Pattern of glomerulopathy diagnosed at Ain Shams Specialized Hospital (A 5-years retrospective study)

Abstract

G lomerulonephritis remains as a major cause of morbidity and mortality from renal disease in many parts of the world, particularly in the tropical and subtropical regions. According to several local registries and sporadic publications, it seems to be responsible for 23.2 to 58.4% of patients on regular dialysis in the tropics, compared to recent figures of around 6-8% in the United States and 7.5-19.6% in Europe. Its prevalence among dialysis patients in Egypt has been reported as 7.8% in 2008. The incidence of biopsy proven GN varies in different geographical areas, as it is affected by socioeconomic condition, race, indication for renal biopsy and differences in genetic susceptibility and environmental exposure. Recent studies reported a changing pattern of incidence of GN in different parts of the world. Our study aimed to obtain a comprehensive review of the incidence of biopsy proven glomerulonephritis in Ain Shams University Specialized hospital over a period of 6 years. We analyzed the clinical and pathological data of all percutaneous renal biopsies for medical renal disease submitted to the pathology and electron microscopy unit of Ain Shams University Specialized hospital from January 2005-December 2010 with a total of 1320 renal biopsies. The mean age was 27.48 ± 17.48 years. We classified the different age groups into three groups: age group <18 years {473 cases (35.8%)}, age group from 18 years - 65 years {828 cases (62.8%)}, and age group >65 years {19 cases (1.4%)}. As regards gender, 677 renal biopsies (51.3%) were obtained from male patients and 643 biopsies (48.7%) were obtained from female patients. There were nine clinical syndromes as an indication for renal biopsy, including: 1. Nephrotic syndrome {335 cases (25.3%)}, 2. Proteinuria; persistent sub-nephrotic proteinuria of more than 1 gm/24 hours and < 3.5 gm/24 hours {249 cases (18.9%), 3. SLE evaluation; assessment of serologically confirmed SLE with renal involvement {218 cases (16.5%}, 4. CKD of unknown etiology {210 cases (15.9%)}, 5. Hematuria; after exclusion of urological causes {134 cases (10.2%)}, 6. Acute renal failure (ARF) {62 cases (4.7%)}, 7. Nephritic syndrome {50 cases (3.8%)}, 8. Rapidly progressive renal failure {25 cases (1.9%)} and 9. Others {37 cases (2.8%)}.

Primary glomerulonephritis was more frequent {585 cases (44.3%)} than secondary glomerulonephritis {349 cases (26.4%). Primary GN (PGN) was more common in males {368 cases (62.9% of PGN)} than females {217 cases (37.1% of PGN)}, while secondary GN (SGN) was more common in females {229 cases (65.5% of SGN)} than males {120 cases (34.5% of SGN)}. In primary GN (PGN) diagnosis category, membranoproliferative GN (MPGN) was the most frequent histopathological diagnosis {166 cases (28.4% of PGN)}, followed by IgA nephropathy {137 cases (23.4% of PGN)}, followed by FSGS {116 cases (19.8% of PGN)}, followed by membranous GN {105 cases (17.9% of PGN)}, followed by minimal change disease {36 cases (6.2% of PGN)}, followed by crescentic GN {24 cases (4.1% of PGN)}. In secondary GN (SGN) diagnosis category, lupus nephritis (LN) was the most frequent histopathological diagnosis {212 cases (60.7% of SGN)}, followed by post-infectious GN {74 cases (21.2% of SGN)}, followed by renal amyloidosis {35 cases (10% of SGN)}, followed by diabetic nephropathy {18 cases (5.2% of SGN)}.