Omega-3 fatty acids upregulate Nrf2 expression and attenuate apoptosis, inflammation, and fibrosis in a rat model of cyclosporine-induced nephropathy / 고신대학교의과대학학술지

Background@#Cyclosporine A (CsA)-induced kidney injury is characterized by renal impairment with inflammatory cell infiltrations, apoptosis, fibrosis, and hypoxic injury. It is not clear whether omega-3 fatty acids (O-3 FAs), which have anti-inflammatory and antioxidant roles, affect nuclear factor erythroid 2-related factor 2 (Nrf2) expression. The aim of this study was to investigate whether O-3 FAs affect Nrf2 expression and exert anti-inflammatory, anti-apoptotic, and anti-fibrotic effects in CsA-induced nephropathy. @*Methods@#Male Sprague-Dawley rats were divided into control, CsA-treated, and CsA-treated with O-3 FA groups. Nrf2 expression was measured by Western blots and immunohistochemical staining. @*Results@#Kidney function was impaired in the CsA-treated rats compared to the controls. Caspase-3 and caspase-7 were activated in the CsA-treated group, and the Bax/Bcl2 ratio was higher. O-3 FAs attenuated these apoptosis-related changes. ED-1 and inhibition of kappa B (IĸB) protein expression were significantly upregulated in the CsA-treated group. Compared to the control group, O-3 FA supplementation attenuated the increased expression of ED-1 and IĸB related to inflammation. Smad2/3, Smad4, and transforming growth factor-β1 were activated in the CsA group, and O-3 FA treatment prevented these changes related to renal fibrosis. The expression of Nrf2 was reduced in CsA-treated rats, but Nrf-2 was increased by O-3 FA treatment. @*Conclusions@#We suggest that Nrf2 is a potential mediator induced by O-3 FA supplementation and that it attenuates pro-inflammatory pathways, fibrotic processes, and apoptosis. Further studies are needed to elucidate the crosstalk between Nrf2 expression and signals related to O-3 FA treatment.

Dietary education may reduce blood cadmium and mercury levels in chronic kidney disease patients with higher blood cadmium and mercury levels / 고신대학교의과대학학술지

Background@#Exposure to cadmium and mercury is associated with renal dysfunction. This study aimed to investigate the possible ability of dietary education to decrease blood cadmium and mercury levels in patients with chronic kidney disease (CKD). @*Methods@#Twenty-seven patients with CKD were enrolled in this prospective, single-arm pilot study. Patients with blood cadmium levels ≥1.4 μg/L were instructed to reduce their intake of shellfish, while those with blood mercury levels ≥5.0 μg/L were asked to reduce their intake of externally blue-colored fish. @*Results@#Seven dialysis patients and 15 pre-dialysis patients completed the study. Compared with baseline, the blood cadmium (2.0±0.7 μg/L vs. 1.8±0.7 μg/L, p=0.031) and mercury levels (4.4±2.6 μg/L vs. 3.5±1.9 μg/L, p=0.005) after 1 year significantly decreased, although the dietary intake was not significantly different in patients with blood cadmium levels ≥1.4 μg/L and blood mercury levels ≥5.0 μg/L. In pre-dialysis patients, kidney function worsened after 1 year compared with that at baseline despite the reduction in blood cadmium and mercury levels. @*Conclusions@#Reduction of food intake containing cadmium and mercury may lower the blood cadmium and mercury levels in CKD patients with higher cadmium and mercury levels. Higher blood cadmium levels may cause renal disease progression in pre-dialysis patients, and further studies are necessary to determine the underlying mechanisms.

Effect of pravastatin on erythrocyte membrane fatty acid contents in patients with chronic kidney disease

Background@#Statin treatment has decreased the risk of cardiovascular events in patients with chronic kidney disease (CKD). Erythrocyte membrane oleic acid level is higher in patients with acute coronary syndrome. This study aimed to evaluate the effect of pravastatin on the erythrocyte membrane fatty acid (FA) contents in patients with CKD. @*Methods@#Sixty-two patients were enrolled from January 2017 to March 2019 (NCT02992548). Pravastatin was initially administered at a dose of 20 mg for 24 weeks. The pravastatin dose was increased to 40 mg after 12 weeks if it was necessary to control dyslipidemia. The primary outcome was change in erythrocyte membrane FA, including oleic acid, after pravastatin treatment for 24 weeks. @*Results@#Forty-five patients finished this study, and there was no adverse effect related to pravastatin. Compared with baseline, total cholesterol and low-density lipoprotein cholesterol levels were significantly decreased after pravastatin treatment. Compared with baseline, saturated FA, oleic acid, and arachidonic acid levels were significantly increased and polyunsaturated FA and linoleic acid (LA) levels were significantly decreased after pravastatin treatment. There was also a decrease in eicosapentaenoic acid after pravastatin treatment in CKD patients with estimated glomerular filtration rate <60 mL/min/1.73 m2. @*Conclusion@#Administration of pravastatin in patients with CKD leads to a decrease in FA known to be protective against the risk of CVD. Omega-3 FA or LA supplementation might be necessary to recover changes in erythrocyte membrane FA contents when pravastatin is used for treating dyslipidemia in patients with CKD.

Serum myostatin levels are associated with abdominal aortic calcification in dialysis patients

BACKGROUND: Serum myostatin levels are increased according to renal function decline and myostatin may be a main mediator of chronic kidney disease–related sarcopenia. A previous study reported that serum myostatin level was negatively associated with abdominal aortic calcification (AAC) in older males. The aim of this study was to assess the association between serum myostatin level and AAC among dialysis patients of both sexes. In addition, we analyzed the relationship between serum myostatin level, muscle mass, and bone mineral density (BMD).METHODS: In this cross-sectional study, we evaluated AAC in the lateral lumbar spine using plain radiography and BMD in 71 patients undergoing dialysis. We classified patients into two groups according to the median value of myostatin as follows: those with high myostatin levels (≥ 5.0 ng/mL) and those with low myostatin levels (< 5.0 ng/mL).RESULTS: The proportion of patients with an AAC score of five points or more was higher among those with low myostatin levels. Myostatin level was negatively associated with AAC scores on plain radiography and had a positive association with skeletal muscle mass and T-scores for BMD measured at the total hip and femur neck. Lower myostatin levels were independently associated with higher AAC scores following adjustment for age, sex, diabetes mellitus, dialysis vintage, dialysis modality, and osteoprotegerin level.CONCLUSION: Lower serum myostatin levels were associated with higher AAC scores, lower muscle mass, and lower BMD in dialysis patients. Further, prospective studies and those with larger cohorts are necessary to validate these findings.

Supplementary nutrients for prevention of vascular calcification in patients with chronic kidney disease

Vascular calcification (VC) and malnutrition associated with cardiovascular disease are common in patients with chronic kidney disease (CKD) treated with dialysis. VC, which reflects vascular aging, and malnutrition are also encountered in the non-CKD elderly population. This similarity of clinical findings suggests that the progression of CKD is related to aging and the existence of a causal relationship between VC and malnutrition. To retard renal progression, a low- or very-low-protein diet is usually recommended for CKD patients. Dietary education may induce malnutrition and deficiency of important nutrients, such as vitamins K and D. Menaquinone-7, a type of vitamin Kâ‚‚, is under investigation for inhibiting VC in elderly patients without CKD, as well as for prevention of VC in patients with CKD. Nutritional vitamin D, such as cholecalciferol, may be considered to decrease the required dose of active vitamin D, which increases the risk of VC due to increased calcium and phosphate loads. Omega-3 fatty acids are important nutrients and their ability to inhibit VC needs to be evaluated in clinical trials. This review focuses on the ability of supplementary nutrients to prevent VC in patients with CKD, in whom dietary restriction is essential.

Relationship between Nutrition Intake and Estimated Glomerular Filtration Rate in Korean Adults (30–65 years) from the Korea National Health and Nutrition Examination Survey 2013–2014

This study aimed to examine the relationship between nutrition intake and estimated glomerular filtration rate (eGFR) indicating kidney function in Korean individuals without diabetes or cardiovascular disease. Study participants from the Korea National Health and Nutrition Examination Survey 2013–2014 (n = 4,378, 30–65 years) were classified by their eGFR levels (mL/min/1.732 m²): ≥ 120 (n = 299), 119–105 (n = 789), 104–90 (n = 1,578), 89–60 (n = 1,685), < 60 (n = 27). After adjusted for confounding factors (age, sex, cigarette smoking, alcohol drinking, total caloric intake [TCI], income status, education level, body mass index, and physical activity), blood pressure, low-density lipoprotein (LDL) cholesterol, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, fasting glucose, and glycated hemoglobin were higher, and high density lipoprotein cholesterol levels were lower in participants with lower eGFR levels than those with higher eGFR levels. n-3 fatty acid (FA) and n-6 FA (% of TCI/day) intake were also significantly higher in participants with higher eGFR levels than in those with lower eGFR levels. Based on the above results, participants were subdivided into 3 groups according to n-6 FA intake levels (Q1: ≥ 2.93%, n = 1,462; Q2: 2.92%–1.88%, n = 1,463; Q3: < 1.88%, n = 1,453). People consuming higher n-6 FAs, particularly the Q1 group showed higher eGFR levels and lower levels of LDL cholesterol and creatinine. In conclusion, higher intake of n-6 FAs within the range of dietary reference may be beneficial to maintain healthy kidney function.

The Effect of Mycophenolate Mofetil versus Cyclosporine as Combination Therapy with Low Dose Corticosteroids in High-risk Patients with Idiopathic Membranous Nephropathy: a Multicenter Randomized Trial

BACKGROUND: Appropriate immunosuppressive therapy for patients with idiopathic membranous nephropathy (MN) remains controversial. The effect of mycophenolate mofetil (MMF) versus cyclosporine (CsA) combined with low-dose corticosteroids was evaluated in patients with idiopathic MN in a multi-center randomized trial (www.ClinicalTrials.gov NCT01282073). METHODS: A total of 39 biopsy-proven idiopathic MN patients with severe proteinuria were randomly assigned to receive MMF combined with low-dose corticosteroids (MMF group) versus CsA combined with low-dose corticosteroids (CsA group), respectively, and followed up for 48 weeks. Complete or partial remission rate of proteinuria and estimated glomerular filtration rate (eGFR) at 48 weeks were compared. RESULTS: The level of proteinuria at baseline and at 48 weeks was 8.9 ± 5.9 and 2.1 ± 3.1 g/day, respectively, in the MMF group compared to 8.4 ± 3.5 and 3.2 ± 5.7 g/day, respectively, in the CsA group. In total, 76.1% of the MMF group and 66.7% of the CsA group achieved remission at 48 weeks (95% confidence interval, −0.18 to 0.38). There was no difference in eGFR between the two groups. Anti-phospholipase A2 receptor Ab levels at baseline decreased at 48 weeks in the complete or partial remission group (P = 0.001), but were unchanged in the no-response group. There were no significant differences between the two groups in changes in the Gastrointestinal Symptom Rating Scale and Gastrointestinal Quality of Life Index scores from baseline to 48 weeks. CONCLUSION: In combination with low-dose corticosteroids, the effect of MMF may not be inferior to that of CsA in patients with idiopathic MN, with similar adverse effects including gastrointestinal symptoms. Trial registry at ClinicalTrials.gov (www.ClinicalTrials.gov NCT01282073).

A Case of Steroid Resistant Minimal Change Disease Associated with Portal Vein Thrombosis Treated by Combined Immunosuppressive Agents / 고신대학교의과대학학술지

Minimal change disease (MCD) is a common cause of nephrotic syndrome and relatively well responds with steroid treatment. However, nearly half of patients with MCD experience recurrence of nephrotic syndrome. Thromboembolic events including renal vein thrombosis may occur in patients with MCD, but portal vein thrombosis rarely occurs. We experienced a case of frequent relapse/steroid dependent MCD with nephrotic syndrome progressed to steroid resistance associated with portal vein thrombosis. This patient showed complete remission of MCD and resolution of portal vein thrombosis after treatment with corticosteroid, cyclosporine, mycophenolate mofetil, and anticoagulant.

A Case of Lactate Containing Peritoneal Dialysis Solution Induced Lactic Acidosis Corrected by Changing to Hemodialysis / 고신대학교의과대학학술지

Elevated lactate levels are associated with acute illnesses, and the mortality is high. Here, we report a case of lactate-containing peritoneal dialysis (PD) solution inducing lactic acidosis corrected by changing to hemodialysis (HD). This 70-year-old female patient was treated with PD 8 months previously for end-stage renal disease caused by diabetes mellitus. She was admitted complaining of general weakness. Initial lactate level was 22.1 mg/dL and increased to 62.4 mg/dL showing high anion gap metabolic acidosis and compensatory hyperventilation. There are no definite causes of lactic acidosis besides the use of PD solutions containing a lactate component. The patient's lactate level was decreased after temporarily changing the dialysis modality to HD. Her lactate level was increased again after restarting PD, and decreased to normal after restarting HD. We report this case because physicians should consider lactate-containing PD solution as a possible cause of lactic acidosis.

Resistive index as a predictor of renal progression in patients with moderate renal dysfunction regardless of angiotensin converting enzyme inhibitor or angiotensin receptor antagonist medication

BACKGROUND: Previous studies have shown that a higher resistive index (RI) on renal duplex ultrasonography was related with renal progression and acute kidney injury, especially in patients with chronic kidney disease (CKD) using an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB). We evaluated whether a RI value is a predictive factor for renal progression regardless of ACEI or ARB medication in patients with moderate renal dysfunction. METHODS: We retrospectively analyzed 119 patients with moderate renal dysfunction that had been evaluated with renal duplex ultrasonography from February 2011 to April 2015. Moderate renal dysfunction was defined as a stage 3 to 4 CKD. Renal progression was defined as a doubling of the baseline serum creatinine (sCr), a decrease of baseline glomerular filtration rate by > 50%, or initiation of renal replacement therapy. RESULTS: The mean age was 64.7 ± 11.0 years and sCr level was 2.1 ± 1.2 mg/dL. The RI ≥ 0.79 group showed a higher incidence of renal progression (P = 0.004, log-rank test) compared with the RI < 0.79 group, irrespective of ACEI or ARB usage. In the Cox proportional hazard model, RI ≥ 0.79 was an independent prognostic factor after adjusting for age, sex, diabetes mellitus, sCr, proteinuria, and use of ACEI or ARB (hazard ratio, 4.88; 95% confidence interval, 1.06–22.53; P = 0.043). CONCLUSION: RI ≥ 0.79 on the renal duplex ultrasonography can be a helpful predictor for renal progression in patients with moderate renal dysfunction, regardless of their ACEI or ARB usage.

Dietary Analysis of Kidney Transplant Patients Who Eat Korean Foods: Single Center Study / 대한이식학회지

BACKGROUND: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. METHODS: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. RESULTS: The mean energy and protein of daily intake were 2,088+/-1,016 kcal and 75.5+/-38.2 g. Patients' diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. CONCLUSIONS: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.

Association between mortality and abdominal aortic calcification and their progression in hemodialysis patients

No abstract available.

A Case of Condyloma Acuminata in a Virgin Systemic Lupus Erythematosus Patient

Anogenital infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The majority of HPV infections are transient and subclinical, with subsequent clearance by the immune system. However, in some individuals, especially those with impaired immunity, HPV infection may persist and result in condyloma acuminatum, pre-cancerous cervical abnormalities, as well as cervical cancer. Because of the intrinsic immunological aberrations and immunosuppressive treatment, patients with systemic lupus erythematosus (SLE) have higher prevalence of anogenital HPV infection, and SLE itself appears to be a major risk factor for HPV infection. HPV infection is sexually transmitted via genital contact; autogenesis of condyloma acuminatum without sexual contact is rare. In this case, a 27-year old virgin female with SLE was admitted to our clinic, presenting anogenital condyloma acuminata. It report that SLE patient can have a disease of anogenital HPV infection, despite the lack of sexual contact. Therefore, we recommend that patients with SLE have regular gynecological evaluations, in addition to prophylactic HPV vaccinations.

Resistive index as a predictor of acute kidney injury caused by an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker in chronic kidney disease patients

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) may induce acutekidney injury (AKI).The aim of this study was to evaluate the role of the resistive index (RI), which reflects renal artery resistance on renal duplex ultrasonography, as a predictor of AKI in chronic kidney disease (CKD) patients who are prescribed an ACE inhibitor or ARB. METHODS: We screened 105 CKD patients evaluated with renal duplex ultrasonography from 2008 to 2012. We excluded patients not treated with ACE inhibitor or ARB and diagnosed with renal artery stenosis. Finally, we retrospectively analyzed the medical records of 54 patients. AKI was defined as increased serum creatinine by >30% compared with baseline after starting ACE inhibitor or ARB treatment. RESULTS: The mean age of the patients was 60.5+/-13.0 years, serum creatinine level was 1.85+/-0.85 mg/dL and 22.2% of the patients had AKI after the use of an ACE inhibitor or ARB. The RI (P=0.006) and the percentages of patients with diabetes (P=0.008)and using diuretics (P=0.046) were higher in the AKI group.The area under the receiver operating characteristics curve for the prediction of AKI was 0.736 (95% confidence interval=0.587-0.885, P=0.013),and RI> or =0.80 predicted AKI with 83.3% sensitivity and 61.9% specificity. In the multivariate analysis, RI> or =0.80 was an independent prognostic factor [Exp (B)=8.03, 95% confidence interval=1.14-56.74, P=0.037] for AKI. CONCLUSION: RI> or =0.80 on the renal duplex ultrasonography may be a helpful predictor for AKI in CKD patients who are prescribed an ACE inhibitor or ARB.

Urinary Neutrophil Gelatinase-Associated Lipocalin Levels in Comparison with Glomerular Filtration Rate for Evaluation of Renal Function in Patients with Diabetic Chronic Kidney Disease

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury. There is a growing body of evidence suggesting that NGAL is also a marker of kidney disease and severity in chronic kidney disease (CKD). We studied the utility of urinary NGAL in more accurately predicting renal function in patients with diabetic CKD. METHODS: We studied possible relationships between urinary NGAL, estimated glomerular filtration rate (eGFR), and proteinuria in diabetic CKD patients and in healthy populations. RESULTS: Urinary NGAL levels were significantly higher in CKD patients than in healthy controls (96.0 [2.7 to 975.2] ng/mL vs. 18.8 [1.3 to 81.9] ng/mL, P=0.02), and the GFR was lower among CKD patients (49.3 [13.1 to 78.3] mL/min/1.73 m2 vs. 85.6 [72 to 106.7] mL/min/1.73 m2, P<0.0001). The urinary NGAL level showed a significant inverse correlation with GFR (r=-0.5634, P<0.0001). The correlation analyses between urinary protein level and urinary NGAL levels and GFR were as follows: urine protein and urinary NGAL (r=0.3009, P=0.0256), urine protein and GFR (r=-0.6245, P<0.0001), urine microalbumin and urinary NGAL (r=0.1794, P=0.2275), and urine microalbumin and GFR (r=-0.5190, P=0.0002). CONCLUSION: From these results, we concluded that urinary NGAL is a reliable marker of renal function in diabetic CKD patients. However, urinary NGAL did not provide more accurate information regarding renal function than GFR.

Reliability of Hemodialysis Adequacy Measured by Ionic Dialysance / 대한신장학회지

PURPOSE: Quantification of the dialysis dose is an essential element in the management of hemodialysis. The author investigates the reliability of hemodialysis adequacy measured by ionic dialysance (Online clearance monitoring(R), OCM). Because OCM is a non-invasive and instantly accessible method, it could be replaced Kt/V derived from single-pool variable volume urea kinetic model (UKM). METHODS: Kt/V using UKM and OCM were measured simultaneously in 51 patients who have received hemodialysis therapy via arteriovenous fistula. The analysis of the data collected from 186 hemodialysis sessions were performed. RESULTS: Kt/V of conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration measured by UKM were 1.39+/-0.24, 1.41+/-0.23 and 1.53+/-0.17, and by OCM were 1.24+/-0.17, 1.26+/-0.19 and 1.39+/-0.19, respectively. The data of UKM were significantly higher than those of OCM (p=0.00). Also, there were strong positive correlations between UKM and OCM in hemodialysis (r=0.80, p=0.00), high efficiency hemodialysis (r=0.65, p=0.00) and hemodiafiltration (r=0.67, p=0.00). CONCLUSION: The Kt/V using OCM measured by ionic dialysance provided slightly lower data than that of UKM derived from single-pool variable volume urea kinetic model, but it may be a reliable test to evaluate dialysis adequacy in conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration.

Comparison of Vascular Calcification Scores on Plain Radiographs to Predict Coronary Artery Disease According to Dialysis Modality / 대한신장학회지

PURPOSE: Vascular calcification (VC) scores on simple plain radiographic films are known to be associated with coronary artery disease (CAD) in hemodialysis (HD) patients. However, there is no report comparing VC scores on plain radiographic films according to dialysis modality. We hypothesized that there are some differences of VC scores on plain radiographs for the assessment of CAD according to dialysis modality. METHODS: We recruited 78 peritoneal dialysis (PD) patients and compared to 61 HD patients. We defined significant VC as any one finding among the abdominal aortic calcification (AAC) score > or =5, VC score of the hands and pelvis > or =3, or medial artery calcification of the feet on plain radiographs. RESULTS: The prevalence of CAD and significant VC were not different according to dialysis modality. Every VC score on the plain radiographs was highly correlated with each other, but VC evaluation on plain radiographs by single method overlooked nearly 30% of other significant VC sites in PD and HD patients. AAC score was most useful method for the prediction of CAD as a single VC scoring method. There was no association between VC of the feet and CAD in PD patients. Lower high density lipoprotein cholesterol was associated with significant VC on plain radiograph in PD patients. CONCLUSION: Significant VC formation on plain radiographs was not different according to dialysis modality. It is helpful to check several plain radiographs for the decision of CAD evaluation and not overlooking significant VC in both HD and PD patients.

Adult Onset Still's Disease Developed in a Patient with Membranous Nephropathy Treated with Immunosuppressive Agent / 대한신장학회지

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disease characterized by high spiking fever, leukocytosis, high serum ferritin, salmon-colored rash, arthritis, lymphadenopathy, and hepatosplenomegaly. The etiology of AOSD is obscure. AOSD is diagnosed after exclusion of infection, malignancy and other connective tissue diseases. A 53-year-old female patient with membranous nephropathy was admitted with high fever and leukocytosis. She was taking immunosuppressive agents with low dose steroid and cyclosporine to control of proteinuria caused by membranous nephropathy. She was initially treated with antibiotics, antiviral agent and antifungal agent to control of hidden infection. High spiking fever was sustained for 2 weeks and controlled after hydrocortisone treatment. AOSD was diagnosed according to the criteria of Yamaguchi. It should be considered that AOSD is a cause of high fever in patients treated with immunosuppressive agents.

Nephrogenic Systemic Fibrosis / 대한신장학회지

No abstract available.

Prevalence of Primary Glomerulonephritis: A Single Center Analysis / 대한신장학회지

PURPOSE: To evaluate the exact prevalence of primary glomerular diseases in Korea. METHODS: We analyzed a retrospective cohort of biopsy proven 1,100 patients with primary glomerular disease in OO Hospital from April 1990 to March 2010. RESULTS: Pathologic diagnosises of 1,100 cases were as follows: IgA nephropathy (IgAN), 557 cases (50.6%), was the most common followed by 200 cases (18.1%) of minor glomerular abnormalities (MGA), 168 cases (15.2%) of focal segmental glomerulosclerosis (FSGS), 93 cases (8.0%) of membranous nephropathy (MN), 31 cases (2.8%) of membranoproliferative glomerulonephritis type I (MPGN), 17 cases (1.5%) of focal glomerulonephritis and 7 cases (0.6%) of diffuse mesangial proliferative glomerulonephritis (DMGN) in order. In idiopathic nephrotic syndrome, the most common pathologic diagnosis was minimal change nephrotic syndrome (MCNS) (40.2%), followed by FSGS (27.5%), MN (24.2%), MPGN (8.1%) and DMGN (0.5%). When the incidence rates between 1990-1992 and 2008-2010 were compared, IgAN and FSGS increased from 34.7, 12.5 to 47.8%, 30.4%, but MCNS (from 33.3 to 6.5 %) decreased significantly. CONCLUSION: IgAN was the most common primary glomerulonephritis. During the past 20 years, the prevalence of IgAN and FSGS were increased, while MCNS and MN were decreased.