Abstract
BackgroundAmong the proteinuric patients with chronic kidney disease (CKD) who undergo a renal biopsy, we sometimes encounter those who cannot be classified as having a known primary or secondary glomerular disease. The pathogenesis and pathophysiology of these CKD patients have not been sufficiently elucidated.MethodsWe recruited 34 proteinuric patients without known glomerular diseases. The glomerular volumes (GV) of the biopsy specimens from those patients were determined by a morphometric analysis. Glomerular hypertrophy (GH) was defined as having more than 3.6 × 106 μm3. The patients were divided in two groups: those with GH (Group 1) and those without GH (Group 2). We compared the clinical and pathological parameters between Group 1 and Group 2, and among the three groups of patients: non-obese, overweight and obese group.ResultsThe patients with Group 1 had significantly higher values for the proportion of males, the body mass index (BMI), uric acid and significantly lower values for the glomerular density (GD). Of note, a multivariate regression analysis revealed that sex, the BMI and GD were significant factors correlated with the mean GV. The values for the mean GV were significantly higher in the overweight and obese groups as compared to the non-obese group, and the values for the GD were significantly lower in the obese group than in the non-obese group.ConclusionsWe identified a subgroup of patients who were characterized as having a high BMI and GV, and a low GD among the proteinuric CKD patients without known glomerular diseases.
Highlights
Chronic kidney disease (CKD) is a worldwide public health problem [1, 2]
A multivariate regression analysis revealed that sex, the body mass index (BMI) and glomerular density (GD) were significant factors correlated with the mean glomerular volumes (GV)
We identified a subgroup of patients who were characterized as having a high BMI and GV, and a low GD among the proteinuric chronic kidney disease (CKD) patients without known glomerular diseases
Summary
Chronic kidney disease (CKD) is a worldwide public health problem [1, 2]. It has been reported that the prevalence of CKD is 13 % in the United States [3], 10–13 % in European countries [4, 5], 13 % in Japan [6] and 12–13 % in China [7]. A renal biopsy is a useful diagnostic procedure to elucidate the pathogenesis in proteinuric patients, we sometimes encounter those who do not fit the diagnostic criteria for any known primary or secondary glomerular diseases. We hypothesized that the GD, GH and obesity could be the characteristic findings of the proteinuric CKD patients without known glomerular diseases. To investigate this hypothesis, we carried out an investigation to explore the pathogenic role of GD, the glomerular volume (GV) and obesity in those patients. Among the proteinuric patients with chronic kidney disease (CKD) who undergo a renal biopsy, we sometimes encounter those who cannot be classified as having a known primary or secondary glomerular disease. We compared the clinical and pathological parameters between Group 1 and Group 2, and among the three groups of patients: nonobese, overweight and obese group
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