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Glomerulonephritis is a group of diseases characterized by glomerular damage, commonly immune-mediated, with risk of progression to chronic kidney disease. The kidney biopsy is the gold standard for diagnosing. In Mexico there is 1 report until 2012 of 423 kidney biopsies while in the USA a study reported 4128 biopsies in 6 years. More records are needed to know the clinical and epidemiological characteristics of the patients.
The aim of this study was clinical and histopathological characterization of glomerular diseases in a hospital in southeastern Mexico from March 2022 to July 2023. A descriptive, observational and prospective study was carried out, included: age, sex, clinical presentation, baseline creatinine, baseline glomerular filtration rate (GFR) by CKD-EPI equation, creatinine clearance (CrCl) from 24-hour urine collection, proteinuria, histopathological diagnosis and renal function at 6 months. All were performed ultrasound-guided by a nephrologist with trans-procedural confirmation of optimal sampling by a nephropathologist.
Thirteen renal biopsies were obtained, 69% were women and 31% men, with a mean age of 31+9.3 years. The mean time from the onset of illness to hospital admission was 216 days. The main clinical manifestations were: edema in 23%, macroscopic hematuria in 15.38% and skin manifestations in 15.38%. About the clinical presentation 23% debuted with hematuria-proteinuria syndrome, 15.38% with nephrotic syndrome, 15.38% with nephritic syndrome, 15.38% with isolated proteinuria and 38.4% were rapidly progressive glomerulonephritis. The mean baseline creatinine on admission was 4.8+7.3mg/dl, the mean baseline GFR was 54.9 ml/min/1.73m2, the mean baseline CrCl from 24h urine was 47.87ml/min, the mean proteinuria was 2.9+2.2g/ 24h. Nobody had positive serology for HIV, HBV, HCV or syphilis, 1 patient had positive ANCA-P and 2 had positive ANAs test by immunofluorescence assay. A media of 9+5.9 days was found from admission to the kidney biopsy; hematomas were found in 30.8%, all less than 2 cm, none required surgical management. The mean time from admission to immunosuppressive treatment was 3.5 days. In the followed up 30.7% required renal replacement therapy, 75% needed peritoneal dialysis (PD) and 25% hemodialysis (HD); the means time of PD was 75 days and for HD 3 days; 30% had Cr levels <1 mg/dl at 6 months and 3 deaths occurred: 1 secondary hemorrhagic cerebrovascular event, 1 for septic shock and the third due to sepsis secondary to peritoneal dialysis-associated peritonitis. In the histopathological results 23% were lupus nephritis,15.2% were IgA nephropathy and 15.2% focal and segmental glomerulonephritis, were found 1 case of P-ANCA pauciimmune glomerulonephritis, 1 extracapillary proliferative diffuse glomerulonephritis and 1 immune-complex glomerulonephritis with diffuse extracapillary proliferative pattern.
The present study represents the 1st registry in our hospital, due to social and economic difficulties that for a long time have prevented their performance and registration. The most frequent clinical manifestation was edema and the clinical syndrome on admission was hematuria-proteinuria. Lupus nephritis was the most frequent histopathological diagnosis.