Back
The clinical presentation of glomerular diseases (GD) can vary widely. Renal immunofluorescence (IF) has not been widely available in Sri Lanka, limiting pathological diagnosis. Electron microscopy (EM) is not available. This study was aimed at describing the clinicopathological spectrum of biopsy proven GD reported in an academic centre in Sri Lanka. The centre receives samples from the National Hospital of Sri Lanka and the Lady Ridgeway Hospital, which are tertiary care hospitals based in Colombo that cater for adult and paediatric nephrology patients. IF has been routinely performed on kidney biopsies since 2021.
The records of all native kidney biopsies (adult and paediatric) reported at the Department of Pathology, Faculty of Medicine, University of Colombo Sri Lanka from January 2017 to October 2023 for which both light microscopy (LM) and IF descriptions were available were reviewed.
Of 1975 native kidney biopsies processed at the centre, data for both LM and IF was available for 468(75 paediatric; 393 adult). Mean age of the study population was 36.5 ± 1.8 years; male: female ratio was 1:1.03. A history of diabetes, hypertension or systemic lupus erythematosus was present in 24.4% (n=114), 47.3% (n=221) and 10.3% (n=48) respectively. The commonest indication for biopsy was nephrotic range proteinuria/nephrotic syndrome(NRP/NS) (n=249, 53.2%), followed by sub-nephrotic range proteinuria (SNP) (n=105, 22.4%), acute kidney injury (AKI) (n=51, 10.9%), and chronically increased serum creatinine (n=29, 6.2%).
The clinical presentations, morphological patterns on LM and IF and final diagnoses are summarised in Figure 1 and Tables 1 and 2.
The indication for kidney biopsy in more than half the patients was nephrotic range proteinuria. A diagnosis was not reached in a significant number, including cases that were normal on LM with negative IF, cases with IC deposition but no identified cause and cases with mild and/or non-specific changes. Further serological, microbiological and pathological investigations including IF with pronase digestion, EM and follow up data would be useful to further categorise cases.