Incidence Of Glomerular Diseases Research Articles

Effect of the COVID-19 Pandemic on Incidence of Glomerular Disease: A Single Centre Report

Effect of the COVID-19 Pandemic on Incidence of Glomerular Disease: A Single Centre Report

Glomerular Disease in Temporal Association with SARS-CoV-2 Vaccination: A Series of 29 Cases.

Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several patient reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated GN, collapsing glomerulopathy, or diffuse lupus nephritis diagnosed on kidney biopsies postimmunization, as well as recurrent ANCA-associated GN. This included 28 cases of de novo GN within native kidney biopsies and one disease flare in an allograft. The patients with collapsing glomerulopathy were of Black descent and had two APOL1 genomic risk alleles. A brief literature review of patient reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown; however, there was no overall increase in incidence of glomerular disease when compared with the 2 years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Glomerular disease to vaccination is rare, although it should be monitored as a potential adverse event.

Socioeconomic Position and Incidence of Glomerular Diseases.

Social deprivation is a recognized risk factor for undifferentiated CKD; however, its association with glomerular disease is less well understood. We sought to investigate the relationship between socioeconomic position and the population-level incidence of biopsy-proven glomerular diseases. In this retrospective cohort study, a provincial kidney pathology database (2000-2012) was used to capture all incident cases of membranous nephropathy (n=392), IgA nephropathy (n=818), FSGS (n=375), ANCA-related GN (ANCA-GN, n=387), and lupus nephritis (n=389) in British Columbia, Canada. Quintiles of area-level household income were used as a proxy for socioeconomic position, accounting for regional differences in living costs. Incidence rates were direct standardized to the provincial population using census data for age and sex and were used to generate standardized rate ratios. For lupus nephritis, age standardization was performed separately in men and women. A graded increase in standardized incidence with lower income was observed for lupus nephritis (P<0.001 for trend in both sexes) and ANCA-GN (P=0.04 for trend). For example, compared with the highest quintile, the lowest income quintile had a standardized rate ratio of 1.7 (95% confidence interval, 1.19 to 2.42) in women with lupus nephritis and a standardized rate ratio of 1.5 (95% confidence interval, 1.09 to 2.06) in ANCA-GN. The association between income and FSGS was less consistent, in that only the lowest income quintile was associated with a higher incidence of disease (standardized rate ratio, 1.55; 95% confidence interval, 1.13 to 2.13). No significant associations were demonstrated for IgA nephropathy or membranous nephropathy. Using population-level data and a centralized pathology database, we observed an inverse association between socioeconomic position and the standardized incidence of lupus nephritis and ANCA-GN.

Disease-specific incident glomerulonephritis displays geographic clustering in under-serviced rural areas of British Columbia, Canada

There is little known about geographic variability in the incidence of glomerular disease and its potential implications for care delivery. To evaluate this, we performed a population-level cohort study using a provincial renal pathology database (2000-2012) to capture all incident cases of glomerulonephritis in British Columbia, Canada. This included 401 patients with membranous nephropathy (MN), 824 patients with IgA nephropathy (IgAN), 385 patients with focal segmental glomerulosclerosis (FSGS), 397 patients with lupus nephritis (LN) and 399 patients with ANCA-related glomerulonephritis (ANCA-GN). Geographic clusters were identified using Bayesian spatial models to estimate the incidence of each disease in 74 regions compared to the mean incidence in the entire province (incidence rate ratio, [IRR]), adjusted for region-level age, sex and race. The proportion of overall variability in incidence attributed to inter-regional differences varied by disease: 18% in MN, 81% in IgAN, 18% in FSGS, 59% in ANCA-GN, and 89% in LN. Except for LN, clustering was not explained by demographics. All IgAN and LN clusters were in urban regions close to nephrology centers, whereas ANCA-GN, MN and FSGS clustered mainly in rural regions. All ANCA-GN clusters were rural with median population density 1.2 persons/km2 and driving distances of 10-676 km to the nearest nephrology center. Thus, we found significant geographic clustering in the incidence of different glomerular diseases. MN, FSGS and ANCA-GN clustered in sparsely populated regions with limited access to care, underscoring the importance of regional variability in glomerular diseases to inform health services delivery.

Histomorphological and clinical study of primary and secondary glomerulopathies in Southeast Serbia (20-year period of analysis)

Epidemiological studies of renal biopsies have been performed to follow up the incidence of glomerular diseases on a specified territory and to compare the obtained results with results from other regions. The aim of this study was to analyze the frequency of certain histopathophysiological types of glomerular diseases on the territory of Southeast Serbia. In a 20-year period (1986-2006), 316 kidney biopsies were performed in patients with clinical signs of impaired renal function, in Southeast Serbia. On average 1.6 biopsies were made per year per 100 000 inhabitants. Biopsies of adult patients represented 88% of all biopsies, biopsies in children (aged under 18 years) represented 8%, while biopsies of elderly patients (more than 60 years) represented 4% of all biopsies. The predominance of male patients was described with male/female ratio of 1.4. The most frequent clinical manifestation in patients at the time of biopsy were nephrotic syndrome (42.5%), and asymptomatic proteinuria and/or hemamuria (31.3%) and nephritic syndrome (14.9%). The most common glomerular disease was IgA nephropathy with an incidence of 21.5% of total biopsy diagnosed glomerulopathies, followed by: membranous glomerulonephritis (12.6%), focal segmental proliferative and sclerosing glomerulonephritis (10.7%), lupus nephritis (8.4%), nephroangiosclerosis (7.0%), mesangio-proliferative glomerulonephritis (6.1%), minimal change disease (2.8%), mesangiocapillary glomerulonephritis (2.3%). The frequency of certain histopathologic findings significantly correlated with data from studies that we used for comparison, with the exception of minimal change disease whose incidence in our study was smaller.

Treatment of primary focal segmental glomerulosclerosis

Urinalysis had 4 protein with 5 red blood cells/high-power field along with granular and waxy casts. A 24-hour urine collection contained 8.2 g of protein, and the creatinine clearance was 42 mL/min. The sedimentation rate was 64 mm/h; rheumatoid factor and ANA were normal; C3, 135 mg/dL; C4, 41 mg/dL; and both urine and serum immunoelectrophoresis were negative for paraproteins. A rapid plasma reagin test (RPR) was nonreactive. Hepatitis B surface antigen was negative as was an ELISA evaluation for HIV antibody. A chest radiograph demonstrated her heart to be normal in size, and her lungs were clear, but bilateral pleural effusions were noted. An ultrasound of the kidneys demonstrated them to be normal in size and echogenicity. The renal arteries and veins were patent. A sodiumand water-restricted diet was prescribed, and the patient was treated with furosemide with good response. She underwent a percutaneous renal biopsy 3 weeks after presenCASE PRESENTATION tation. At the time of the biopsy, her blood urea nitrogen was A 53-year-old African American woman who had previously 29 mg/dL; serum creatinine, 3.2 mg/dL; serum albumin, 1.1 been in excellent health presented 11 years ago with increasing g/dL; and cholesterol, 784 mg/dL. weight, leg edema, and facial swelling that had developed over The renal biopsy revealed 17 glomeruli by light microscopy; one month. She had no history of sickle cell disease, recurrent one was hyalinized. The remaining glomeruli manifested mildly urinary tract infections or pyelonephritis, vesicoureteral reflux, increased mesangial matrix and cellularity. The glomerular basediabetes mellitus, hypertension, renal or systemic diseases, or ment membranes were thin and delicate, and the capillary loops morbid obesity. There was no family history of hypertension were patent. One glomerulus had a segmental scar with hyalinoor renal disease. She had not been taking any prescribed medisis, and a second glomerulus had a segmental scar with a small cations nor had she been using nonsteroidal anti-inflammaadhesion to Bowman’s capsule. Acute tubular necrosis and intertory agents. stitial edema were evident but no significant tubulointerstitial Physical examination revealed: blood pressure, 120/84 mm Hg; atrophy or fibrosis was seen. Immunofluorescence examination no skin rashes; lungs were clear; cardiac examination was norof the tissue was negative. Electron microscopy disclosed difmal; no hepatosplenomegaly; and no significant lymphadenopfuse foot process fusion with villous transformation; no elecathy. Her joints were unremarkable but she had 3 pre-tibial tron-dense deposits were seen in the mesangium or along the edema bilaterally. Laboratory evaluation demonstrated a blood capillary wall. urea nitrogen of 32 mg/dL; serum creatinine, 1.8 mg/dL; albuThe patient was given oral prednisone, 60 mg/day; 2 weeks min, 1.6 g/dL; and cholesterol, 612 mg/dL. Hemoglobin was 14.6 later her serum creatinine had fallen to 0.9 mg/dL but the proteing/dL with a normal white blood cell count and platelet count. uria had risen to 12.4 g/day. However, after 2 months of highdose steroid therapy, the proteinuria had decreased to 0.1 g/day, the serum albumin level was 3.8 g/dL, and the cholesterol level Portions of this article are republished with permission from Korbet was down to 326 mg/dL; she was edema free. A steroid taper SM: Primary focal segmental glomerulosclerosis, in Therapy in Nephrolwas completed over an additional 2 months. One week after ogy and Hypertension: A Companion to Brenner and Rector’s The Kidney (2nd ed), edited by Brady RJ, Wilcox CS, Philadelphia, W.B. Saunders discontinuing steroids she had a relapse of the nephrotic syn(in press). drome (13.6 g/day) but again responded to a second course of high-dose prednisone with a complete remission. She remained The Nephrology Forum is funded in part by grants from Amgen, in a complete remission for 4 months after the discontinuation Incorporated; Merck & Co., Incorporated; Dialysis Clinic, Incorpoof steroids and then relapsed a second time (proteinuria of 13 rated; and Bristol-Myers Squibb Company. g/day). She was treated with prednisone and oral cyclophospha

An Address Delivered at the Opening of the Section of Anatomy and Physiology

Background: Immune responses to vaccination are a known trigger for a new onset of glomerular disease or disease flare in susceptible individuals. Mass immunization against SARS-CoV-2 in the COVID-19 pandemic provides a unique opportunity to study vaccination-associated autoimmune kidney diseases. In the recent literature, there are several case reports demonstrating a temporal association of SARS-CoV-2 immunization and kidney diseases. Methods: Here, we present a series of 29 cases of biopsy-proven glomerular disease in patients recently vaccinated against SARS-CoV-2 and identified patients who developed a new onset of IgA nephropathy, minimal change disease, membranous nephropathy, ANCA-associated glomerulonephritis, collapsing glomerulopathy, and diffuse lupus nephritis diagnosed on kidney biopsies post-immunization, as well as recurrent ANCA-associated glomerulonephritis. This included 28 cases of de novo glomerulonephritis within native kidney biopsies and one disease flare in an allograft. Results: The patients with collapsing glomerulopathy were of African American descent and had two APOL1 genomic risk alleles. A brief literature review of case reports and small series is also provided to include all reported cases to date (n=52). The incidence of induction of glomerular disease in response to SARS-CoV-2 immunization is unknown, however, there was no overall increase in incidence of glomerular disease when compared to the two years prior to the COVID-19 pandemic diagnosed on kidney biopsies in our practice. Conclusions: This suggests that glomerulonephritis in response to vaccination is rare, although should be monitored as a potential adverse event.