A study of clinical presentation and correlative histopathological patterns in renal parenchymal disease

Abstract

Suspicion and subsequent detection of renal disease is by an assessment of the urinalysis and renal function in the clinical context. Our attempt in this study is to correlate initial presenting features of urinalysis and renal function to the final histopathological diagnosis. A retrospective analysis of 1059 native kidney biopsies performed from January 2002 to June 2015 at Amrita Institute of Medical Sciences was conducted. Correlative patterns between urinalysis, renal function, and final histopathological diagnosis were studied. Five hundred and eleven (48%) patients had nephrotic syndrome. Out of these, 193 (38%) had pure: nephrotic syndrome, 181 (35.8%) had associated microhematuria, 110 (21.7%) had microhematuria and renal failure, and 27 (5.3%) had only associated renal failure. Minimal change disease (MCD) (30%), membranous nephropathy (30%), and IgA nephropathy (29%) were the major diseases in the respective groups. Five hundred and five (47.6%) patients had subnephrotic proteinuria. Out of these, 29 (5.6%) had only subnephrotic proteinuria, 134 (27%) had additional microhematuria, 300 (59%) had subnephrotic proteinuria, microhematuria, and renal failure, and 42 (8%) had subnephrotic proteinuria with renal failure. Lupus Nephritis (45% and 40%) and IgA Nephropathy (32% and 21%) were the major disorders in the subgroups respectively. Forty-two patients (3.7%) were biopsied for isolated renal failure with bland urinary sediment. Cast nephropathy and acute interstitial nephritis were the major diseases. Out of 89 patients with diabetes who were biopsied, 15 (16.8%) had diabetic nephropathy, 45 (50.5%) had no diabetic nephropathy, and 29 (32.5%) had diabetic nephropathy along with a non-diabetic renal disease. Postinfectious glomerulonephritis was the major glomerular disease. IgA nephropathy (22.2%) and membranous nephropathy (15.5%) were the major diseases in patients with diabetes with no diabetic nephropathy. In our population, MCD and membranous nephropathy formed the majority of diseases in biopsied nephrotic syndrome. Added microhematuria did not seem to decrease the incidence of either disease on the whole. We found a significant number of patients with membranous nephropathy with nephrotic syndrome, microhematuria, and additional renal failure. IgA nephropathy formed a majority of cases with nephrotic syndrome, microhematuria, and renal failure. The presence of renal failure regardless of other abnormalities in urinalysis showed a trend toward IgA nephropathy. Membranous nephropathy may have a more varied presentation than was originally thought and IgA nephropathy presenting as nephrotic syndrome may not be uncommon. MCD is the major subgroup of diseases in the pediatric population and presents both as nephrotic syndrome as well as nephrotic syndrome with microhematuria. Thus, urinalysis and renal failure may be a valuable tool in assessing renal disease.

The diagnostic value of native kidney biopsy in low grade, subnephrotic, and nephrotic range proteinuria: A retrospective cohort study

“…To date, there are only few clinical studies focusing on patients with subnephrotic proteinuria upon biopsy proven nephropathies. In line with our study, recently published biopsy cohorts comprised about 50% of cases with subnephrotic proteinuria (53% versus 44.77% and 47.6%) [20,21]. Histological results in this studies showed that IgAN is most frequent (20.9% and 35.4%) in the group of subnephrotic patients similar to our results [20,21].…”

“…In line with our study, recently published biopsy cohorts comprised about 50% of cases with subnephrotic proteinuria (53% versus 44.77% and 47.6%) [20,21]. Histological results in this studies showed that IgAN is most frequent (20.9% and 35.4%) in the group of subnephrotic patients similar to our results [20,21]. In detail, the frequency of following diagnosis differed from our study.…”

“…In detail, the frequency of following diagnosis differed from our study. FSGS and lupus nephritis were common diagnoses within the cohort from Kuwait [20], whereas within the cohort from India only lupus nephritis was frequent [21]. In contrast to these studies we observed considerable more patients with ANCA associated glomerulonephritis [20,21].…”

Corrigendum

“…In abstract no. 22 for “Poster Presentations” titled “A study on prevalence of sleep disturbance and factors affecting it in CKD-5 patients on maintenance hemodialysis”, published on pages 28-122, supplement issue 1, volume 28 of Indian Journal of Nephrology,[1] the list of authors and affiliations is incorrectly written as “Avinash Ignatius, Shubhangi Jagtap-Karmakar, Avinash Ignatius, Suresh Sankar; Department of Nephrology; DaVita Care Pvt Ltd.; Bengaluru; Karnataka; India”. The correct list of authors and their affiliations should read as “Shubhangi Jagtap-Karmakar, Avinash Ignatius, Suresh Sankar; Department of Nephrology, Noble Hospital Pune”.…”

“…In abstract no. 96 for “Poster Presentations” titled “Role of Copeptin Assay as an Improved Diagnostic Tool of Hypotonic Polyuria”, published on pages 28-122, supplement issue 1, volume 28 of Indian Journal of Nephrology,[1] the list of authors and affiliations is incorrectly written as “Sameer S Deshmukh, Kaustubh S Chaudhari, Sameer S Deshmukh, Nishant R Tiwari, Rohan S Sharma; Department of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma, USA”. The correct list of authors and their affiliations should read as “Kaustubh S Chaudhari, Sameer S Deshmukh, Nishant R Tiwari, Rohan S Sharma; Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma; USA”.…”