GLOMERUONEPHRITIS;

DISTRIBUTION OF BIOPSY PROVEN GLOMERUONEPHRITIS IN KHYBER PAKHTUNKHWA PROVINCE OF PAKISTAN, A SINGLE CENTRE STUDY.

Abstract

Background: The histological pattern and frequency of glomerular diseases differs according to the geographic area, race, age and indications for renal biopsy. This study was conducted to evaluate the frequency of different histological patterns of glomerulonephritis during a 10 years period at our institute. Study Design: Retrospective Case series. Period: 1^st January 2007 to 31st, December 2017. Study Setting: Institute of kidney diseases, Hayatabad Medical Complex Peshawar, Pakistan. Results and Discussion: Clinical records of 415 native renal biopsies performed in patients with mean age 27.17 ± 14.98 years were included in this study. Males were 266 (64.1%) and females 149 (35.9%). Data was analysed for three age groups separately, Children (<18 years) 147 (35.5%), Adults (18-59 years) 253 (61.0%) and elderly (>60 years) 15 (3.6%). Primary GN (glomerulonephritis) was the most common (74.21%) followed by secondary GN (26.41%). Among primary glomerular diseases, Focal segmental glomerulonephritis (FSGS) was (29.6%), membranoproliferative glomerulonephritis (MPGN) also known as mesangiocapillary glomerulonephritis constituted 19.5% and Membranous glomerulonephritis (MGN) was the third most common (16.6%). Among secondary GN, acute tubular necrosis (ATN) was the most common (25.4%), followed by amyloidosis (14.7%), hypertensive nephropathy (13.7%) and lupus nephritis (12.8%) respectively. There was a slight male predominance in all types of primary GN except for focal necrotizing GN and most of the secondary types except lupus nephritis and chronic tubulointerstitial nephritis (TIN). Below 18 years, MPGN was (58.3%), focal necrotising GN (57.1%) and minimal change disease (MCD) was (52.2%). Crescentic GN (89.5%), MGN (74.5%), immunoglobulin A (IgA) nephropathy (72.7%), chronic sclerosing GN (CSGN) (64.7%) and FSGS (56%) were more common in adults. Frequency of immunoglobulin M (IgM) nephropathy (50%) was equal in children and adults. In elderly patients, the commonest GN reported was hypertensive nephropathy (28.6%), amyloidosis (6.7%) and MGN (5.9%). Conclusion: Among the wide variety of histological patterns, FSGS was the commonest GN in adults followed by MPGN and MGN. Among adults, primary GN was more common. When compared with other studies, FSGS is more common in the present study and some Indian studies, while membranous GN is more common in other regional countries.