Renal Glomerular Diseases (Topics in Renal Disease)
Membranous nephropathy may be idiopathic of unknown cause or associated with infections hepatitis B or stem cell transplant. Various immunosuppressive medications have been shown to induce remission in patients with membranous nephropathy, including steroids, cyclophosphamide, and cyclosporine.
Edema is managed by dietary salt restriction and diuretics, either administered orally or intravenously. Glomerular filtration rate is typically normal at the outset of membranous nephropathy, but in some patients glomerular filtration rate will decline after months or years. Risk factors for progressive loss of kidney function include heavy proteinuria and male sex.
How do glomerular diseases interfere with kidney function?
Patients who have not had prior therapy for membranous nephropathy, and those who have had steroids or cyclosporine, are eligible for an NIH clinical trial testing sirolimus. The study is open label, no placebo, and lasts up to 12 months. Patients with minimal change typically present with the sudden onset of edema, either affecting the legs or, particularly in children, affecting the whole body, including facial edema which may be the first manifestation.
In children, the peak age of onset is age 2, with the disease being uncommon before age 1 and less common in during the teenage years. Minimal change disease also occurs in adulthood, even in the elderly, but is less common with advancing age. On light microscopy, the kidney appears normal or nearly normal. Older pathologic terms for this disease include nil disease i.
Immunofluorescence microscopy may be normal or may show deposition of IgM antibody within the glomerulus.
Glomerular Disease Primer: Selected Glomerular Diseases
Electron microscopy shows podocyte foot process effacement, which is common to nearly all proteinuric diseases. The cause or causes of minimal change disease are largely unknown. Occasionally, minimal change disease is associated with medication use see table above or may follow insect stings. Several lines of evidence suggest that the immune system contributes to the appearance of minimal change disease.
Glomerular Diseases | NIDDK
This evidence includes 1 an increased prevalence of allergic disease tendency atopy in children with minimal change disease; 2 an increased prevalence of minimal change disease in people with lymphoma, a disorder of lymphocytes an immune cell ; 3 an increase in particular HLA genotypes, which indicate a tendency to particular patterns of immune responsiveness; 4 occasional remission of minimal change disease after particular viral infections, which activate the immune system.
Nevertheless, the particular pathways by which the immune system might cause or promote minimal change disease are not understood.
Mortality at present is very low. Many steroid regimens have been used. The most common regimens involve the use prednisone daily or every other day. Unfortunately, relapses are common. When patients are steroid-resistant do not enter complete remission with steroid therapy , other therapeutic options include cyclosporine.
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When patients respond to steroids but experience frequent relapses, therapeutic options include cyclophosphamide, chlorambucil, and cyclosporine. As discussed below, most patients respond to steroids and have an excellent long-term prognosis.
In those who are steroid-resistant, a renal biopsy may subsequently show focal segmental glomerulosclerosis, which has a worse prognosis more likely to progress to end-stage kidney disease. Spontaneous remissions occurring without specific therapy also occur. Kidney Diseases Also called: Resources Reference Desk Find an Expert. Other kidney problems include Cancer Cysts Stones Infections Your doctor can do blood and urine tests to check if you have kidney disease.
Keep Your Kidneys Healthy: Prevention and Risk Factors. Best for Kidney Disease? Bioactive Compounds for the Treatment of Renal Disease. Renal complications of cancer therapies. HIV-associated nephropathy increased from 6. Our data are an important contribution to the epidemiology of renal disease in Africa. We hope that this will form the basis for developing a renal biopsy registry in South Africa and across the continent. Renal biopsy has become one of the cornerstones of nephrology practice, being an important means of diagnosing, prognosticating and guiding the treatment of many renal diseases, especially glomerular diseases [ 1 ].
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The patterns of glomerular disease in many European [ 2—8 ], Asian [ 9—11 ] and American [ 12,13 ] countries are well known and have been published. Several reports of glomerular diseases from Africa have been in the form of small case reports or reports of studies of specific forms of renal disease [ 15—17 ]. Although GN is reportedly the main cause of end-stage renal disease in Africa [ 18 ], little is known of the patterns of renal disease from African countries, mainly due to the non-existence of renal biopsy registries in many countries or because renal biopsy as a tool for diagnosing renal disease is entirely unavailable.
The purpose of this study was to provide a comprehensive report of the relative frequencies of kidney diseases according to clinical presentation and histological diagnoses from the audit of a single-centre renal biopsy registry in Cape Town South Africa. This retrospective study was conducted in a single-centre in the Western Cape province of South Africa to evaluate the epidemiology of the histological types of renal diseases in native kidneys from renal biopsies taken from 1 January to 31 December All the biopsy materials were exclusively analysed at the Department of Anatomical Pathology of the University of Cape Town.
We obtained ethical approval from the University of Cape Town research ethics committee to conduct the study. For each patient, we documented the demographics name, age and gender , the indication for renal biopsy and the renal histological diagnosis. Electron microscopy EM was generally performed to confirm the light microscopic changes.
What are the kidneys and what do they do?
For light microscopy LM , paraffin sections were routinely stained with periodic-acid Schiff, haematoxylin—eosin, silver—methenamine and Congo red. The indications for renal biopsy were categorized into six groups: Haematuria was defined as the presence of red blood cells in the urine without any other symptoms or signs of renal disease. Due to the often late presentation of patients with renal disease in our population, it was occasionally difficult to differentiate ARF from CRF.
The indication for biopsy was also recorded as CRF if a patient presented for the first time with abnormal serum creatinine, low haemoglobin and echogenic kidneys on renal ultrasound scan. We adapted the classification method used by Polito et al. Renal histopathological diagnosis was divided into four main classes: Primary glomerular diseases were classified into eight pathologies: Miscellaneous pathologies included end-stage kidneys ESK of undetermined cause, normal histologies, tumours e.
In order to provide age comparison with kidney disease types, the patients were divided into three age groups: Renal diseases were also classified according to ethnicity blacks, coloureds and whites. Analysis was carried out with the SPSS statistical package version The frequencies of cases were expressed as percentages. The biopsy rate was defined as the number of biopsies performed each year related to the mean total population of Cape Town and was expressed as per million populations p.
Analysis of variance ANOVA was used to determine differences in frequencies of disease by age category, ethnicity or year of biopsy. Chi-square test was used to test for differences in frequency of disease between males and females. Between 1 January and 31 December , we performed renal biopsies in our unit. After excluding transplant biopsies, 41 biopsies with inadequate samples and cases with incomplete data, we present results on analysis obtained from histological diagnoses on native kidney biopsies alone. The mean age of all the patients at the time of renal biopsy was There was a higher frequency of coloured patients The rate of renal biopsy rose from This is similar to biopsy rates reported from other registries in European countries [ 2 ].
Primary GD, primary glomerular diseases; Secondary GD, secondary glomerular diseases; TIN, tubulo-interstitial nephritis; Miscellaneous, end-stage kidney of undetermined cause, normal histologies, tumours and unclassified GN. The frequencies of the clinical indications for renal biopsy were Nephrotic range proteinuria was also the most common clinical indication for a renal biopsy in all the ethnic groups. Haematuria was the least common clinical indication for biopsy 0.
Glomerular Diseases
Overall, MCGN was the most common type of primary glomerular disease IgA nephropathy was the least common of all the primary glomerulopathies, with a frequency of 5. In blacks and coloureds, MCGN was also the dominant form of primary glomerular disease seen The frequency of FSGS was found to be higher among blacks Frequencies of the primary glomerular diseases by different age groups top panel and by gender bottom panel.
The annual frequency of HIVAN was observed to have been on the increase, rising from a frequency of 6. Acute tubular necrosis was the most common type of TIN observed overall