Back
Glomerular disease, one of the leading cause of CKD comprising 25%-45% case of the ESRD in developing nations, like Bangladesh. Incidence of Glomerulonephritis varies among different area.A Renal biopsy is a gold standard tool to know histological pattern of renal disease and to prepare the appropriate management plan. So this study was done aiming to obtain a recent and comprehensive insight into the pattern of glomerular disease in Bangladesh population.
This cross sectional study was done in department of Nephrology, Bangladesh Medical College Hospital. Total 211 ,histologically adequate samples were included in this study. In diabetic patients strict indication for renal biopsy was mainatined. The renal biopsy specimens were evaluated by light microscopy and DIF. Demographics, clinical feature, histopathological diagnosis and outcome were noted into a specially designed questionnaire and were analyzed using SPSS version 22.
Among 211 patients ,112 patients were male and 99 female (male: female =1.13:1) with mean age 33.4 years ( range 12-63). Total 158 (75%) patients were from low socieo-economic status. Total 15 patients had concomitant DM. Among clinical presentation 110 patients presented with nephrotic syndrome which was most common clinical feature 52% followed by nephrito-nephrotic syndrome 28%,nephritic syndrome 12.% and isolated hematuria 4%(Figure:1).Thirteen patients (6%) presented with RPGN like feature among them 10 patients required immediate hemodialysis before renal biopsy. On biopsy 206 (97.6%) were diagnosed with glomerulopathy[primary GN were 193(91.4%) and secondary13(6%)].Four(2%)as tubulo-interstital nephritis and one (0.5%) as chronic sclerosing GN(Figure:2). Among all, Mesangioproliferative (60,28.43%) found to be most common histological pattern, followed by Diffuse Membranoproliferative glomerulonephritis (DMPGN),(48,23.59%),focal segmental glomerulosclerosis (FSGS) 11.%, Membranous nephropathy (MN)9%,IgA nephropathy 7.58%,Minimal change disease(MCD) 2.84%, IgM1.89%,C3GN 1.42% and C1GN 0.5%. Eleven (5.21%) patients found with crescentic glomerulonephritis among them 5 patients were immune mediated and 6 patients were Pauciimmune mediated. (figure:3) Among all crescentic GN 6 (3%) patients progressed to ESRD.
Among patients with Mesangioproliferative GN,most common presentation was nephrito-nephrotic syndrome 32(54.3%) and total 51 patients reached complete remission . Among secondary GN Total 13 (6.16%) patients were lupus nephritis (class II 3,class IV 8,class V 1,class VI 1). Total 10 patients were female and 8 patients had associated systemic features (arthritis 6/13,oral ulcer 7/13 ,rash 8/13) and 4 patients had only renal involvment and 3 patients presented with RPGN like presentation and two required immediate hemodialysis. We had total 15 diabetic patients one patient presented with RPGN like presentation renal biopsy report revealed pauci-immune GN and now on immunosuppressive management with stable renal function.
Conclusions
In our study we conclude that male are more affected and nephrotic syndrome being most common clinical feature. Mesangioproliferative and Membranoproliferative glomerulonephritis are two common cause of primary GN and among secondary GN lupus nephritis was most common which is very similar other studies in our country. So this study may help in the pathway of future research in our country.