POS-121 REGIONAL REFERENCE SERVICE GLOMERULAR DISEASES PROFILE - EIGHT-YEAR ANALYSIS

Abstract

Glomerular diseases are an important etiology of chronic kidney disease and are associated with significant morbidity and mortality related to its clinical evolution. Epidemiological variations of clinical presentation and conduct are frequent. The aim of the study was to make a clinical and/or histopathological characterization of the cases followed up at the Glomerulopathy outpatient clinic of the Nephrology service of a tertiary hospital, a reference for the region, whether or not undergoing renal biopsy. Retrospective analysis of the medical records of patients referred and treated between June 2012 and June 2020. We collected demographic data, clinical presentation and histopathological reports of renal biopsies. Descriptive analysis of sociodemographic data was performed. For a better understanding of the sample, patients were divided into primary vs secondary glomerulopathies and patients with renal biopsy vs without renal biopsy. 350 patients were evaluated, 80.3% underwent renal biopsy. The mean age of all patients at diagnosis of glomerulopathy was 38.5 years (±16.3), with a predominance of females (57.1%) and white race (71.4%). Regarding the characterization of the renal disease presented, 59.7% were defined as primary glomerulopathies. In patients without renal biopsy, the main presentation was isolated hematuria (34.8%) and in biopsied patients, the main presentation was nephrotic syndrome (39.1%). In cases with biopsy, the most frequent primary glomerulopathy was Membranous Nephropathy (23.4%), followed by IgA Nephropathy (22.8%) and Primary Focal Segmental Glomerulosclerosis (21.6%). Among the secondary glomerulopathies, the most frequent was Lupus Nephritis (49.6%), followed by Secondary Focal Segmental Glomerulosclerosis (11.1%) and ANCA-Associated Vasculitis (5.2%). Considering all cases of biopsied glomerulopathies (primary and secondary), the most frequent was lupus nephritis (23.8%). In a specific analysis, 72 patients with renal involvement by lupus were evaluated, with a mean age at diagnosis of 32.4 years (±16.2), predominantly female (76.4%) and white (56.9%). The most frequent initial clinical presentation was nephritic-nephrotic syndrome (26.4%). In the histopathological evaluation, the most frequent class of lupus nephritis was IV (45.8%), followed by classes V (29.2%), III (18.1%) and II (1.4%). Lupus podocytopathy represented 5.5% of cases. During follow-up, 29.2% of patients with lupus nephritis underwent more than one kidney biopsy. A better characterization of the profile of glomerulopathies is essential in planning actions to meet the needs of this specific group of kidney diseases. Cases of lupus nephritis are highlighted, the most frequent glomerular disease in the study population, with a predominance of young patients and with more severe histopathological involvement (about half of the cases with Class IV lupus nephritis).