Histopathological Study of Glomerular Disaese (in Patients with Significant Proteinuria): A Study of 50 Cases

Ceaser, R (2007) Histopathological Study of Glomerular Disaese (in Patients with Significant Proteinuria): A Study of 50 Cases. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Injury to glomeruli results in a variety of signs and symptoms of disease, including proteinuria, hematuria, azotemia, oliguria, edema and hypertension. Specific glomerular diseases tend to produce particular syndromes of renal dysfunction; although multiple glomerular diseases can produce the same syndrome. Evaluation of pathogenic features identified in a renal biopsy specimen may be required for definitive diagnosis. In patients with glomerular disease, renal biopsy provides tissue that can be used to determine the cause, predict the prognosis, and direct the treatment. In the absence of comprehensive knowledge of disease etiology, most glomerulopathies are still classified and named according to their morphologic features. The major inflammatory glomerulopathies are focal proliferative glomerulonephritis (termed mesangial proliferative glomerulonephritis if the proliferating cells are predominantly mesangial cells), diffuse proliferative glomerulonephritis, and cresentic glomerulonephritis. These diseases typically present with a nephritic- type active urine sediment characterized by the presence of red blood cells, red blood cast, leukocytes, and subnephrotic proteinuria. The severity of renal insufficiency varies in proportion to the degree of glomerular inflammation. AIM OF THE STUDY: To evaluate the renal histopathology of patients with glomerular disease (with Significant Proteinuria > 1 gms / 24 hours). MATERIALS AND METHODOLOGY: This is a prospective study of fifty consecutive patients attending the Nephrology clinic in the Stanley Medical College Hospital, Chennai in whom ultrasonogram guided renal biopsy were done in patients with the following criteria. Inclusion Criteria: 1. Patients aged more than twelve years. 2. Proteinuria more than 1 gms / 24 hours. Exclusion Criteria: 1. All known cases of diabetes mellitus. 2. All known cases of systemic hypertension. 3. All known cases with contracted kidneys proved by ultrasonogram. 4. Post transplant patients. 5. Cases of nephrotic syndrome responding to immunosuppressive therapy. Renal biopsy helps in establishing accurate diagnosis, identifying any reversible pathology, helps in devising appropriate management plan for the patients and is very useful in understanding the histological nature of the disease. The incidence of glomerular disease had increased dramatically in last decade and the pattern of glomerular pathology is changing dynamically with time. The type of glomerular disease varies in different geographies and among different age group of patients The amount of proteinuria, renal insufficiency, hypertension, and microscopic hematuria differ in different histopathological types and in different age groups. Hence all these parameters and the histopathological type of glomerular disease have prognostic implications in patients with glomerular disease Renal biopsy was performed in patients with glomerular disease (proteinuria <1 gms/24 hrs) attending the nephrology clinic from august 2004 to august 2006 All the biopsy specimen were evaluated by light microscopy and immunofluorescent staining. Laboratory investigations including twenty four hour urinary proteinuria, serum creatinine, hemoglobin, total leukocyte count, differential count, erythrocyte sedimentation rate, serum proteins, serum calcium, serum cholesterol, ultrasonogram of kidneys were done along with the histopathological analysis of kidney biopsy. SUMMARY: 1. 50 patients with proteinuria more than 1 gram per 24 hours above the age of 12 years were biopsied for renal histopathological examination. There were 32(65%) females and 18(36%) males, with a mean age of 27.54 years. 2. The commonest histopathological type found was FSGS in 11(22%) patients followed by, IgAN in8 (16%), MCD in 8(16%), mesangioproliferative in 7(14%), membranous nephropathy in 6(12%), lupus nephritis in 6(12%), MPGN in 3(6%) and amyloidosis in 1(2%). 3. MCD was commonest histopathological type in age group of less than 20 years of age, FSGS in 21 to 40 years and mesangiproliferative glomerulonephritis above 40 years of age group. 4. 23(46%) of the 50 patients had renal insufficiency and is common in patients with MPGN (100%), amyloidosis (100%), IgAN (87.5%) and lupus nephritis (66.66%). None of the patients with MCD had renal insufficiency. 5.20(40%) of the total patients studied had microscopic hematuria. 6. 22(44%) of the 50 patients studied had hypertension. The prevalence of hypertension was highest in patients with IgAN. 7. 32(64%) of patients had nephrotic range of proteinuria; where the mean amount of proteinuria was 6.29 grams per 24 hours. The prevalence of nephrotic range of proteinuria was highest in patients with MCD, where 5(83.33%) had nephrotic range of proteinuria. CONCLUSION: • The most common histopathological type was Focal segmental glomerulosclerosis (FSGS). • Renal insufficiency was common in patients with Membranoproliferative glomerulonephritis (MPGN). • Hypertension was common in patients with IgA nephropathy (IgAN). • Nephrotic range proteinuria was common in patients with Minimal change disease (MCD). • Microscopic hematuria was common in patients with IgA nephropathy (IgAN).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Glomerular disease ; Histopathological study ; 50 cases.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 04:02
Last Modified: 24 Mar 2018 05:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/6447

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