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2018 ; 28
(1
): 28-34
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A Study of Clinical Presentation and Correlative Histopathological Patterns in
Renal Parenchymal Disease
#MMPMID29515298
Ganesh K
; Nair RR
; Seethalekshmy NV
; Kurian G
; Mathew A
; Sreedharan S
; Paul Z
Indian J Nephrol
2018[Jan]; 28
(1
): 28-34
PMID29515298
show ga
Suspicion and subsequent detection of renal disease is by an assessment of the
urinalysis and renal function in the clinical context. Our attempt in this study
is to correlate initial presenting features of urinalysis and renal function to
the final histopathological diagnosis. A retrospective analysis of 1059 native
kidney biopsies performed from January 2002 to June 2015 at Amrita Institute of
Medical Sciences was conducted. Correlative patterns between urinalysis, renal
function, and final histopathological diagnosis were studied. Five hundred and
eleven (48%) patients had nephrotic syndrome. Out of these, 193 (38%) had pure:
nephrotic syndrome, 181 (35.8%) had associated microhematuria, 110 (21.7%) had
microhematuria and renal failure, and 27 (5.3%) had only associated renal
failure. Minimal change disease (MCD) (30%), membranous nephropathy (30%), and
IgA nephropathy (29%) were the major diseases in the respective groups. Five
hundred and five (47.6%) patients had subnephrotic proteinuria. Out of these, 29
(5.6%) had only subnephrotic proteinuria, 134 (27%) had additional
microhematuria, 300 (59%) had subnephrotic proteinuria, microhematuria, and renal
failure, and 42 (8%) had subnephrotic proteinuria with renal failure. Lupus
Nephritis (45% and 40%) and IgA Nephropathy (32% and 21%) were the major
disorders in the subgroups respectively. Forty-two patients (3.7%) were biopsied
for isolated renal failure with bland urinary sediment. Cast nephropathy and
acute interstitial nephritis were the major diseases. Out of 89 patients with
diabetes who were biopsied, 15 (16.8%) had diabetic nephropathy, 45 (50.5%) had
no diabetic nephropathy, and 29 (32.5%) had diabetic nephropathy along with a
non-diabetic renal disease. Postinfectious glomerulonephritis was the major
glomerular disease. IgA nephropathy (22.2%) and membranous nephropathy (15.5%)
were the major diseases in patients with diabetes with no diabetic nephropathy.
In our population, MCD and membranous nephropathy formed the majority of diseases
in biopsied nephrotic syndrome. Added microhematuria did not seem to decrease the
incidence of either disease on the whole. We found a significant number of
patients with membranous nephropathy with nephrotic syndrome, microhematuria, and
additional renal failure. IgA nephropathy formed a majority of cases with
nephrotic syndrome, microhematuria, and renal failure. The presence of renal
failure regardless of other abnormalities in urinalysis showed a trend toward IgA
nephropathy. Membranous nephropathy may have a more varied presentation than was
originally thought and IgA nephropathy presenting as nephrotic syndrome may not
be uncommon. MCD is the major subgroup of diseases in the pediatric population
and presents both as nephrotic syndrome as well as nephrotic syndrome with
microhematuria. Thus, urinalysis and renal failure may be a valuable tool in
assessing renal disease.
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