Capillaroscopic changes in patients with glomerular diseases: a case control study

Abstract

Background: Glomerulonephritis is a heterogenous group of diseases which is diagnosed mainly by renal biopsy. This study aims to assess nailfold capillaroscopic changes in patients with glomerular diseases. Patients and methods: This study was conducted on 50 patients with glomerular disease confirmed by renal biopsy and 50 age and sex matched healthy controls. Clinical, laboratory evaluation and nailfold capillaroscopic examination were done for all participants. Statistical analysis was done andT test and one way ANOVA test were used for normally distributed variables, while Mann Whitney and Kruskal Wallis tests were used for non-normally distributed variables. Association between 2 continuous variables was done by Pearson’s correlation or spearman’s rank correlation. Results: Lupus nephritis was the most common pathological type among glomerulonephritis group (34%, n=17), followed by focal segmental glomerulosclerosis (18%, n= 9). Tortuous capillaries were significantly higher in patients with glomerular diseases (94%, n=47) (P<0.001). The diameter was significantly lower in patients with glomerular diseases (18.68 µm, 16.83 µm, P=0.021). Subpapillary venous plexus (22%, 6%, P 0.021) and capillary microhemorrhage (42%, P <0.001) were significantly more frequent in patients with glomerular diseases compared to the control group. Patients with lupus nephritis had higher capillary diameter (19.5, 15.6 µm, P 0.02), width (55.6, 44 µm, P 0.003) and microhemorrhage (64.7%, 32%, P 0.03) compared to patients with primary glomerulonephritis. There were no statistically significant differences between patients with different types of primary glomerulonephritis. There was a statistically significant difference as regard diameter (P=0.005) and length (P=0.02) between different classes of lupus nephritis. Conclusion: Nailfold capillaroscopy showed more tortious capillaries and lower capillary diameter in patients with glomerular disease compared to healthy persons. Lupus nephritis patients showed more dilated capillaries and more capillary microhemorrhage compared to primary glomerulonephritis patients.