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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2020  |  Volume : 31  |  Issue : 6  |  Page : 1441-1442
Comment on “Biopsy-proven renal pathologies: Experience from multan institute of kidney diseases”


Department of Nephrology, Dialysis and Renal Transplantation, Civic Hospital, Palermo, Italy

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Date of Web Publication29-Jan-2021
 

How to cite this article:
Li Cavoli G, Tortorici C, Bono L, Ferrantelli A, Carollo C, Azzolina V, Amato A, Mongiovì R, Oliva B, Giammarresi C, Zagarrigo C, Li Cavoli TV, Servillo F, Schillaci O, Tralongo A. Comment on “Biopsy-proven renal pathologies: Experience from multan institute of kidney diseases”. Saudi J Kidney Dis Transpl 2020;31:1441-2

How to cite this URL:
Li Cavoli G, Tortorici C, Bono L, Ferrantelli A, Carollo C, Azzolina V, Amato A, Mongiovì R, Oliva B, Giammarresi C, Zagarrigo C, Li Cavoli TV, Servillo F, Schillaci O, Tralongo A. Comment on “Biopsy-proven renal pathologies: Experience from multan institute of kidney diseases”. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2021 Mar 7];31:1441-2. Available from: https://www.sjkdt.org/text.asp?2020/31/6/1441/308367


To the Editor,

We read with interest the article of Dr. Hashmi et al regarding their histological experience on renal diseases.[1] We would like to offer some comments. We agree with the authors that the rate of biopsy-proven renal diseases under-estimates the true prevalence of diseases because not all patients with renal disease are biopsied. There are several reasons of this underestimation, first of all, the local organization of the health system. In many countries, life expectancy is increasing; therefore, there is a rise in the elderly population and consequent increase in patients with renal disease. In the elderly, secondary renal diseases are more common as compared to primary renal disorders. In these patients suffering from nephrotic syndrome, amyloi-dosis, and membranous nephropathy (MN) are the most common histological diagnoses.[2] MN is a major cause of nephrotic syndrome in adults, with various etiologies and outcomes. MN is of leading interest for the nephrologist. The precise pathogenesis of human MN has long remained unclear and is the common glomerular disease associated with cancer and the most frequent form of nephrotic syndrome in elderly patients.[3] In Western countries, the studies on the changing pattern of renal diseases reported the rising frequency of membranous glomerulonephritis. The variations in the lifestyles of the populations in many countries (diet changes, industrialization, environmental pollution, drugs, minor exposure to parasitic and other infections) determine a different but greater immunological activation.[4] The progressive interaction between genetic factors, environmental and socioeconomic factors could vary the histological pattern of renal changes. According to our experience, in patients with nephrotic syndrome, mostly in the elderly, we need to detect malignancies (solid tumors of the breast, lung, colon), inflammatory bowel diseases, rheuma-tologic disorders). Even in our current clinical practice, a significant percentage of malignant tumors is found simultaneously at the diagnosis of MN, while others presented after the MN diagnosis (mainly lung cancer, gastrointestinal tract cancer and prostate cancer).[5] Therefore, in the follow-up of after the diagnosis, in the patients with MN (particularly the elderly), we always consider the latter eventuality. Latent tumors accompanied by MN usually become apparent within one year and the risk of cancer in patients with MN can continue even many years after the MN diagnosis suggesting that a long-term follow-up may be necessary if cancers cannot be detected initially.

Conflict of interest: None declared.



 
   References Top

1.
Hashmi MN, Asghar R, Abbasi T, Bashir K, Basharat R, Majeed S. Biopsy-proven renal pathologies: Experience from Multan institute of kidney diseases. Saudi J Kidney Dis Transpl 2020;31:850-5.  Back to cited text no. 1
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2.
Gupta P, Rana DS. Importance of renal biopsy in patients aged 60 years and older: Experience from a tertiary care hospital. Saudi J Kidney Dis Transpl 2018;29:140-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Akiyama S, Imai E, Maruyama S. Immunology of membranous nephropathy [version 1; peer review: 3] F1000 Research 2019;8 (F1000 Faculty Rev):734.  Back to cited text no. 3
    
4.
Woo KT, Chan CM, Lim C, et al. A global evolutionary trend of the frequency of primary glomerulonephritis over the past four decades. Kidney Dis 2019;5:247-58.  Back to cited text no. 4
    
5.
Ronco PM. Paraneoplastic glomerulopathies: New insights into an old entity. Kidney Int 1999;56:355-77.  Back to cited text no. 5
    

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Correspondence Address:
Gioacchino Li Cavoli
Department of Nephrology, Dialysis and Renal Transplantation, Civic Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.308367

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