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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA - AFRICA  
Year : 2018  |  Volume : 29  |  Issue : 5  |  Page : 1159-1164
Histomorphological pattern of renal biopsy in Dhaka: A single center study


Department of Histopathology, Armed Forces Institute of Pathology, Dhaka, Bangladesh

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Date of Submission14-Apr-2017
Date of Decision17-Jun-2017
Date of Acceptance18-Jun-2017
Date of Web Publication26-Oct-2018
 

   Abstract 

Renal biopsy is a useful procedure to understand the histological pattern of renal disease. We present the histomorphological characteristics of renal biopsy specimen received at histopathology department, Armed Forces Institute of Pathology, Dhaka received during July 2015 to December 2015 for six months period was included in the study.

How to cite this article:
Islam SJ, Haque WS, Akhter S, Mahbubul Alam S M. Histomorphological pattern of renal biopsy in Dhaka: A single center study. Saudi J Kidney Dis Transpl 2018;29:1159-64

How to cite this URL:
Islam SJ, Haque WS, Akhter S, Mahbubul Alam S M. Histomorphological pattern of renal biopsy in Dhaka: A single center study. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2018 Dec 16];29:1159-64. Available from: http://www.sjkdt.org/text.asp?2018/29/5/1159/243940

   Introduction Top


Renal biopsy is a useful procedure to understand the histological pattern of renal diseases.[1] It helps in establishing the accurate diagnosis, identifying the exact pathology, and devising the appropriate management plan for patients suffering from different types of renal diseases. Significant differences in the disease spectrum were found in different national and international studies.[2]

Glomerular disease comprises 25%–45% case of the end-stage renal disease in developing nations, including Bangladesh.[3] The pattern of glomerulonephritis (GN) varies widely from the country-to-country and also in different regions of the same country, reflecting the possible effects of socioeconomic status and genetic and environmental factors.[4],[5] Here, we present the histomorphological characteristics of renal biopsy specimen received at the histopathology department, Armed Forces Institute of Pathology (AFIP), Dhaka.


   Materials and Methods Top


This study was conducted at the Department of histopathology, AFIP, Dhaka, one of the pioneer renal pathology centers of Bangladesh. The entire renal biopsy specimen received during July 2015 to December 2015 for six months period was included in the study. The renal biopsy specimens received in 10% formalin were undergone hematoxylin and eosin (H and E) and periodic acid–Schiff (PAS) stain followed by light microscopy. Moreover, the sample received soaked in normal saline were undergone direct immunofluorescence (DIF) study for IgG, IgA, IgM, and C3. For light microscopy as well as for immunofluorescence study glomeruli >5 was considered as adequate. All the data were retrieved from the request form were endorsed in a predesigned data sheet.


   Results Top


A total of 235 renal biopsy specimens were received for histopathological study and DIF. The male:female ratio was 1:1.06. The mean age was 31.93 ± 15.13 years ranges from five years to 71 years. The largest age group was 21–30 years (73, 31.06%). The age of distribution is shown in [Figure 1].
Figure 1: Age distribution (n = 208).

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Among the clinical presentation, the most common presentation was nephrotic syndrome (NS), 134 (57.02%), followed by nephritic syndrome – 78 (33.19%), nephritonephrotic presentation – nine (3.83%), hematuria – four (1.7%), acute renal failure – five (2.13%), and chronic renal failure – five (2.13%) [Table 1].
Table 1: Clinical presentation of the patients (n = 235).

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On histopathological examination, 27 (11.49%) were inadequate due to the absence of renal tissue or lack of glomerulus or suboptimal number of glomerulus (<5). Among the adequate tissue 198 (95.19%) were diagnosed with glomerulopathy, seven (3.37%) as tubulointerstitial nephritis, and three (1.44%) as acute tubular necrosis. Among the glomerulopathies 164 (82.83%) were primary and 34 (17.17%) were secondary. Diffuse mesangioproliferative glomerulonephritis (DMPGN) [Figure 2] was found to be the most common histological pattern (35, 21.34%), followed by focal segmental glomerulosclerosis (FSGS) (32, 19.51%) [Figure 3], membranoproliferative glomerulonephritis (MPGN) (30, 18.29%), IgA nephropathy (24, 14.63%), membranous nephropathy (MN) (17, 10.37%). Among the secondary glomerulopathies, the most common cause was lupus nephritis (LN) 29 (85.29%) followed by diabetic nephropathy with five (14.7%). Different histological patterns of glomerulopathies are shown in [Figure 4] and pattern of 134 nephrotic syndrome are shown in [Figure 5].
Figure 2: Photomicrography of diffuse proliferative glomerulonephritis.

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Figure 3: Photomicrography of focal segmental glomerulosclerosis.

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Figure 4: Histological pattern of renal diseases (n = 208).

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Figure 5: Nephrotic syndrome (n = 134).

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Among 117 NS patients whose sample were adequate, the most common histological pattern of primary glomerulopathy was FSGS (32, 27.35%), followed by IgA nephropathy (19, 16.24%), MN (17, 14.53%) [Figure 6], MPGN (17, 14.53%), minimal change disease (MCD) (4, 3.42%) while LN comprises 23 (19.65%) and diabetic nephropathy with five (4.27%). Two of the DN were also associated with MPGN.
Figure 6: Photomicrography of membranous glomerulopathy.

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Among 68 nephritic syndrome whose biopsy were adequate, the most common histological pattern was DMPGN (35, 51.47%), followed by IgA/IgM nephropathy (12, 17.65%), MPGN (11, 16.18%), others (9, 13.23%) which includes an unremarkable renal tissue on light microscopy as well as in DIF [Table 2].
Table 2: Histological pattern of renal biopsy according to clinical presentation (n = 208).

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Among 43 (18.30%) pediatric age group (5–18 years) patients, three (6.98%) were inadequate, seven (16.28%) were lupus nephritis, 33 (76.74%) were primary glomerulopathy. Among primary glomerulopathies, the most common cause was FSGS - nine (27.27%), followed by IgA nephropathy – seven (21.21%), MCD - five (15.15%) and MN - four (12.12%).


   Discussion Top


Renal biopsy is an essential procedure to diagnose the histological pattern of renal diseases which is very much required for management planning of the patients. Special staining such as PAS, silver stain, and Masson trichrome, as well as immunofluorescence study, are an essential part of the renal histological examination.[6] In our study, we could do PAS staining and immunofluorescence study in addition to routine H and E staining. With the limited staining facilities, an effort was taken to categorize the disease patterns of renal diseases in a center at Dhaka, Bangladesh.

In this study, slight higher incidence of renal diseases are noted in female (male: female- 1:1.6) which is in contrast to Ahmed et al but closer to Habib et al.[4],[7] The most common affected age group in our study is 21–30 years, it is quite similar to Habib et al and Mohammad et al.[2],[4]

We got 11.49% inadequate samples which were not suitable for reporting. While Tyagi et al got 7.95% samples inadequate in light microscopy.[8] In certain cases, inadequacy in paraffin was tried to be resolved by using tissue received for DIF which were transported to us from near vicinity within few hours of biopsy.

NS was the most common (57.02%) clinical presentation in our study followed by nephritic syndrome (33.19%) which was quite closer to the study of Jalalah at Saudi Arabia[9] and Mardanpour et al at Iran.[10]

Among the adequate biopsies, 95.19% were glomerular diseases, 3.37% were tubulointerstitial nephritis and 1.44% were ATN. These incidences are closer to study at CMC, Velore,[11] and China.[12] While a study at Pakistan reveals the very high incidence of TIN (11.6%).[13] Mohammad et al got 3% ATN among 100 renal biopsies in Pakistan.[2]

In our study, FSGS (27.35%) topped among the NS followed by IgA nephropathy (16.24%) while DMPGN was the most common pattern of glomerulopathy among nephritic group followed by MPGN. Among all, the most common pattern of glomerulopathy was DMPGN followed by FSGS and MPGN. Habib and Badruddoza reported the focal segmental mesangioproliferative glomerulonephritis 29.47% to be the most common pattern of primary GN in a two-year study in Bangladesh, followed by DMPGN (15.8%).[4] While Singh et al got MN (25.8%) as the leading cause of primary glomerulopathy followed by MPGN (17.2%) in India.[14] According to Okpechi et al, MPGN was the most common cause of primary glomerulopathy, MN was the most common cause of NS and lupus nephritis was the most common cause of secondary nephropathy in South Africa. They got FSGS about 5.9%.[15] In our study, we got lupus nephritis as the most common cause of secondary NS. This study does not reveal any case of amyloidosis as secondary cause of NS while Habib et al got only one case of amyloidosis in his study in Bangladesh.[4] Lack of routine Congo red staining in our cases may be one of the reason.

Among the pediatric age group, the most common cause of steroid-resistant NS was FSGS (27.27%) followed by IgA (21.21%) nephropathy and MCD (15.15%). Mubarak et al[16] as well as Moorani et al[17] also got FSGS (38.7% and 29.66%, respectively) as the most common cause of NS among the pediatric age group while Hemrajani et al got MCD (40%) as the leading cause.[18]

The most important limitations of our study are the lack of all the special staining facilities such as Masson trichrome, silver and Congo red staining along with complete lack of electron microscopic support. Similar limitations also noted in some of the studies in some other developing countries.[19]


   Conclusion Top


In our study, DMPGN was the most common glomerular pathology followed by FSGS. While in pediatric age group, FSGS was the most common cause of glomerulopathy followed by IgA nephropathy and MCD. Lupus nephritis was the most common cause of secondary nephropathy in this study. The study was carried out in a country which is not having all the essential tools such as electron microscopy. Hence, there may be some la in the final diagnosis of the renal diseases.

Conflict of interest: None declared.

 
   References Top

1.
Fuiano G, Mazza G, Comi N, et al. Current indications for renal biopsy: A questionnaire-based survey. Am J Kidney Dis 2000; 35:44857.  Back to cited text no. 1
    
2.
Mohammad N, Khan TM, Orakzai AN, Imran M. Histological pattern of glomerulopathies. Gomal J Med Sci 2012;10:7-11.  Back to cited text no. 2
    
3.
Rashid HU. Nephrotic syndrome-evidence based management. Bangladesh Renal J 2003; 22:1-4.  Back to cited text no. 3
    
4.
Habib MA, Badruddoza SM. Pattern of glomerular diseases among adults in Rajshahi, the Northern region of Bangladesh. Saudi J Kidney Dis Transpl 2012;23:876-80.  Back to cited text no. 4
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5.
Mannan R, Singh PA, Misra V, et al. Clinical characteristics and histopathological findings in renal parenchymal disease patients: Our single centre experience from Northern plains of India. Glob J Med Res 2015;5:17-23.  Back to cited text no. 5
    
6.
Laurino L. Special stains in native and transplant kidney biopsy interpretation. Connection 2010;14:161-8.  Back to cited text no. 6
    
7.
Ahmed PI, Zaman SU, Jahan F, Gupta RD, Chowdhury MN, Khan MF. Pattern of primary glomerulonephritis in Dhaka Medical College Hospital, Bangladesh. Bangladesh J Med 2014; 25:42-6.  Back to cited text no. 7
    
8.
Tyagi I, Majumdar K, Kamra S, Batra VV. Retrieval of kidney tissue for light microscopy from frozen tissue processed for immunofluorescence: A simple procedure to avoid repeat kidney biopsies. Indian J Nephrol 2013; 23:206-10.  Back to cited text no. 8
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9.
Jalalah SM. Patterns of primary glomerular diseases among adults in the western region of Saudi Arabia. Saudi J Kidney Dis Transpl 2009;20:295-9.  Back to cited text no. 9
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10.
Mardanpour K, Rahbar M. Histopathologic patterns of adult renal disease in Kermanshah, Iran: A 6-year review of two referral centers. Caspian J Intern Med 2013;4:717-21.  Back to cited text no. 10
    
11.
Balakrishnan N, John GT, Korula A. Spectrum of biopsy proven renal disease and changing trends at a tropical tertiary care centre 1990-2001. Indian J Nephrol 2003;13:29-35.  Back to cited text no. 11
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12.
Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: Analysis based on 13,519 renal biopsies. Kidney Int 2004;66:920-3.  Back to cited text no. 12
    
13.
Mubarak M, Kazi JI, Naqvi R, et al. Pattern of renal diseases observed in native renal biopsies in adults in a single centre in Pakistan. Nephrology (Carlton) 2011;16:87-92.  Back to cited text no. 13
    
14.
Singh S, Marwah N, Sen R, Sangwan M, Verma R, Ralli M. Profile of renal biopsies in a tertiary care hospital. Int J Healthcare Biomed Res 2014;2:53-9.  Back to cited text no. 14
    
15.
Okpechi I, Swanepoel C, Duffield M, et al. Patterns of renal disease in cape town South Africa: A 10-year review of a single-centre renal biopsy database. Nephrol Dial Transplant 2011;26:1853-61.  Back to cited text no. 15
    
16.
Mubarak M, Kazi JI, Shakeel S, Lanewala A, Hashmi S. The spectrum of histopathological lesions in children presenting with steroid-resistant nephrotic syndrome at a single center in Pakistan. Scientific World Journal 2012; 2012:681802.  Back to cited text no. 16
    
17.
Moorani KN, Sherali AR. Histopathological pattern in childhood glomerulonephritis. J Pak Med Assoc 2010;60:1006-9.  Back to cited text no. 17
    
18.
Hemrajani D, Solanki R, Gupta VK, Chaudhary VK. Histopathological patterns of renal biopsies in children with various glomerulopathies. Int J Med Res Prof 2016; 2:183-7.  Back to cited text no. 18
    
19.
Golay V, Trivedi M, Kurien AA, et al. Spectrum of nephrotic syndrome in adults: Clinicopathological study from a single center in India. Ren Fail 2013;35:487-91.  Back to cited text no. 19
    

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Correspondence Address:
Dr. Sk. Md. Jaynul Islam
Department of Histopathology, Armed Forces Institute of Pathology, Dhaka
Bangladesh
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DOI: 10.4103/1319-2442.243940

PMID: 30381513

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