Spectrum of Secondary Glomerular Diseases in Adult Nephrotic Syndrome.

Background: In developing countries like India, thecauses for end stage renal failure has been changingwith glomerular diseases occupying an important place.The trend of various primary and secondary causes ofNephrotic Syndrome (NS) over the past few decadeshas been debatable especially with reference togeographical locations. Aim and Objectives: This studywas intended to find out the histologic patterns ofglomerular disease associated with NS in South Indiaand analyze the corresponding clinical and biochemicalabnormalities associated with these conditions.Material and Methods: One hundred eighty eightpatients in the age group of 18-80 years with NS whounderwent renal biopsy between the periodst thfrom1 January 2018 to 30 September 2019 wereincluded in this study. Baseline investigations and otherinvestigations related to renal profile evaluationincluding complement levels and HIV antibody weredone. Results: Focal Segmental Glomerulosclerosis(FSGS) accounted for the majority (25.5%) amongprimary glomerular diseases while among thesecondary glomerular diseases Lupus Nephritis (LN)(51.19%) constituted the majority and a substantialcontribution from Human Immunodeficiency VirusAssociated Nephropathy (HIVAN). LN was seen onlyin female patients with a mean age of 33.36 ± 10.74years. Among LN, Class III was the most predominantwhile Class IIIC was less frequent. C3 and C4complement levels were less than normal in Class IVand Class variants of LN. Conclusion: This studyhighlights the spectrum of Lupus Nephritis and HIVassociated nephropathy as a cause for adult NS in atertiary care center in South India

Progress of T helper cell 17,regulatory T cell,podocyte injury and primary glomerular disease / 国际儿科学杂志

In recent years,T helper cell 17(Th17),regulatory T cell(Treg) and podocyte injury attrac-ted widespread attention in the pathogenesis of primary glomerular disease. Th17 cells have the function of re-cruiting neutrophils and macrophages to the infected tissue through the secretion of cytokines such as IL-17. Treg cells have immune function, mediated immune tolerance, protecting the body against inflammatory injury. The imbalance of Th17 cells increase and Treg cells decrease could play an important role in the pathogenesis and progression of primary glomerular disease. As the important part of the glomerular filtration barrier,podocyte be-comes the focus in recent years. Study on relationship among Th17,Treg,podocyte injury and primary glomeru-lar disease will provide more theoretical basis for the prevention and treatment of primary glomerular disease.

Frequency of primary glomerular disease in northeastern China

Most frequently reported Chinese renal biopsy data have originated from southeastern China. The present study analyzed the renal biopsy data from northeastern China. The records of 1550 consecutive native patients who were diagnosed with primary glomerular diseases (PGD) after renal biopsy at our hospital during 2005-2009 were used. These patients were divided into four age groups for stratified analysis: <15, 15-44, 45-59, and ≥60 years old. Among PGD, minimal change disease (MCD) was the most common histologically diagnosed disease (30.7 percent), followed by IgA nephropathy (IgAN), mesangial proliferative glomerulonephritis (MsPGN), membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN), focal segmental glomerulosclerosis (FSGS), and endocapillary proliferative glomerulonephritis (EnPGN). MCD was the disease most frequently observed (43.7 percent) in the <15-year-old group. MsPGN was the most common disease in the elderly group (38.1 percent). MsPGN was more prevalent in females (27.8 percent), whereas MCD was more prevalent in males (35.3 percent). Primary glomerular diseases constituted the most commonly encountered group of diseases with a high prevalence of MCD, which predominantly affected males and young adults. The prevalence of MCD was high in northeastern China. Further study is necessary to expand the epidemiologic data available for renal disease in China.

Evaluación de los regímenes inmunosupresores utilizados en pacientes con transplante renal y glomerulopatías primarias: servicio de nefrología del Hospital Regional Teodoro Maldonado Carbo / Evaluation of immunosupresive drug regimens used in patients with renal transplant and primary glomerular diseases: nephrology Service at Teodoro Maldonado Carbo Regional Hospital

Tipo de estudio: retrospectivo, analítico, longitudinal. Objetivos: evaluar el uso del micofenolato de mofetil (MMF) en el tratamiento inmunosupresor en pacientes con transplante renal y glomerulopatías primarias. Materiales y métodos: se realizó un estudio retrospectivo que evaluó a 19 pacientes de 23-61 años: 14 con transplante renal (TR) y 5 con glomerulopatías primarias (GP). Todos los pacientes con TR recibieron: ciclosporina A (CsA) + prednisona (P), de los cuales 10 recibieron adicionalmente azatriopina (AZA) y 4 MMF. Las pacientes con GP recibieron MMF exclusivamente. Ambos grupos fueron seguidos por 12 meses, tiempo durante el cual se evaluó la función renal y efectos adversos. Resultados: el valor del injerto mejoró significativamente en aquellos pacientes tratados con esquemas que incluían MMF. Los valores promedio de creatinina sérica a los 12 meses fueron de 1.5  0.4 mg/dL grupo MMF vs. 1.7  0.2 mg/dL AZA. Los efectos secundarios se presentaron en un 40% en el grupo AZA y en un 25 % en el grupo MMF. Algunos pacientes con GP mejoraron su función renal. Conclusiones: en aquellos pacientes que recibieron tratamiento inmunosupresor con MMF, la función renal del injerto mejoró al ser comparado con el esquema que incluía AZA. En las GP los resultados fueron poco concluyentes.

Objective: Evaluate the usefulness of mycophenolate mofetil (MMF) as an immunosuppressive therapy for patients with renal transplants and primary glomerular disease. Materials and methods: This was a retrospective study which evaluated a total of 19 patients aged 23-61: 14 with renal transplants (RT) and 5 with primary glomerular disease (PGD). All patients with RT received: cyclosporine A (CsA) + prednisone (P), 10 of those additionally received azathioprine (AZA) and 4 MMF. Patients with PGD received only MMF. Both groups were followed up for 12 months during which renal function and adverse effects were evaluated. Results: The value of the graft was significantly improved among those patients who received regimens with MMF. Average creatinine serum values at 12-month follow-up were 1.5  0.4 mg/dL in MMF group vs. 1.7  0.2 mg/dL in AZA group. Adverse effects presented in 40% of those treated with regimens including AZA and in 25% of those including MMF. Some patients with PGD improved their renal function. Conclusions: Renal graft function improved among patients receiving immunosuppressive regimens that included MMF when compared to those regimens that included AZA. Results among patients with PGD were inconclusive.

A Case of Membranoproliferative Glomerulonephritis Type II: Dense Deposit Disease, DDD

Type II membranoproliferative glomerulonephritis (Dense deposit disease ) is an acquired primary glomerular disease characterized by electron microscopic evidence of a continuous dense membrane deposition replacing the lamina densa. It is a subtype of idiopathic membra- noproliferative glomrulonephritis, and was described as a separate entity by Berger and Galle in 1963. It frequently occurs in older chilren and young adults and the clinical course is variable, but is generally progressive. The presenting feature is nephrotic syndrome in many patients, and proteinuria and hematuria are also seen frequently. The purpose of this paper is to present a case of DDD (Dense deposit disease) from a 10 year old boy who was diagnosed as a acute poststreptococcal glomurulonephritis with protenuria, hematuria, and facial edema by renal biopsy 4 years ago.

Clinical and Histopathological Analysis of 494 Cases of Percutaneous Renal Biopsies / 대한신장학회잡지

Percutaneous renal biopsy is an essential component for diagnosis and management of glomerular diseases. In order to elucidate clinical and pathological features, 494 renal patients who had undergone renal biopsies at Gil Medical Center from January 1989 to June 1999 were studied retrospectively. The male to female ratio was 1.3 : 1 and average age was 33.2 years. There were 370(83.5%) cases of primary glomerular disease and 58(13.1%) cases of secondary glomerular disease. Among primary glomerular disease, IgA nephropathy was the most common(175 cases), followed by minimal change disease(84 cases), membranous glomerulonephritis(34 cases), and focal segmental glomerulosclerosis(33 cases). In secondary glomerular disease, lupus nephritis was the most common(21 cases), followed by 11 cases of hepatitis B associated glomerulonephritis, 9 cases of Henoch-Sch nlein purpura, and 4 cases of diabetic nephropathy. Among 99 cases of asymptomatic urinary abnormalities, IgA nephropathy was most common(69 cases) followed by 12 cases of thin basement membrane disease, 4 cases of minimal change disease, and 3 cases of focal segmental glomerulosclerosis, membranous glomerulonephritis, nonspecific glomerulonephritis. Among 159 cases of nephrotic syndrome, minimal change disease was most common(60 cases) followed by 25 cases of IgA nephropathy, 23 cases of focal segmental glomerulosclerosis, 21 cases of membranous glomerulonephritis, and 13 cases of lupus nephritis. Documented complication of renal biopsies included 23 cases of gross hematuria, 6 cases of perirenal hematoma, and 4 cases of infection. Death, AV fistula, aneurysm or serious compications that required surgical intervention were not reported. In conclusion, the percutaneous renal biopsy is relatively safe, and useful for diagnosis and management of glomerular diseases. The most common type of primary glomerular disease was IgA nephropathy.

RELATION OF PLASMA SELENIUM TO OXIDATIVE STRESS IN PATIENTS WITH PRIMARY GLOMERULAR DISEASES / 营养学报

Objective: To study the relation of plasma Se to oxidative stress in the patients with primary glomerular diseases (PGS) and its clinical significance. Methods: Plasma Se concentration ,GSH-Px and SOD activities and contents of MDA in 45 patients with PGS and 20 normal control (NC)were measured by catalytic polarography and colorimetric assay. Serum creatinine, urea nitrogen and uric acid concentrations in these patients were determined simultaneously. Results: 1. Plasma Se contents of both PGS patients of normal(groupⅠ) and impaired renal function (groupⅡ) were significantly lower than those in NC;2. PGS patients of groupⅠandⅡhad significantly lower plasma GSH-Px and SOD activities than NC and their MDA contents were siginificantly higher. 3. Plasma GSH-Px and SOD activities and MDA contents between groupⅠand Ⅱ were not different; 4. Multiple logistic regression analysis showed that plasma Se content in patients with PGS was positively related to plasma GSH-Px , SOD activities and negatively correlated with MDA. Serum creatinine concentrations were negatively correlated significantly with plasma Se, GSH-Px, SOD and positively related to MDA. Conclusion: Plasma Se deficiency may be an important non-immune factor resulting in or worsening PGS through weakening body抯 antioxidative defence. It is suggested that sufficient Se supplementation in practice may be obviously beneficial to oxidative stress in the patients with PGS.