Epidemiology of glomerulonephritis in Northern Germany.

BACKGROUND: Knowledge of the exact numbers of patients suffering from chronic diseases, possibly requiring costly continuous treatment, is mandatory for future health care plans. Despite some regional biopsy registries, no valid data about the epidemiology of glomerulonephritis in Germany exist, because all publications are hampered by their retrospective character and lack of completeness. METHODS: In a unique cooperation of out-patient nephrologists with a single major teaching hospital serving a population of approx. 600,000 in the capital of Schwerin and surrounding counties, all patients with abnormal urine findings and/or decreasing renal function of unknown cause were referred for renal biopsy between October 2002 and December 2008. The drop-out rate is assumed to be less than 5%. All biopsies were analysed according to international standards and traditional epidemiological and clinical parameters were collected for comparison with the micro-census of Mecklenburg-Lower Pomerania region of the year 2008. We present the first valid estimations of incidence and 7 year prevalence of glomerulonephritis in Germany. RESULTS: In 222 patients, 251 renal biopsies were performed. The annual biopsy rate was 64 per million population (pmp; range 46.2-87.2). The incidence and prevalence of glomerulonephritis over 7 years was 52 and 285 pmp, respectively. The most frequent glomerulonephritis subtype was mesangioproliferative glomerulonephritis (20.9 pmp) followed by focal and segmental glomerulosclerosis (FSGS, 11.2 pmp) of which 43% had an etiologic underlying condition. The incidences of minimal change nephropathy (MCN), membranous nephropathy and necrotising glomerulonephritis (NGN) were 3.2, 5.2 and 4.9 pmp. In one third of all cases, the glomerulonephritis was secondary (incidence of secondary glomerulonephritis 17.5 pmp). Lupus nephritis and ANCA-associated glomerulonephritis were found in 2.9 and 5.4 cases pmp.

Immunosuppressive treatment for focal segmental glomerulosclerosis in adults.

BACKGROUND: Corticosteroids remain the mainstay of treatment in idiopathic nephrotic syndrome, including focal and segmental glomerulosclerosis (FSGS). However, only about 20% of patients with FSGS experience a partial or complete remission of nephrotic syndrome despite treatment. OBJECTIVES: To assess the effects of different immunomodulatory and immunosuppressive regimes in adults with FSGS. SEARCH STRATEGY: We searched MEDLINE, EMBASE and CENTRAL and handsearched congress reports of the American Society of Nephrology and the European Dialysis and Transplantation Association. Date of search: 31 January 2007. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs which examined the effects of different doses, dose strategies and duration of treatment of steroids, alkylating agents, cyclosporin A and antimetabolites in the treatment of FSGS in adults, where included. DATA COLLECTION AND ANALYSIS: At least two authors independently assessed abstracts and/or full text articles to determine which studies satisfied the inclusion criteria. Information was entered onto a separate data sheet for each identified study. Data relevant to outcomes (complete or partial remission of nephrotic syndrome, doubling of serum creatinine, adverse effects) from identified studies were included. Results were expressed as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS: Four studies (108 participants) were included. Three studies investigated cyclosporin A (CSA) with or without prednisone versus prednisone or no treatment and one compared chlorambucil plus prednisone versus no treatment. Outcome data was only available for complete or partial remission and doubling of serum creatinine. There was a significant increase in the number of participants who obtained complete or partial remission with CSA plus low dose prednisone versus prednisone alone (one study, 49 participants: RR 8.85, 95% CI 1.22 to 63.92). Pooled analyses were not performed due to the heterogeneity of the data. AUTHORS' CONCLUSIONS: Adult patients treated with CSA at an initial dose of 3.5-5 mg/kg/d in two divided doses perhaps in combination with oral prednisolone 0.15 mg/kg/d are more likely to achieve a partial remission of the nephrotic syndrome compared with symptomatic treatment or prednisolone alone. However, there is a probability of deterioration of kidney function due to the nephrotoxic effect of CSA in the long term. For CSA, a larger controlled trial with longer follow-up should be performed to prove the benefit of this regimen not only on proteinuria but also on the preservation of kidney function. Present available data do not support the general use of alkylating substances for the treatment of FSGS in adults.

Influence of amifostine on toxicity of CHOP in elderly patients with aggressive non-Hodgkin's lymphoma--a phase II study.

Due to concerns about toxicity, many elderly patients with aggressive non-Hodgkin's lymphoma (NHL) are not considered candidates for standard chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). The cytoprotective agent amifostine has the potential to reduce toxicity when added to chemotherapy. The purpose of the current study was to examine the toxicity of CHOP combined with amifostine in elderly patients with aggressive NHL. A prospective phase II study was performed in patients aged 60 years and older. Patients with stage I/II disease received 4 cycles of CHOP followed by involved-field irradiation. Patients with stage III/IV received 6-8 cycles of CHOP. Amifostine (740 mg/m(2)) was administered as a 15-min i.v. infusion immediately before chemotherapy. Forty-one (median age 69.5 years, range 60-87) of 49 consecutive previously untreated patients, aged 60 years and older, with aggressive NHL seen in our center were included in the study. Twenty-one patients had stage I/II disease and 20 had stage III/IV disease. The patients received a total of 207 cycles of amifostine-CHOP. Infusion of amifostine caused mild to moderate transient side effects, including a drop of systolic blood pressure >20 mmHg in 54 cycles and nausea/vomiting in 36 cycles. Hematotoxicity of CHOP consisted of leukopenia grade 4 in only 15.4% of cycles. There were two cases of grade 3 anemia. No thrombocytopenia higher than grade 2 occurred. Febrile neutropenia was rare, occurring in 4.3% of cycles. One patient died after the first CHOP administration because of anthracycline-related acute cardiomyopathy (corresponding to a toxic death rate of 2.4%). The complete response rates were 85 and 75% in stage I/II and stage III/IV patients, respectively. After median follow-up of 33 months (range 17-50 months) the median overall survival was not reached in patients with stage I/II and was found to be 32 months in patients with stage III/IV. At 2 years, 76% of patients with stage I/II and 70% with stage III/IV were alive. Twelve of the 15 patients who died were aged older than 70. Amifostine pre-treatment was associated with a low toxicity of CHOP in elderly patients with aggressive NHL treated with curative intent. Treatment outcomes appeared not to be impaired by the addition of amifostine to CHOP. This schedule merits further testing in a randomized trial.