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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ASIA - AFRICA  
Year : 2013  |  Volume : 24  |  Issue : 1  |  Page : 168-171
Pattern of glomerular diseases in a tertiary care center in south India: A prospective study


Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, India

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Date of Web Publication22-Jan-2013
 

   Abstract 

This prospective study was undertaken to evaluate the distribution and pattern of glomerular diseases from a clinico-pathological perspective in our hospital, which is a tertiary care center in Southern India. Seventy-five consecutive patients who underwent renal biopsy and were diagnosed to have glomerular disease over a two-year period were studied and followed-up for one year. Primary glomerular disorders were more common than secondary glomerular disorders. Minimal change disease was the most common primary glomerular disease and lupus was the most common secondary glomerular disorder. Other common primary glomerular disorders were IgA nephropathy (16%) and post-infectious glomerulonephritis (10.7%), while focal and segmental glomerulosclerosis accounted for only 5.3% of the cases. In one-third of the cases, the initial clinical diagnosis did not correlate with the final biopsy diagnosis, further emphasizing the importance of renal biopsy in glomerular disorders.

How to cite this article:
Jeganathan J, Kumar S, Khalid M, Maroli C. Pattern of glomerular diseases in a tertiary care center in south India: A prospective study. Saudi J Kidney Dis Transpl 2013;24:168-71

How to cite this URL:
Jeganathan J, Kumar S, Khalid M, Maroli C. Pattern of glomerular diseases in a tertiary care center in south India: A prospective study. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2021 Sep 19];24:168-71. Available from: https://www.sjkdt.org/text.asp?2013/24/1/168/106363

   Introduction Top


The pattern of glomerular disease is different in various countries, and is changing with time within the same country. For instance, minimal change disease (MCD) was the most common cause of glomerular disease in Northern India, [1],[2] primary IgA nephropathy (IgAN) was more common in young adults from Western India [3] and mesangioproliferative glomerulonephritis (MesGN) was the predominant disease in South India. [4] In Saudi Arabia, focal and segmental glomerulosclerosis (FSGS) was found to be the most common cause in one study, [5] whereas membranous glomerulonephritis (MGN) was predominant in Western Saudi Arabia. [6] IgAN is now the most common glomerulonephritis (GN) worldwide. [7] FSGS appears to be more prevalent in the United States of America, [8] and its prevalence appears to be increasing. [9] The prevalence of post-streptococcal GN appears to have decreased. [10]

With this background, this study was undertaken in a tertiary care center in Southern India to determine the pattern of GN.


   Subjects and Methods Top


Seventy-five consequent biopsy-proven patients with glomerular diseases were studied. All patients were followed-up for a period of one year. A detailed history and physical examination was done and the following investigations were performed in all patients: urine routine examination, urine culture and sensitivity, 24-h urine protein, complete hemogram, blood urea and creatinine, serum albumin and cholesterol, ultrasound abdomen and pelvis and renal biopsy. Renal biopsy was done using a biopsy gun. The specimen were studied under light microscopy, electron microscopy and immunofluorescence. All biopsy specimens were examined by a histopathologist and were subsequently interpreted. The following tests were done if deemed necessary based on the clinical picture: anti-nuclear antibody, anti-glomerular basement membrane antibody, anti-neutrophilic cytoplasmic antibody, complement C3, antibody to human immunodeficiency virus, hepatitis B surface antigen, antibody to hepatitis C and VDRL. Patients in whom the urine sediment was benign and urine protein was less than 500 mg/dL once the treatment was started were considered to be in remission. Patients who responded within the first four weeks of treatment were termed steroid responsive. Patients who relapsed on withdrawal of steroids were termed steroid dependent.


   Results Top


Of the 75 patients on whom biopsies were performed, 33 were males and 42 were females. Sixty patients (80%) had primary glomerular disease and 15 patients (20%) had secondary glomerular disease. As shown in [Table 1], MCD was the most common cause among the primary glomerular disease group comprising 15 patients (20%). Lupus nephritis, seen in eight patients (10.7%), was the most common cause among the secondary glomerular disorders. The other common glomerular disorders were IgAN, seen in 12 patients (16%), post-infectious GN (PIGN), seen in eight patients (10.7%), crescentic GN, seen in six patients (8%) and focal GN and MCGN, seen in five patients each (6.7%). As shown in [Table 2], edema was the most common presentation as seen in 47 patients (62.7%), followed by hematuria in 35 patients (46.7%) and renal impairment, which was seen in 23 patients (30.7%). As shown in [Table 3], the glomerular disorders that had nephrotic manifestations predominantly were MesGN (100%), MCGN (80%) and MCD (80%). Hematuria was seen in a higher proportion among cases with MesGN (100%), MCGN (80%), IgAN (83.3%) and lupus nephritis (75%). Hypertension was seen in most of the cases of MGN (66.7%), FGN (60%), FSGS (50%) and diabetes (33.3%). During the follow-up period of one year, 45 patients attained remission, six patients were on dialysis and four patients died [Table 4]. All cases of PIGN, lupus nephritis, MesGN and MCGN had attained remission. Remission was also seen in 73.3% of the MCD patients, 66.7% of the membranous group and 60% of the patients with FGN. None of the cases of crescentic GN, diabetes or allograft nephropathy were in remission at the end of one year. In 51 patients (68%), the clinical diagnosis correlated with the subsequent biopsy diagnosis, whereas in 24 patients (32%), the clinical diagnosis was not in line with the final biopsy diagnosis. The clinical diagnosis correlated with the biopsy diagnosis in all cases of Henoch Scholein purpura, PIGN and diabetic nephropathy. However, in none of the cases of MesGN did the initial clinical diagnosis correlate with the final biopsy diagnosis.
Table 1. Distribution of glomerular diseases in the study patients (n = 75).

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Table 2. Initial presentation of patients with various
glomerular diseases.


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Table 3. Clinical manifestations of glomerular diseases in the study patients.

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Table 4. Outcome of glomerular diseases in the study patients after one year follow-up.

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   Discussion Top


In our study, primary glomerular disorders constituted 80% of the cases, and were more common than the secondary glomerular disorders. A similar observation was made in other studies from Kashmir, India [2] (91.73%) and Vellore, India [4] (71%). In a study from Saudi Arabia, primary glomerular diseases constituted 63.5% of the glomerular diseases. [5] In our study, MCD constituted 20% of the cases, and was the most common cause of primary GN. Similarly, in the study from Kashmir, MCD was seen in 43.79% of their cases, and was the most common cause. [2] However, in the study from Vellore, MCD was seen in only 11.6% of their cases and MesGN comprised 20.2% of the cases, and was the most common cause. [4] In the study from Western Saudi Arabia, [6] MGN was found to be the most common cause and in another study from the King Khalid University Hospital in Saudi Arabia, [5] FSGS was the most common cause. Hence, in various locations within the same country, the prevalence of various glomerular diseases differed. The other common primary glomerular disorders seen in our study were IgAN and PIGN. In a study from Haryana, India, PIGN was seen in 37.7% of their nephritic cases. [11] However, the proportion of cases of PIGN was relatively lower in the studies from Kashmir [2] and Vellore. [4] In the study from Western Saudi Arabia also, PIGN comprised only 2% of their primary glomerular diseases. [6] FSGS was seen in only 5.3% of the cases in our study. In the studies from Kashmir [2] and Vellore, [4] FSGS was seen in a higher proportion, and was found to be the second most common cause. In the study from Western Saudi Arabia also, FSGS was the second most common cause, comprising 21.3% of the cases. [6] Among the secondary GN, lupus nephritis was the most common cause seen in our study. Similar results have been reported from Vellore [4] and the King Khalid University Hospital in Saudi Arabia. [5] However, in the study from Kashmir, [2] diabetes was the most common and lupus was the second most common cause of secondary glomerular diseases. Remission at the end of one year was more commonly seen in MCD, MGN and FGN in our study. Hypertension was found more frequently in FSGS, FGN and MGN. Acute renal failure as a presentation was most frequently seen in crescentic GN. In 68% of the cases, the initial clinical diagnosis correlated with the biopsy diagnosis, while in the remaining 32% of the cases, the initial clinical diagnosis did not.

In conclusion, a high frequency of MCD was seen in our study. The proportion of FSGS was not very high. Outcome was poor in patients with diabetic and crescentic GN. One-third of our patients were not diagnosed correctly by clinical methods alone. This further reinforces the vital importance of kidney biopsy in the diagnosis, treatment and prognosis of patients with glomerular disease.

 
   References Top

1.Agarwal SK, Desh SC. Spectrum of renal diseases in Indian adults. J Assoc Physicians India 2000; 48:594-600.  Back to cited text no. 1
    
2.Reshi AR, Bhat MA, Najar MS, et al. Etiological profile of nephrotic syndrome in Kashmir. Indian J Nephrol 2008;18:9-12.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Vanikar AV, Kanodia KV, Patel RV, Trivedi HL. Primary IgA Nephropathy in western India. Indian J Nephrol 2005;15:227-31.  Back to cited text no. 3
  Medknow Journal  
4.Narasimhan B, Chacko B, John GT, Korula A, Kirubakaran MG, Jacob CK. Characterization of kidney lesions in Indian adults: Towards a renal biopsy registry. J Nephrol 2006;19:205-10.  Back to cited text no. 4
[PUBMED]    
5.Mitwalli AH, Al Wakeel J, Abu-Aisha H, et al. Prevalence of Glomerular Diseases: King Khalid University Hospital, Saudi Arabia. Saudi J Kidney Dis Transpl 2000;11:442-8.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.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. 6
[PUBMED]  Medknow Journal  
7.D'Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med 1987;64: 709-27.  Back to cited text no. 7
[PUBMED]    
8.Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis 1996;27: 647-51.  Back to cited text no. 8
[PUBMED]    
9.Braden GL, Mulhern JG, OShea MH, Nash SV, Ucci AA, Germain MJ. Changing incidence of glomerular diseases in adults. Am J Kidney Dis 2000;35:878-83.  Back to cited text no. 9
    
10.Yap HK, Chia KS, Murugasu B, et al. Acute glomerulonephritis changing patterns in Singapore children. Pediatr Nephrol 1990;4:482-4.  Back to cited text no. 10
[PUBMED]    
11.Aggarwal HK, Yashodara BM, Nand N, Sonia, Chakrabarti D, Bharti K. Spectrum of Renal Disorders in a tertiary Care Hospital in Haryana. J Assoc Physcians India 2007;55:198-202  Back to cited text no. 11
    

Top
Correspondence Address:
Jayakumar Jeganathan
Department of Medicine, Kasturba Medical College, Manipal University, Mangalore
India
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DOI: 10.4103/1319-2442.106363

PMID: 23354219

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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    Abstract
   Introduction
   Subjects and Methods
   Results
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