Abstract
Introduction: The renal biopsy is a very important tool for the evaluation of patients with medical and surgical renal diseases.
Materials & Methods: A prospective, cross-sectional and descriptive study was conducted in the Department of Pathology, Sir Salimullah Medical College, Dhaka, Bangladesh and Histopathology Department of Armed Forces Institute of Pathology (AFIP), Dhaka, Bangladesh over a period of 2 years from July 2015 to June 2017. Patients of different age group and both sex were selected for this study according to inclusion and exclusion criteria. Inclusion criteria was histologicaly proven glomerular disease. The exclusion criteria were, HIV infection, Nephrectomy. Solitary kidney, Intravenous drug abuse.
Results: Present study included 119 cases of histologically proven glomerular disease, the age range of the patients was 3-67 years, 65 were male and 54 were female. Minimal change disease was found to be the most common diagnosis followed by membranoproliferative and IgM nephropathy. Nephrotic syndrome was the most common clinical presentation. Most common immune deposition was IgG Among 119 cases 11.76% was diffuse proliferative glomerulonephritis, 3.36% crescentic glomerulonephritis, 10.93% membranous glomerulonephritis, 13.44% minimal change disease, 7.56% focal segmental glomerulsclerosis, 12.60% membranoproliferative glomerulonephritis, 10.08% IgA nephropathy, 1.68% C1q nephropathy, 5.04% C3 glomerulopathy, 12.61%IgM nephropathy and 10.93% lupus nephritis).
Conclusion: In this study we addressed IgM nephropathy, C3 glomerulopathy, C1q nephropathy as well as IgA nephropathy mostly based on Immunofluorescence findings. As now various type of immunotherapy are introduced in the therapeutic world and glomerular diseases are mostly immune mediated. It’s a new hope for renal disease. The recent availability of an anti-complement agent (eculizumab) has allowed to consider therapeutic options for C3 glomerulopathy.
Keyword: IgA nephropathy, IgM nephropathy, C1q nephropathy, C3 glomerulopathy.
References
- Nelson G. Ordonez and Juan Rosai:Urinary tract: Kidney, renal pelvis, and ureter; Bladder’ In: Rosai and Ackerman's Surgical Pathology, 10th, Mosby Elsevier .London, 2011: 17: pp 1101-72
- Khalid, Jamal Ahmad, MuhammadAzmat Khan: Histopathological pattern of glomerular lesions on percutaneous renal biopsy in protenuric patient: Pak Arme Forces Med J 2017; 67 (2): 211-15.
- Hossain T, Begum M, Rahman A, Kamal M. Immune Deposits in glomerular diseases and their clinical, histopathological and immuunopathological correlation, Bangladesh Journal of Pathology. 2011; 26(1): 14-9.
- Pasquariello A, Innocenti M, Batini V, Rindi S, Moriconi L. Routine immunofluorescence and light microscopy processing with a single renal biopsy specimen: 18 years’ experience in a single centre. J Nephrol. 2000 Mar-Apr;13(2):116-9.
- Schena FP, Gesualdo L. Renal biopsy--beyond histology and immunofluorescence. Nephrol Dial Transplant. 1994;9(11):1541-4.
- Wasserstein AG. Membranous glomerulonephritis. J Am Soc Nephrol. 1997 Apr; 8(4): 664-74.
- Larsen S, Brun C. Immune deposits in human glomerulopathy. Fluorescent microscopy findings in 366 kidney biopsies correlated to symptoms, clinical course and immunosuppressive therapy. Acta Pathol Microbiol Scand A. 1979 Sep;87A(5):321-33.
- Devasahayam, Gowrishankar Erode-Singeravelu, Zeenat Bhat, Tony Oliver, Arul Chandran, XuZeng 2016; Clq Nephropathy: The Unique Underrecognized Pathological Entity, European Renal Association – European Dialysis and Transplant Assoc, Oxford JournalsOxford University 1753-0784.,
- Markowitz, J. A. Schwimmer, M. B. Stokes et al., “Clq nephropathy: a variant of focal segmental glomerulosclerosis,” Kidney International, 2003 vol. 64, no. 4, pp. 1232-1240.
- Said, M L. D. Comell, A. M. Valeri et al., “Clq deposition in the renal allograft: a report of 24 cases,” Modern Pathology, 2010: vol. 23, no. 8, pp. 1080-1088.
- Hisano S, Fukuma Y, Segawa Y, et al.: Clinicopathologic correlation and outcome of Clq nephropathy. Clin J Am SocNephrol 2008; 3: 1637-1643.
- Vizjak A, Ferluga D, Rozic M, et al. Pathology, clinical presentations, and outcomes of Clq nephropathy. J Am SocNephrol 2008; 19: 2237-2244.
- Pescovitz MD. Rituximab, an anti-cd20 monoclonal antibody: history and mechanism of action. Am J Transplant 2006;6:859-866.
- Sinha A, Bagga A, Moudgil A. Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 2007;356:2751-2752.
- Pickering MC, D'Agati VD, Nester CM, et al. C3 glomerulopathy: consensus report. Kidney Int2013;84: 1079-1089.
- Medjeral-Thomas NR, O’Shaughnessy MM, O’Regan JA, Traynor C, Flanagan M, Wong L, et al. C3 glomerulopathy: Clinicopathologic features and predictors of outcome. Clin J AM Soc Nephrol. 2014; 9: 46-53.
- Barbour TD, Pickering MC, Cook HT: Recent insights into C3 glomerulopathy.Nephrol Dial Transplant: 2013: 28: 1685–1693.
- Thomas N, Morgan BP, Nast CC, Noel L-H, Peters DK, Rodríguez de Córdoba S, Servais A et al.C3 glomerulopathy: consensus report. Kidney Inter 2013 Oct 30 ; 84:1079-89.
- Bomback AS, Smith RJH, Barile GR, Zhang y, Heher EC, Herlitz L et al: Eculizumab for Dense Deposit Disease and C3 Glomerulonephritis. Clin J Am Soc Nephrol 2012 Mar: 8; 7(5): 748-56.
- Donia AF, Sobh MA, Moustafa FE, Bakr MA, Foda MA: Clinical significance and long-term evolution of minimal change histopathologic variants and of IGM nephropathy among Egyptians. J Nephrol. 2000; 13(4): 275-81.
- Sethi S, Fervenza FC, Zhang Y, Zand L, Vrana JA, Nasr SH, Theis JD, Dogan A, Smith RJH. C3 Glomerulonephritis: clinicopathologic findings, complement abnormalities, glomerular proteomic profile, treatment and follow-up. Kidney Inter 2012 Jun 6 [Epub ahead of print]; 82:465-73, 2012.
- Kopolovic J, Shvil Y, Pomeranz A, Ron N, Rubinger D, Oren R. (1987). IgM nephropathy: morphological study related to clinical findings. Am J Nephrol, V0l. 7, No. pp, 275-80.
- Helin H, Mustonen J, Pasternack A, Antonen J: IgM-associated glomerulonephritis. 1982; 31(1): 11-6.
- Hamed RM: Clinical significance and long-term evolution of mesangial proliferative IgM nephropathy among Jordanian children. Ann Saudi Med. 2003; 23(5): 323-7.
- Al-Saegh Riyadh Muhi and LinaWagih Assad, The Spectrum of Glomerular Diseases as Studied by Immunofluorescence Microscopy: a Single Center Study in Iraq Arab Journal of Nephrology and Transplantation. 2013 Sep;6(3):161-7
- Ziauddin A and Hossain, A clinicopathologic analysis of glomerulonephritis, Bangladesh Armed Forces Medical JounalVol-XVII 1993, 51-54.
- J. and A.N.2014 Turner,Kidey and urinary tract disease, Brian R. Waiker, Nicki R. Colledge, Stuart H. Ralston and Ian D. Penmen, Davidson’s Principles & Practice of Medicine, 22 th edition, 17; 461-524
- Shakir IK, Al-Saedi AJ, Al-Salam S, Saleem MS, Al-ShammaIA.Spectrum of glomerular disease in Iraqi patients from a single center. Saudi J Kidney Dis Transpl.2002 October-December; 13(4): 515-9.
- Sharmin F, Khan BR, Rahman M, Rashid HU, Islam B, Kamal M, Borua AR, Chowdhury MA, Mohsin AU, Ahmed S: IgA Nephropathy in Teaching Hospital of Dhaka.Bangladesh Med Res Counc Bull, . Apr 1997, 23 (1),25-9
- Banu SG, Ruhini Kumar Das, Mohammed Kamal: Distribution of immune Deposits in the glomerular mesangiumin mesangial proliferative and mesangiocapillary glomerulonephritis; Bangladesh J Pathol 22 (2); 13-15.
- Pound SE, Macdonald M, Thomson Detal: Diffuse proliferative glomerulonephritis: How many types ? Histopathology, 1987: 11(3)227-43.
- Das RK, Saleh AF, Kabir AN, Talukder SI, Kamal M: Immunofluorescence studies of renal biopsies: Dinajpur Med Col J: 2008: 1(1): 8-13.
- Khakurel, R.K. Agrawal, R.Haa: Pattern of glomerular disease in Nepal: A single centre experience: Saudi J Kidney Dis Transpl: 2015: 26 (4): 833-838.
- D’Agati VD, Kaskel FJ, Falk RJ Focal Segmental glomerulosclerosis.N.Engl.J.Med. 365,2011, 2398-2411
- Cohen AH, Border WA, Glassock RJ: Nehprotic syndrome with glomerular mesangial IgM Lab Invest. 1978; 38(5): 610-9.
- Bhasin HK, Abuelo JG, Nayak R, Esparza AR: Mesangial proliferative glomerulonephritis. Lab Invest. 1978; 39(1): 21-9.
- Mubarak M, Kazi JI, Shakeel S, Lanewala A, Hashmi S, Akhter F. Clinicopathologic characteristics and steroid response of IgM nephropathy in children presenting with idiopathic nephrotic syndrome. APMIS. 2011; 119(3): 180-6.
- Lawer W, Williams G, Tarpey P, Mallick NP. (1980). IgM associated primary diffuse mesangial proliferative glomerulonephritis. J ClinPathol, Vol. 33, No. 11, pp. 1029-38.
- Hsu HC, Chen WY, Lin GJ, Chen L, Kao SL, Huang CC, et al: Clinical and immunopathologic study of mesangial IgM nephropathy: report of 41 cases. Histopathology. 1984; 8(3): 435-46.
- Malleshappa R. Ranganath, A. P. Chaudhari, A. Ayiangar, and S. Lohitaksha, “Clq nephropathy presenting as acute renal failure,” Saudi Journal of Kidney Diseases and Transplantation, 2011, vol. 22, no. 2, pp. 324-326.
- Markowitz, J. A. Schwimmer, M. B. Stokes et al., “Clq nephropathy: a variant of focal segmental glomerulosclerosis,” Kidney International, 2003 vol. 64, no. 4, pp. 1232-1240.
- Baqui M.N, ShabnamAkhter, Enamul Kabir, Mohammad Shamiul Islam: A clinicopathologicalsudy on lupas nephritis; experience of 34 cases from Bangladesh: J Nephropharmacol. 2016: 5(2): 19-23.
Corresponding Author
Dr Nur-E-Jannatul Ferdous
Associate Professor, Department Of Pathology, Ashiyan Medical College, Dhaka