Outcome study of renal biopsy patients in Okinawa, Japan

Abstract

Here we report a community-based epidemiologic study of patients who received renal biopsy in Okinawa, Japan between 1967 and 1994. The total number of cases was 2832 (1395 men and 1437 women), and the mean (SD) age at biopsy was 30.0 (10.0) years (range 1.0 to 88.0 years). The most common clinical indications for renal biopsy were proteinuria/hematuria (46.7%), nephrotic syndrome (21.2%), acute glomerulonephritis (10.1%), and systemic lupus erythematosus (7.5%). Patients who received renal biopsy between 1985 and 1994 (N= 1480) were much less likely to have acute glomerulonephritis than patients treated between 1967 and 1984 (N= 1352); the rates of proteinuria/hematuria, renal failure, and diabetes mellitus were slightly higher in the later period. Okinawa patients who began dialysis between 1971 and 2000 (N= 5246) were also studied. Among them, a total of 468 patients (260 men and 208 women) began dialysis after renal biopsy. The cumulative incidence of end-stage renal disease (ESRD) among these patients was 17% in 17 years. Half of these patients developed ESRD in the 5.8 years after renal biopsy. Among the dialysis patients, the biopsy rate was 12.6% in chronic glomerulonephritis, 1.7% in diabetes mellitus, 2.6% in nephrosclerosis, and 52.1% in systemic lupus erythematosus. The diagnoses of primary renal diseases were primarily made clinically. The survival rate after starting dialysis therapy was slightly better in those with than in those without renal biopsy but this finding was not statistically significant (adjusted hazards ratio 0.855, 95% CI 0.711-1.028, P= 0.095). The clinical significance of renal biopsy, other than its provision of histologic evidence, remains to be shown.

Clinical Outcomes and Predictors for ESRD and Mortality in Primary GN

“…Also, many of our patients with IgAN lived to develop ESRD. These observations were consistent with the idea that most CKD patients in Asia tend to develop ESRD before dying from any cause (22,31,32). However, the outcomes of our patients with MN were similar to their Western counterparts, with more patients dying than developing ESRD (33,34).…”

“…There are many reports showing regional epidemiologic and clinicopathological features pertaining to various glomerulopathies in Western countries (4,9,(21)(22)(23). By contrast, relatively little is known about the longterm outcomes of different histologic types of primary GN in Asian populations.…”

Incidence of biopsy-proven glomerulonephritis

“…This would agree with the Danish registry data with 13% of the subjects with glomerulonephritis reaching end-stage disease in a 10-year follow-up, and with another study showing that the incidence rate in 17 years of ESRD was 17%, and that the biopsy rate had been 12% in those subjects on RRT with a glomerulonephritis [10]. The Australian study showed a 6-fold relation between IgAGN incidence and RRT incidence.…”

Comparison of the Clinical and Laboratory Presentations of Primary and Secondary Glomerular Diseases

“…Comparing with the other studies that have investigated the secondary GN, the high frequency of amyloidosis in this study can be attributed to the high prevalence of familial Mediterranean fever (FMF) in Turkey. 3,11,12 Whereas rheumatoid arthritis has been reported as the leading cause of reactive amyloidosis in the European countries, 13 FMF, which is a heredofamilial disease, is the leading cause of reactive amyloidosis in Turkey. 14,15 Similar with the studies in the literature, we determined that NS was the most common indication for biopsy in the patients with amyloidosis.…”