The changing spectrum of primary glomerular diseases within 15 years: A survey of 3331 patients in a single Chinese centre

Zhou, Fu-de; Zhao, Ming‐Hui; Zou, Wan-zhong; Liu, Gang; Wang, Haiyan

doi:10.1093/ndt/gfn554

Cited by 179 publications

(166 citation statements)

References 21 publications

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“…The incidence of MPGN has been reported to decrease over time from about 7-10% in the 1970s to about 2% during 1990-2011 [3][4][5][6][16][17][18][19]. In the present study, among the 26,535 patients with biopsy-confirmed disease, 593 (2.2%) patients were registered as having a histopathology of MPGN types I and III.…”

Section: Discussionmentioning

confidence: 44%

“…In the clinical setting, MPGN is one of the most common causes of nephrotic syndrome in both children and adults, and accounts for approximately 2-10% of all cases of biopsy-confirmed glomerulonephritis [3][4][5][6]. Traditionally, MPGN has been classified based on the findings of electron microscopy as primary MPGN type I (MPGN I), MPGN II, MPGN III, or secondary MPGN [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

et al. 2017

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Background The incidence and age distribution of membranoproliferative glomerulonephritis (MPGN) vary throughout the world by race and ethnicity. We sought to evaluate the clinical features, pathogenesis, and age distribution of MPGN among a large nationwide data from the Japan Renal Biopsy Registry (J-RBR). Methods A cross-sectional survey of 593 patients with MPGN (types I and III) registered in the J-RBR between 2007 and 2015 was conducted. Clinical parameters, and laboratory findings at diagnosis were compared between children (< 20 years), adults (20-64 years), and elderly patients (≥ 65 years). Results The median age of the patients was 59.0 years and mean proteinuria was 3.7 g/day. The rate of nephrotic syndrome was significantly higher in adults (40.4%) and elderly patients (54.0%) than in children (14.9%), whereas the rate of chronic glomerulonephritis was significantly higher in children (66.2%) than in adults (34.4%) and elderly patients (31.2%). According to the CGA risk classification, high-risk (red zone) cases accounted for 3.4% of children, 52.5% of adults and 84.1% of elderly patients with MPGN. As for pathogenesis, primary MPGN was most frequent (56.0%). Lupus nephritis was the most common disease among adult patients with secondary MPGN, whereas infectious disease was more common in elderly patients. Multiple regression analysis revealed that high systolic blood pressure and high proteinuria were independent factors associated with decreased estimated glomerular filtration rate (eGFR) in adults and elderly patients with MPGN. Conclusions In Japan, adults and elderly patients with MPGN had a lower eGFR and severer proteinuria than children.

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Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

et al. 2017

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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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“…IgA nephropathy (IgAN) is the most common type of primary GN worldwide [1][2][3] and widely considered to be a polygenic disease. [4][5][6] Although the exact pathogenesis is still unclear, a multihit mechanism has been proposed for IgAN, including at least four hits (production of galactose-deficient IgA1 [Gd-IgA1], production of antiglycan antibodies, formation of IgA1-containing immune complexes, and glomerular injury after mesangial deposition).…”

mentioning

confidence: 99%

Variants in Complement Factor H and Complement Factor H-Related Protein Genes, CFHR3 and CFHR1, Affect Complement Activation in IgA Nephropathy

Zhu

Zhai

Wang

et al. 2015

Journal of the American Society of Nephrology

127

108

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Complement activation is common in patients with IgA nephropathy (IgAN) and associated with disease severity. Our recent genome-wide association study of IgAN identified susceptibility loci on 1q32 containing the complement regulatory protein-encoding genes CFH and CFHR1-5, with rs6677604 in CFH as the top single-nucleotide polymorphism and CFHR3-1 deletion (CFHR3-1Δ) as the top signal for copy number variation. In this study, to explore the clinical effects of variation in CFH, CFHR3, and CFHR1 on IgAN susceptibility and progression, we enrolled two populations. Group 1 included 1178 subjects with IgAN and available genome-wide association study data. Group 2 included 365 subjects with IgAN and available clinical follow-up data. In group 1, rs6677604 was associated with mesangial C3 deposition by genotype-phenotype correlation analysis. In group 2, we detected a linkage between the rs6677604-A allele and CFHR3-1Δ and found that the rs6677604-A allele was associated with higher serum levels of CFH and lower levels of the complement activation split product C3a. Furthermore, CFH levels were positively associated with circulating C3 levels and negatively associated with mesangial C3 deposition. Moreover, serum levels of the pathogenic galactose-deficient glycoform of IgA1 were also associated with the degree of mesangial C3 deposition in patients with IgAN. Our findings suggest that genetic variants in CFH, CFHR3, and CFHR1 affect complement activation and thereby, predispose patients to develop IgAN.

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The changing spectrum of primary glomerular diseases within 15 years: A survey of 3331 patients in a single Chinese centre

Cited by 179 publications

References 21 publications

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015

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

Variants in Complement Factor H and Complement Factor H-Related Protein Genes, CFHR3 and CFHR1, Affect Complement Activation in IgA Nephropathy

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