Clinico-pathological study of glomerular diseases in patients with significant proteinuria in North India

Abstract

Proteinuria is a common manifestation of renal disease. The present study was carried out to analyze the clinic-pathological correlation, assess the value of histopathology and immunofluorescence (IF) as well as note the spectrum of renal diseases in patients with significant proteinuria. Fifty consecutive patients having proteinuria >1 g/24 h underwent ultrasound-guided percutaneous renal biopsy. Clinical information was correlated with the pathological findings and the results were analyzed. The patients were in the age range of 12-79 years. Males (60%) outnumbered females (40%) in all the disease categories except lupus nephritis and IgA nephropathy. The most common clinical presentation was the nephrotic syndrome, seen in 31 cases (62%). Primary glomerular diseases (72%) were more common than secondary glomerular diseases (24%) and tubulointerstitial diseases (4%). Overall, the most common pathological diagnosis was focal and segmental glomerulosclerosis (FSGS) (20%), followed by membranous glomerulonephritis (MGN) (18%). In young patients (age <20 years), minimal change disease (36.4%) was the most common diagnosis while in adults it was MGN (23.5%) and in elderly patients (age >60 years) it was FSGS (60%). IF modified the diagnosis in 12% of the cases. The concordance between clinical diagnosis and pathological diagnosis was 66%. The difference between clinical diagnosis and final diagnosis was statistically significant. Our study further reinforces the knowledge that renal biopsy helps in accurate diagnosis and, thus, helps in appropriate management of the patients. IF provides additional information that can make the morphologic diagnosis considerably more precise.

A Two Year Observation on Trend of Primary Glomerulonephritis in A Tertiary Care Hospital of Bangladesh

“…Mundi I et al found most of the cases were in 21-40 age range and distinct pattern of PGN was found in different age ranges. 13 Proliferative glomerular disease is the most prominent renal disease in our study as well as in all recent studies. 2,[14][15][16][17][18][19][20][21][22] In the current study MPGN is the commonest primary GN seen.…”

“…9, 33 Mundi I etal and Mannan R et al demonstrated FSGS, MN and minimal change disease(MCD) being the commonest form of PGN in India. 12,13 Data from Singapore and other countries also showed that the prevalence of FSGS and MN have become increased in recent time 1 This may be related to increasing number of patients with obesity, DM and smoking habits, a pattern representing the rising affluence in these countries where FSGS represents the changing life style of fast food and unhealthy diets predisposing to disease like obesity and DM. In our study though many of our cases were diabetic but there average body built and life style do not yet match with that of the affluent society.…”

“…Apart from this FSGS has been found to have a racial predilection. 13 Meckenzie etel, have suggested that genetic variation may play a role in sporadic FSGS in adult. ,34 These hypothesis also fits with our findings of FSGS but the reason of low incidence of MN could not be explained by us.…”

“…12,13,35 Most of the studies did not mention IgM nephropathy as a distinct category. 12 Incidence of IgA nephropathy in our study is only 2.3% (1/42.…”

Proteinuria persistente en pacientes pediátricos, caracterización histopatológica y su influencia en la progresión de la enfermedad renal crónica

“…Las glomerulopatías más frecuentemente en niños que cursan con proteinuria persistente son: la glomerulonefritis (GMN) por IgA, la púrpura de HenochSchönlein (PHS), la glomerulonefritis membranoproliferativa, la glomeruloesclerosis focal segmentaria (GEFS), la GMN membranosa, el síndrome de Alport y la esclerosis mesangial [13][14][15] . Estas enfermedades usualmente evolucionan hacia la cronicidad, es por esto que ante la presencia de proteinuria, incluso en valores bajos se sugiere la realización de biopsia renal; estudio histopatológico que sumado a los hallazgos clínicos y de laboratorio permiten establecer un diagnóstico y un tratamiento específico 15,16 .…”