Renal Disease in Nepal, Under Microscope: One Year Study

IgA Nephropathy

Histologic classification of glomerular diseases: clinicopathologic correlations, limitations exposed by validation studies, and suggestions for modification

A study was undertaken on the specificity of circulating IgA antibodies in patients with IgA nephropathy detected by immunofluorescence using avidin-biotin complexes. Renal biopsy specimens and serum samples were obtained from 33 patients with IgA nephropathy, 14 other glomerular diseases and 3 normal renal tissues. These renal specimens were treated with citrate buffer (pH 3.2), and then incubated with serum samples obtained from the same and other patients with IgA nephropathy, other glomerular diseases or healthy adults at 37 degrees C for 30 min. The specimens were incubated with biotin conjugated gout F(ab')2 anti-human IgA antiserum at 37 degrees C for 30 min, and then with fluorescein-labeled avidin at 37 degrees C for 30 min. It was found that IgA antibodies in the sera from patients with IgA nephropathy specifically combined with the autologous glomerular mesangial areas, but only 25.7% of them combined with allogeneic renal tissues of IgA nephropathy patients. Confirmatory findings were obtained using an automatic image analyzer. However, these IgA antibodies did not combine with the renal tissues from patients with other glomerular diseases or normal renal tissues. In parallel studies, in order to distinguish IgA nephropathy from other glomerular diseases before renal biopsy, the renal specimens from patients with IgA nephropathy were also incubated with serum samples obtained from 42 patients with proteinuria and/or hematuria before renal biopsy. It was demonstrated that the incidence of IgA binding in IgA nephropathy was significantly higher than that in other glomerular diseases prior to renal biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives To retrospectively analyze the pathologic type of renal biopsy and the change of disease spectrum of recent 10 years in our hospital. Methods The clinical data of 996 patients with renal biopsy from February 2006 to February 2016 in our department were collected and analyzed. Results Among the 996 patients, primary glomerular disease (PGD) was 76.31%, secondary glomerular disease (SGD) was 21.18%, renal tubulointerstitial was 2.21% and hereditary kidney disease was 0.30%. Among the PGD, IgA nephropathy was the most common pathological type with 238 cases (31.32%), followed by mesangial proliferative glomerulonephritis with 199 cases (26.18%), membranous nephropathy with 127 cases (16.71%). Among the SGD, lupus nephritis was the most common pathological type with 76 cases (36.02%), followed by henoch-schonlein purpura nephritis with 56 cases (26.54%) and hepatitis B virus associated glomerulonephritis (HBV-GN) with 24 cases (11.37%). Among the PGD, nephritic syndrome was the most common clinical manifestation with 446 cases (58.68%), followed by chronic glomerulonephritis with 223 cases (29.34%) and latent glomerulomephritis with 69 cases (9.08%). Conclusions PGD is the most frequent glomerular disease in clinic. IgA nephropathy is the most common pathological type in PGD and the proportion of membranous nephropathy increases significantly in recent years. In SGD, Lupus nephritis is the most common pathological type and the proportion of HBV-GN also increases significantly. Key words: Kidney Diseases; Biopsy, Needle

Several registries and single centers have reported the results of their renal biopsies from different parts of the world. As there are only few data regarding the epidemiology of glomerulonephritides in Iran, this study was conducted to determine the results of renal biopsy findings during the last 10 years in our center. Data from 1,436 patients who had undergone a renal biopsy in our center between 1998 and 2007 were collected retrospectively for the first 989 patients and prospectively for the rest of them, including demographic data, renal syndrome at presentation and laboratory findings. All kidney specimens were studied with light and immunofluorescent microscopies. Among 1,407 patients with a definite pathologic diagnosis, 1,052 (74.8%) had a primary glomerular disease, 241 (17.2%) had a secondary glomerular disease, 66 (4.6%) had tubular disease, 19 (1.3%) had vascular disease and 7 (0.5%) had end-stage kidney disease. The most frequent types of biopsy-proven renal diseases were membranous glomerulopathy (MG) (377 patients, 26.8%), IgA nephropathy (IgAN) (155 patients, 11%), lupus nephritis (155 patients, 11%), focal segmental glomerulosclerosis (141 patients, 10%) and minimal change disease (117 patients, 8.3%). The predominant presentation was nephrotic syndrome in almost all cases, with the exception of chronic glomerulonephritis, acute tubular necrosis and acute tubulointerstitial nephritis. The epidemiology of our renal biopsy findings was similar to reports from most European countries and United Arab Emirates, but different from many other neighboring countries, North America and Far East. In our report of 1,407 renal biopsy specimens, MG and IgAN were the most frequent biopsy-proven renal diseases. FSGS was the third cause of primary glomerular disease, and lupus nephritis was the most common secondary glomerular disease. The unusually high frequency of presentation as nephrotic syndrome may be due to referral nature of our center and less liberal indications for renal biopsy.

Immunohistochemical Expression of Activated Caspase-3 as a Marker of Apoptosis in Glomeruli of Human Lupus Nephritis

IgA Nephropathy: Progress Before and Since Berger

37-Year-Old Woman With Bilateral Lower Extremity Edema, Proteinuria, and Microscopic Hematuria

Cytokine gene polymorphisms: Can these differentiate renal disease entities?

Objective To investigate the epidemiological characteristics and pathological changes of glomerular diseases in Heilongjiang province, and to provide theoretical basis for the prevention and treatment of glomerular diseases. Methods A total of 462 patients with chronic kidney diseases(CKD) who underwent percutaneous renal biopsy in our hospital from January 2010 to October 2016, were selected as study subjects, their clinical and pathological data were analyzed retrospectively. Results ①Of the 462 cases of renal biopsy, 366 cases (79.22%) had primary glomerular disease (PGD), 92 cases (19.91%) were secondary glomerular disease (SGD), and renal tubulointerstitial diseases (TID) in 3 cases (0.65%), hereditary nephropathy in 1 case (0.22%). PGD was mainly membranous nephropathy (49.73%), followed by IgA nephropathy (25.96%), minimal change nephropathy (6.28%) and so on. ② PGD was predisposed to males (85.71%), while SGD was mostly female (27.18%). The proportion of male membranous nephropathy in PGD was higher than that in female (39.16%), and that in female IgA nephropathy (35.66%) was higher than that in male (21.57%). Lupus nephritis(LN)was predisposed to female in SGD (66.67%), hepatitis B virus associated glomerolunephritis(HBVGN) predominantly in male (33.33%). ③There were significant differences in renal biopsy between different sexes(P 0.05). Conclusions The most common for the PGD, and membranous nephropathy in PGD is the most common, followed by IgA nephropathy in renal biopsy. In recent years, the incidence of membranous nephropathy has increased significantly. Key words: Kidney Diseases; Kidney Glomerulus; Biopsy

Glomerular diseases are numerous and difficult to diagnose without a renal biopsy. Despite the development of many radiological and laboratory tests and the use of up-to-date equipment, renal biopsies are the best method for diagnosing renal diseases. This study aimed to analyze the histopathological patterns of glomerular diseases in Oman. Light microscopy and immunofluorescence markers such as immunoglobulin (Ig) G, IgA, IgM, C3, and C1q, which are routinely used to evaluate the presence of immune deposits, were analyzed. In total, 596 renal biopsies were retrospectively analyzed at the Sultan Qaboos University Hospital for a 5-year period (2011-2015). Males represented 45.8%, and the median age was 29.7 years. Primary glomerular diseases were more common in males (54%); secondary glomerular diseases were more prevalent among females (76.7%). The prevalence of primary glomerular diseases (65.6%) was more dominant than secondary glomerular diseases (34.4%). Lupus nephritis (LN) was the most common secondary glomerular disease and was the most prevalent among all biopsies (29.9%). Focal segmental glomerulosclerosis (FSGS), membranous glomerulopathy, IgA nephropathy, minimal change disease, and diffuse global glomerulosclerosis were the most common primary glomerular diseases, accounting for 21.5%, 9.1%, 8.6%, 6.4%, and 6.2%, respectively. The level of the fluorescein isothiocyanate C1q marker in the top five renal diseases was low compared with other markers. In conclusion, in Oman, LN was the most common glomerular disease encountered and FSGS was the most common primary glomerular disease. The findings suggest that the localization of glomerular C1q in renal diseases needs to be investigated further.

Background: The spectrum of renal diseases varies with different ethnic populations, geographical locations and environmental factors. In children, many signs of kidney disease are either hidden or mimic other systemic diseases. There is a need of identifying renal disorders at an early stage to retard the rapid progression. This study aims to identify the different histopathological spectrum of glomerular diseases in pediatric renal biopsies. Materials and Methods: This was a cross-sectional prospective study undertaken at the Pathology Department at Pratham Pathology Laboratory, Lazimpat for 17 months duration (May 1ST - December 31ST 2023). The final diagnosis was made by a pathologist after correlating the histopathological findings with immunofluorescence and other clinical and laboratory findings. Results: A total of 97 pediatric patients’ renal biopsy specimens were evaluated. Patients’ age ranged from 0-16 years. The majority of patients were in the age group of 11-16 years (62.8%). The study showed slight female predominance with male to female ratio of 0.8:1. The most common glomerular disease was Lupus Nephritis with a frequency of 19 (19.6%). The most common cause for Rapid progressive Glomerulonephritis in the pediatric population was Post Infectious Glomerulonephritis with a frequency of 5 (50%). Conclusions: The most commonly diagnosed glomerular disease in pediatric renal biopsies was Lupus Nephritis. The leading cause of Rapid Progressive Glomerulonephritis was Post Infectious Glomerulonephritis and Lupus was one of the leading causes of chronic kidney disease.

BACKGROUND: Renal biopsy plays an important role in diagnosis of renal disease, especially in nephrotic syndrome. IgA nephropathy had been the most common glomerular disease in the whole world. However, there were not many reports about the epidemiological incidence and causes of renal disease in Taiwan.METHODS: We performed a single-center, retrospective analysis of patients with renal disease that was documented by precutaneous renal biopsy from October 2000 to December 2010. Demographic data (age, gender), laboratory investigations such as serum urea, serum creatinine, proteinuria, haematuria, 24-hour urinary protein, and creatinine clearance, and clinical diagnosis were collected for analysis.RESULTS: There were 444 native kidney biopsies performed, 238 males (53.6%) and 206 females (46.7%). The average age of patients was 47.6 years. The most common clinical presentation as an indication for renal biopsy was nephrotic syndrome (52%). Membranous nephropathy (17.5%) was the most common glomerular disease and the most frequent cause (29.8%) of nephrotic syndrome. Primary glomerular disease accounted for 55% of all biopsies and membranous nephropathy was the most frequent cause (31.7%) of the primary glomerular disease. Lupus nephritis was the most frequent secondary glomeurlonephritis (53.21%).CONCLUSIONS: Instead of IgA nephropathy, membranous nephropathy was the most common primary glomerular disease and lupus nephritis was the most common secondary glomerulonephritis in our analysis. The high prevalence of membranous nephropathy could be due to older age and higher incidence of patients with nephrotic syndrome in our database.

Objective To explore the pathological characteristics of elderly patients with renal biopsy in recent ten years. Methods Clinical and pathological data were analyzed in 408 elderly patients undergoing renal biopsy in the hospital between November 2005 and November 2015. According to the time of receiving renal biopsy, the patients were divided into two groups: group A(patients receiving biopsy between November 2005 and October 2010) and group B (patients receiving biopsy between November 2010 and November 2015). Results The main clinical presentation was nephrotic syndrome (61.8%) and chronic nephritis syndrome (29.4%). Compared with the patients from 2005 to 2010, the proportion of renal biopsy due to acute renal failure was decreased in recent 5 years (P<0.001) . Patients with primary glomerular disease were 67.4%(275/408), while secondary glomerular diseases were 26.0%(106/408). Patients with tubulo-interstitial disease accounted for 2.2%(9/408)and patients incorporated with two renal diseases were 3.2%(13/408). The diagnosis rate of tubulo-interstitial disease was significantly decrease in group B (P<0.05). In patients with primary glomerular diseases, membranous nephropathy was the most common pathologic category which accounting for 60.0% followed by IgA nephropathy which accounting for 13.5%. Meanwhile, in patients with secondary glomerular diseases, the major pathological types were hepatitis B virus-associated glomerulonephritis (14.2%), systemic vasculltis-associated glomerulonephritis(14.2%), respectively. The diagnosis rate of hepatitis B virus-associated glomerulonephritis in the patients from Guangdong was significantly higher in group B (P<0.05). Conclusions Primary glomerular disease is the most common renal disease in elderly patients with renal biopsy. The major pathologic category of primary glomerular diseases is membranous nephropathy, while the major pathologic type of secondary glomerular disease is hepatitis B virus-associated glomerulonephritis. The diagnosing rate of tubule-interstitial disease is significantly decrease in recent 5 years which accounting for the decreasing of patients who undergoing renal biopsy due to acute renal failure. Clinicians should pay more attention to receive renal biopsy in patients with acute renal failure. The diagnosing rate of hepatitis B virus-associated glomerulonephritis is significantly higher followed by the routine detection of hepatitis-B antigen in renal biopsy. It suggests that routine detection of hepatitis-B antigen in renal biopsy will be benefit to diagnose. Key words: Kidney Diseases; Biopsy; Aged

To search for biomarkers of IgA nephropathy, protein profiles of urine samples from patients with IgA nephropathy and normal volunteers were compared using two-dimensional DIGE. Most of the 172 spots identified in the urine were serum proteins, and their amounts in IgA nephropathy urine were much higher than those in normal urine; this can be explained as proteinuria caused by glomerular dysfunction. However, only alpha(1)-microglobulin, also one of the major serum proteins, in IgA nephropathy urine was not higher in amount than that in normal urine. We confirmed using ELISA analysis that the amounts of transferrin and albumin in IgA nephropathy and diabetic nephropathy urine were much higher than those in normal urine, whereas the amount of alpha(1)-microglobulin in IgA nephropathy urine was not higher than that in normal urine and was much lower than that in diabetic nephropathy urine. Approximately 50% of alpha(1)-microglobulin forms a complex with IgA in serum. These results suggest that alpha(1)-microglobulin in IgA nephropathy urine is a characteristic protein and might be a biomarker for IgA nephropathy and that alpha(1)-microglobulin might have a relationship with IgA nephropathy pathology.