in the mesangium þ CLs (all p < 0.05). Moreover, patients with a higher intensity of glomerular IgG deposits or C3 deposits or C1q deposits were also associated with a lower survival rate. A multivariate Cox regression model identified the location of IgG deposits in the mesangium þ CLs as an independent risk factor for poor prognosis (HR, 2.11; 95% CI: 1.06-4.18; p ¼ 0.005). Conclusions: Glomerular IgG co-deposition and the location of glomerular IgG deposits in the mesangium þ CLs were both associated with adverse renal outcomes, but only the location of glomerular IgG deposits in the CLs was an independent risk factor for poor prognosis in IgAN.

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“…Membranous glomerulonephritis (MGN) is a leading cause of the nephrotic syndrome in adults and occurs as a primary disorder (primary membranous nephropathy -PMN) or secondary to other disorders like lupus nephritis, infections and certain drugs. [1][2][3][4][5][6] Primary membranous nephropathy is a kidney-specific autoimmune disorder in which autoantibodies develop against self, podocyte antigens. [5] Phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain containing 7A (THSD7A) are two podocyte specific antigens that have been identified in PMN.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of glomerular PLA2R and THSD7A antibodies in biopsy confirmed primary membranous nephropathy in South Africans

Lwezaula

Ameh²,

Ekrikpo

et al. 2021

BMC Nephrol

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Background: Serum and tissue-based tests using phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain containing 7A (THSD7A) are established immune biomarkers for the diagnosis of primary membranous nephropathy (PMN). This study assessed the diagnostic performance of these biomarkers in the diagnosis of PMN in South Africans. Methods This was a cross-sectional analysis from a single centre in Cape Town, South Africa. Relevant biodata was collected from all patients. Histology, including slides for PLA2R and THSD7A were processed and assessed by typical microscopic and immunohistochemical features. Biopsy tissues of patients with membranous lupus nephritis (LN-V) and diabetic nephropathy (DN) were used as controls. The diagnostic accuracy for diagnosis of PMN using positive PLA2R and THSD7A were evaluated. Results Of the 88 patients included, 41 had PMN with a mean age of 44.5 ± 17.5 years and 61.0% were female. Histologically, PLA2R and THSD7A were only positive in the PMN group (51.2% and 4.9%, respectively) but negative in both control groups. The sensitivity of PLA2R and THSD7A for identifying PMN was 51.2% and 4.9%, respectively. The sensitivity of both tests together was 53.7% while the specificity and positive predictive values (PPV) for any of the tests (alone or in combination) was 100%. There was no difference in the sensitivity and specificity when using PLA2R alone compared to combining the two tests (p=0.32). Conclusion Glomerular staining of PLA2R and THSD7A could have potential diagnostic values in South Africans. This has implications on how immunotherapies can be initiated and used in these settings.

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A Global Evolutionary Trend of the Frequency of Primary Glomerulonephritis over the Past Four Decades

Cited by 31 publications

References 46 publications

Increased incidence and improved prognosis of glomerulonephritis: a national 30-year study

Increased incidence and improved prognosis of glomerulonephritis: a national 30-year study

IgG deposits in the mesangium and capillary loops predict poor renal outcome in patients with IgA nephropathy: a single-center retrospective study

Diagnostic performance of glomerular PLA2R and THSD7A antibodies in biopsy confirmed primary membranous nephropathy in South Africans

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