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Objective: Antenatal visits play a very important role to diagnose and manage pregnancy related health issues. This study was an attempt to identify the reasons that increase the risk of postpartum acute kidney Injury with special focus on antenatal care. Methods: We analyzed 110 patients in Nephrology and Gynaecology wards in Lahore General Hospital. Out of these 40 had Postpartum Acute Kidney Injury and 70 patients did not have it. Questionnaire regarding aspects of antenatal care (demographics, timing and number of antenatal visits) was filled by the patient or immediate family members. Results: Mean age of the 110 patients was 26.45 years. Mean Duration of pregnancy in the control group was 36.12 weeks and in cases it was 31.62 weeks. Out of 110 patients, 36(32.72%) patients did not have any antenatal visit while 62(56.3%) patients had more than five visits. Out of the 40 Postpartum Acute Kidney Injury patients, 23(57.5%) patients did not get any antenatal care. Out of 70 patients without Postpartum Acute Kidney Injury, 13 did not have any antenatal care. There were 19 patients who did not have booked visits because of financial Issues, followed by lack of awareness in 12 patients, distance issues for three patients and lack of family support for two patients. Conclusion: Patients who did not have antenatal care were at an increased risk of developing PPAKI. Financial issues and lack of awareness were the most common risk factors for compromised antenatal care.
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Focal segmental glomerulosclerosis (FSGS) is a common renal disorder, characterized by progressive segmental sclerosis of renal glomeruli and clinical symptoms corresponding to proteinuria. Classically, it is not considered to be an antibody-mediated disease, however, IgM and C3 deposition may be seen in a subset of cases of FSGS. The impact of this immune deposition on histopathological features in renal core biopsies, on the urinary biochemical parameters, and the clinical outcomes, has not been previously investigated in our population. The aim of this study is to analyze the aforementioned parameters in patients with primary FSGS having antibody deposition as compared to those who do not have any antibody deposition. Some 155 patients diagnosed with FSGS were retrospectively enrolled in our study. The renal biopsies were reviewed for histopathological features and immunofluorescence (IF) findings of IgM and C3 glomerular deposition. These histological features were then compared with the biochemical parameters as well as the clinical outcomes of patients. The patients were assigned to Groups 1 and 2 based on the IF findings. The IgM and/or C3 glomerular deposition had a low incidence in patients with primary FSGS in our study (28.3%). Patients having IgM and C3 co-deposition had a significantly longer time duration since the onset of their clinical symptoms; active disease duration (42 months vs 22 months, p=0.049). The mean pre-treatment serum creatinine of patients with IgM and C3 co-deposition was 6.00 mg/dL as compared to 3.29 mg/dL in patients with no immune deposition (p=0.037). The immune deposition was associated with higher rates of segmental and global glomerulosclerosis, but this finding along with other evaluated histological parameters did not show statistical significance. The number of patients having IgM and/or C3 deposition and with active steroid use/renal dialysis was similar to patients having no IgM and/or C3 deposition. The IgM and/or C3 deposition in FSGS has a low incidence within and is not associated with any significant differences in histological parameters on renal core biopsies of patients from the Pakistani population. IgM and/or C3 deposition is also associated with a significantly longer duration of active disease and these patients may present with higher pre-treatment serum creatinine. Other biochemical parameters and clinical outcomes appear comparable between the groups based on the available clinical data.
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Background: The updated version of predictive classification for immunoglobulin A nephropathy (IgAN) prognosis "The Oxford Classification" identifies five histopathological features including mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C), the MEST-C. However, few studies suggest that tubulointerstitial inflammation, which is not included in the MEST-C, is also linked to disease progression and is, consequently, a neglected determinant of prognosis among others. Therefore, there is a need to evaluate this histopathological parameter in patients with IgA nephropathy. Materials and Methods: This cross-sectional descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Data of histopathological and immunofluorescence proven renal biopsies (300) of IgA nephropathy patients from January 2016 through May 2022 were extracted using a convenient sampling technique. Biopsies were histologically reviewed for type and severity of tubulointerstitial inflammation, in addition to the MEST-C score. Renal biopsies of patients who had a history of transplant, autolyzed tissue, no glomeruli on histological examination, and/or a tubular atrophy/interstitial fibrosis score of 2 (T2) in MEST-C scoring were excluded. Data were analyzed using SPSS 20. An association between the variables was analyzed using the chi-square and Fischer exact tests. A p value less than 0.05 was considered statistically significant. Results: A total of 247/300 biopsies were eligible for inclusion. The mean age at the time of biopsy was 31.90 ± 12.48 with 63.6% in the age group between 21 and 40 years, and 69.6% were male. Tubulointerstitial inflammation was observed in 90.2% cases with 49.4% showing moderate while 4.5% showing severe degree of inflammation. A strong association of both the type and severity of tubulointerstitial inflammation was found with M, E, T, and C scores (p value < 0.05). Conclusion: The high-frequency and strong statistical association of tubulointerstitial inflammation with the M, E, T, and C scores in our study elucidate its prognostic role in the progression and management of IgA nephropathy.
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BACKGROUND: Post-infectious glomerulonephritis (PIGN) (immune complex-mediated glomerulonephritis) and C3 glomerulopathy are sub-types of glomerulonephritis (GN) with hypercellularity. Both have overlapping clinical and morphologic features on a kidney biopsy, however, the treatment and prognosis of these diseases are quite different making their distinction of utmost importance. Immune complex-mediated glomerulonephritis arises from glomerular deposition of immune-complexes (Igs) and C3 as a result of activation of classical (CP) and lectin pathways (LP). C4d is produced as a result of activation of the CP/LP. On the other hand, C3 glomerulopathy results from activation of alternative pathway of complement. AIM: To distinguish between PIGN and C3 glomerulopathy with the help of C4d IHC stain. MATERIALS AND METHODS: We studied 28 biopsies reported as GN with hypercellularity from January 2015 to January 2020. Clinical information, histological features and immunofluorescence patterns were analyzed. C4d IHC was performed on all the biopsies. Six known cases of immune complex-mediated GN were selected to act as a positive control for C4d staining. RESULTS: Amongst 28 cases originally reported as GN with hypercellularity, 18 were labeled as post-infectious GN and 10 as C3 glomerulopathy based on clinical information and serological findings. 13 of 18 (72.2%) cases of PIGN had mild to moderate (1-2+) C4d staining, 2 (11.1%) had strong (3+) staining and 3 (16.7%) cases were negative for C4d staining. In the 10 biopsies of C3 glomerulopathy, mild (1+) C4d staining was noted only in 3 (30%) biopsies. C4d had moderate to strong (2-3+) staining in the control group. CONCLUSION: C4d IHC stain can be helpful in distinguishing PIGN from C3 glomerulopathy.
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OBJECTIVE: To find out the frequency of pulmonary hypertension (PH) and its association with various contributing factors in patients undergoing regular hemodialysis (HD) due to end-stage renal disease (ESRD). STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Nephrology Department, Lahore General Hospital, Pakistan, from July to December 2016. METHODOLOGY: Fifty patients with end-stage renal disease. Various parameters, including the pulmonary arterial systolic pressure (PASP), were recorded. Pulmonary arterial pressure greater than 25 mmHg at rest was defined as pulmonary hypertension. It was further divided into three sub categories as mild (25-40 mmHg), moderate (40-55 mmHg), and severe (greater than 55 mmHg). Data were correlated with age, gender, body mass index, systemic hypertension, diabetes, duration of dialysis, and Hb (hemoglobin) concentration. Data was analysed using SPSS version 23.0. RESULTS: The median (IQR) duration of dialysis was 12 (11.25) months. Eighteen (36%) patients were found to have PH. It is greater in patients who had been on dialysis for more than 5 months. A positive association was seen between the duration of dialysis and the prevalence of PH (p=0.024). CONCLUSION: A considerable number of patients on hemodialysis have pulmonary hypertension which is associated with the longer duration of maintenance hemodialysis.
