Spectrum of glomerulonephritides in adults with nephrotic syndrome in Pakistan

Kazi, Javed Iqbal; Mubarak, Muhammed; Ahmed, Ejaz; Akhter, Fazal; Naqvi, Syeda Uzma; Rizvi, Syed Adib-ul-Hasan

doi:10.1007/s10157-008-0075-0

Cited by 45 publications

(35 citation statements)

References 17 publications

(35 reference statements)

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“…Columbia classification of FSGS was used for the categorization of FSGS lesions, as illustrated in Figures 1 to 5 (18). The biopsies were studied by light microscopy (LM), immunoflourescence (IF) and electron microscopy (EM) as described in detail in our previous report (12). Cases of secondary FSGS, like lupus nephritis or IgA nephropathy (IgAN) were excluded.…”

Section: Definition Of Fsgsmentioning

confidence: 99%

“…The prevalence of FSGS has increased significantly in the biopsy series in recent years through out the world (7)(8)(9)(10)(11). We have earlier reported a prevalence of 39.87% on native renal biopsies performed on adult nephrotic patients (12). Since the first description by Rich in 1957, several different histological variants of FSGS have been recognized (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome

Shakeel¹,

Mubarak²,

Kazi³

et al. 2013

J Nephropathol

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Background: There is no information on the frequency and clinicopathological presentation of the variants of primary focal segmental glomerulosclerosis (FSGS) in adults presenting with idiopathic nephrotic syndrome (INS) in Pakistan. Objectives: The aim of this study was to determine the frequencies of different histologic variants of primary FSGS with INS at our center and to compare our findings with those published in literature. Patients and Methods: All consecutive adults (≥18 years) with INS, and diagnosis of FSGS on renal biopsies, were included. Their clinicopathological features at the time of presentation were retrieved and compared among the variants. Results: There were 120 (65.2%) males and 64 (34.8%) females. The mean age was 30.62±12.02 years. The mean 24-hr urinary protein excretion was 4.69±2.36 grams. Microscopic hematuria was found in 30 (16.3%) patients. The mean serum creatinine was 1.58±0.87 mg/dL. At presentation, 128 (69.6%) patients were normotensive, while 56 (30.4%) exhibited hypertension. FSGS, not otherwise specified (NOS) was the predominant variant, comprising 76.6% of all; collapsing variant comprised 12%, tip variant, 9.8%, perihilar, 1.1%, and cellular, 0.5%. The mean number of glomeruli involved by segmental scarring was 3.41±2.87 and there was significant difference among the variants (p= 0.001). Arteriolopathy was found in 23.4 % cases and fibrointimal thickening of arteries in 18.5%. Tubular atrophy and interstitial fibrosis (IF/TA) was noted in 93% of cases. There was no significant difference in vasculopathy and IF/TA among the variants. Conclusions: Collapsing variant was the second most common variant following NOS and these findings are different from other regional studies. Implication for health policy/practice/research/medical education:Focal segmental glomerulosclerosis (FSGS) is a heterogeneous lesion with different etiologies, pathogenesis and clinical outcome. Recent classification of FSGS on histological grounds into five variants reflects this heterogeneity of the lesion. A study of these variants in different populations is of utmost importance in understanding the varied etiopathogenetic mechanisms underlying this common lesion in nephrology practice.Please cite this paper as: Shakeel Sh, Mubarak M, Kazi JI, Jafry N, Ahmed E. Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome.

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Section: Definition Of Fsgsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome

Shakeel¹,

Mubarak²,

Kazi³

et al. 2013

J Nephropathol

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“…Along with membranous nephropathy and FSGS, minimal change disease (MCD) is one of the major glomerulonephritides in adult patients with primary nephrotic syndrome (1)(2)(3)(4)(5)(6) and especially common in Asian countries (4)(5)(6). Although few patients with MCD progress to ESRD, a series of studies reported that approximately 30%-70%, most commonly 60%, of adult MCD patients experienced at least one relapse of proteinuria (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and that 50%-60% of patients with a first relapse subsequently experienced a second relapse (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Shinzawa¹,

Yamamoto²,

Nagasawa³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown.Design, setting, participants, & measurements This multicenter retrospective cohort study included 125 adultonset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models.Results During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P,0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding.Conclusions Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change disease patients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.

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“…Majority of the studies have calculated the frequency of IgAN as a percent of all native renal biopsies performed for a variety of clinical indications. The highest prevalence (upto 60%) has been reported in native renal biopsy series from Japan, Korea, China, Singapore, Western Europe, and Australia (Ballardie et al, 1987;D'Amico, 1985;Kazi et al, 2009;Koyama et al, 1997;Lai et al, 1999;Power et al, 185;Rivera et al, 2004;Schena, 1997;Sinniah, 1980;Strata P, et al, 1995). In contrast, studies from United States have reported very low rates at 2 to 10 percent, with the exception of a 38 percent incidence in the Navajo Indians in New Mexico (Julian et al, 1988).…”

Section: Epidemiology and Magnitude Of The Problemmentioning

confidence: 99%

Recent Developments in the Pathogenesis and the Pathological Classification of IgA Nephropathy

Mubarak¹,

Kazi²

2012

Topics in Renal Biopsy and Pathology

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Spectrum of glomerulonephritides in adults with nephrotic syndrome in Pakistan

Cited by 45 publications

References 17 publications

Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome

Frequency and clinicopathological characteristics of variants of primary focal segmental glomerulosclerosis in adults presenting with nephrotic syndrome

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Recent Developments in the Pathogenesis and the Pathological Classification of IgA Nephropathy

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