Spectrum of Nephrotic Syndrome in Adults: Clinicopathological Study from a Single Center in India

Golay, Vishal; Trivedi, Mayuri; Kurien, Abraham; Sarkar, Debansu; Roychowdhary, Arpita; Pandey, Rajendra

doi:10.3109/0886022x.2013.768939

Cited by 13 publications

(18 citation statements)

References 23 publications

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“…[7] In a recent study published from Kolkata, Golay et al ., found that FSGS was underlying disease in 27.4% of their patients making it the most common one while MGN was third most common accounting for about 25%. [13] This figure is very similar to our present data, where FSGS and MGN were responsible for 31% and 25% of cases respectively. However, they found MCD in 27.1% of cases, making it the second most common cause of nephrotic syndrome while MPGN was seen in only 7%.…”

Section: Discussionsupporting

confidence: 92%

Changing histologic spectrum of adult nephrotic syndrome over five decades in north India: A single center experience

et al. 2014

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Glomerular diseases are an important cause of chronic renal failure in developing countries. The spectrum of diseases causing nephrotic syndrome is changing globally in the last few decades. The aim of this prospective study was to look at this spectrum at a tertiary care center in North India and to analyze the changing trends over the last five decades. Patients in the age group 18-60 years with nephrotic syndrome were consecutively included in the study. Renal biopsies were performed in all patients and were subjected to light microscopy, immunofluorescence (IF) and electron microscopy (EM). While the IF was performed in 78% of cases, EM was available in one-fourth of cases. During 2002-2007, 364 patients (60.2% males) were included in the study. The mean age was 31.5 years. Primary glomerular diseases accounted for 89% of cases while lupus nephritis was the most common secondary glomerular disease. Focal segmental glomerulosclerosis (FSGS) accounted for 30.6% of primary glomerular diseases making it the most common cause of nephrotic syndrome. It was followed by membranous glomerulonephritis (MGN) in 24.4%, mesangiocapillary glomerulonephritis in 17.9% and minimal change disease in 14.8%. In the age group >40 years, MGN was the most common lesion (32.5%) followed by FSGS (27.7%). Over the last five decades, there was a nearly five-fold increase in the incidence of FSGS, 3-fold increase in MGN and a 10-fold reduction in diffuse proliferative glomerulonephritis while there was no major change in incidence of other diseases. The biopsy diagnosis of FSGS has increased considerably in last few decades and it is now the most common cause of nephrotic syndrome in adults in North India. MGN is the most common lesion in patients over 40 years of age.

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Section: Discussionsupporting

confidence: 92%

Changing histologic spectrum of adult nephrotic syndrome over five decades in north India: A single center experience

et al. 2014

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“…The fact that we did not use EM could be one of the reasons for such a low incidence in our study group. In our study IgAN was seen in 7.4% of the patients, following the trend of a low prevalence as reported by other Indian studies (4.5%-14%) (1,5,(8)(9)(10)(11). However IgAN is a very common cause of NS in countries like China and Korea (20%-28%) (4,6,15).…”

Section: Discussionsupporting

confidence: 67%

“…In the present study conducted at a single center in south India, MCD (40.2%) was found to be the most common histologic pattern causing NS. This is contrary to the results of several recent Indian studies from North India (5), and Eastern India (8), and South India (2) which report the incidence of MCD as 14.8% (fourth most common in their study), and 23.9% (second most common in their study) and 11.6% respectively. While all three studies report FSGS as the most common pattern with a frequency of 30.6% and 27.4% in the first two studies, Narasimhan et al reported a lower frequency of 17%.…”

Section: Discussioncontrasting

confidence: 56%

Histologic patterns of primary adult onset nephrotic syndrome and their clinical characteristics; a single center study from South India

Konana¹,

Varma²,

Eswarappa³

et al. 2017

J Nephropathol

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Background:The histologic pattern causing nephrotic syndrome (NS) and their clinical outcome varies depending on age, sex, race, socioeconomic status and geographic location. There has been a changing trend in the histologic spectrum of NS in the last few decades, in India as well as worldwide. Objectives: The objective of the present study was to see the histologic spectrum of adult NS in our institution and to compare it with data from other centers. Patients and Methods: All adults (≥ 18 years) with nephrotic range proteinuria who underwent renal biopsy from August 2012 to February 2015, were consecutively included in this prospective study. NS caused by diabetes and other secondary glomerular diseases were excluded. Results: Eighty (65.4%) patients were males and 42 (34.4%) were females. The median age at the time of biopsy was 36 years (interquartile range [IQR]: 24.8-45). The most common lesions were minimal change disease (MCD) in 40.2%, membranous nephropathy (MN) in 24.6% and focal segmental glomerulosclerosis (FSGS) in 16.4% of the patients. MCD was observed mostly commonly in the age group 18-35 years and MN was seen mostly commonly in age group 36-55 years. Conclusions: MCD still continues to be leading cause of NS in south Indian adults as evidenced from previous studies from this region. Other common causes include MN and FSGS. The incidence of MPGN is on the decline.

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“…Therefore for drawing accurate conclusions were difficult by comparison with different data of Asian studies. Agarwal et al [9] Aggrawal et al [10] Das et al [3] Rathi et al [2] Goyal et al [11] Present study …”

Section: Histopathological Distribution Of Glomerular Lesionsmentioning

confidence: 95%

“…A summary of other studies from India is presented in [ [11] found that FSGS was underlying disease in 27.4% of their patients making it the most common one However, they found MCD in 27.1% of cases, making it the second most common cause of nephrotic syndrome. This figure is very similar to our present data, where MCD were responsible for 26.38% of cases.…”

Section: Histopathological Distribution Of Glomerular Lesionsmentioning

confidence: 99%

Histopathological spectrum of Adult Nephrotic Syndrome over 16 years at a Tertiary care center in Mumbai with Clinicopathological ,Electron microscopy and Immunoflurescence Correlation of Renal biopsies

Kshirsagar

Gadgil

Margam

et al. 2017

APALM

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Background:The pattern of diseases causing adult nephrotic syndrome varies globally as well as in India. The aim of our study was to analyze the spectrum of patients with biopsy proven nephrotic syndrome in adults over 15 years, in respect with incidence, age distribution and correlate the clinicopathological features, electron microscopy and immunofluorescence. Methods:We have evaluated and analyzed retrospectively 263 renal biopsies of adult nephrotic syndrome over a consecutive period of 16 years (January 2000 to December 2015) in our tertiary care Hospital.Result: In our study of 235 (89.35%) adequate renal biopsy cases overall male predominance was seen (M: F ratio 1.7:1) with maximum males noted in diabetic nephropathy (M: F ratio 4:1) while SLE was seen exclusively in female (M: F ratio 0:6). Minimal change disease (26.38%), followed by MPGN (16.17%) and FSGS (15.74%) were the common histopathological lesions. In 15-45 years age majority of 78.72% cases were observed with prominently histomorphological pattern as MCD( 25.10%),followed by FSGS ( 13.61%) & MPGN (13.19%). In 45-85 years age , 21.28% cases majority were of membranous glomerulonephritis (5.10%) and diabetic nephropathy (4.25%). Primary glomerular diseases accounted for 78.3% cases commonest was MCD (26.38%) and secondary glomerular diseases in 21.7% of cases, most common being amyloidosis (7.23%) Light microscopy, immunopathology findings correlated with electron microscopy findings in 79 cases (91.86%) out of 86 cases. Sample error was main reason of non correlation of EM & LM diagnosis, especially in FSGS. Conclusion:This data analysis is essential to study the prevalence of biopsy proven renal diseases and its variation and distribution as per age .Which can improve the understanding of utility of renal biopsy for future research of renal parenchymal diseases in adults.

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Spectrum of Nephrotic Syndrome in Adults: Clinicopathological Study from a Single Center in India

Abstract: FSGS is increasingly becoming the most common cause of adult NS. This trend in Asia is seen predominantly in countries of the Indian subcontinent.

Cited by 13 publications

References 23 publications

Changing histologic spectrum of adult nephrotic syndrome over five decades in north India: A single center experience

Changing histologic spectrum of adult nephrotic syndrome over five decades in north India: A single center experience

Histologic patterns of primary adult onset nephrotic syndrome and their clinical characteristics; a single center study from South India

Histopathological spectrum of Adult Nephrotic Syndrome over 16 years at a Tertiary care center in Mumbai with Clinicopathological ,Electron microscopy and Immunoflurescence Correlation of Renal biopsies

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