An analysis of renal biopsy at Prapokklao hospital.

Abstract

Background : There are many reports in Thailand about the epidemiology of glomerular diseases. The definite diagnosis of glomerular disease is made by renal biopsy. The variability regarding the prevalence of glomerular diseases, the indications for renal biopsy, the correlation between the indications and renal histopathology were observed among various reports.

Objective : The aims of this study were to examine the prevalence of glomerular diseases, the indications for renal biopsy, the correlation between the indications and renal histopathology at Prapokklao Hospital.

Material and Method : A retrospective study of renal biopsies in adult patients at Prapokklao Hospital during a 5-year period of 2004 to 2009 was performed.The data was analyzed by age, sex, underlying diseases, blood chemistries,urinary analysis, the indications for renal biopsy, renal histopathology and the change of treatment regimen.

Results : A total of 143 renal biopsies were processed during this period. The subjects were 82 (57.3 percent) female and 61 (42.7 percent) male with mean age of 37.85±13.76 (15-77) years. The glomerular diseases were found in 141 renal biopsies and were diagnosed as primary glomerular diseases in 91 (64.54 percent) and secondary glomerular diseases in 50 (35.46 percent). The prevalence of primary glomerular diseases were IgM nephropathy (21.28 percent), IgA nephropathy (14.18 percent) and focal segmental glomerulosclerosis (11.35 percent). Lupus nephritis was the most prevalent cause of secondary glomerular disease (31.21 percent).The most common indications for renal biopsy were steroid-dependent nephrotic syndrome (26.24 percent) and lupus nephritis (29.79 percent).
The renal histopathology in the group of steroid-dependent nephrotic syndrome without active urine sediment were IgM nephropathy (81.25 percent), minimal change disease (15.63 percent) and proliferative
glomerulonephritis (3.12 percent). The treatment regimen of these diseases were similar.

Conclusion : The most prevalent glomerular diseases in Prapokklao Hospital were IgM nephropathy, IgA nephropathy, focal segmental glomerulosclerosis and lupus nephritis. The most common indications for renal biopsy were steroid-dependent nephrotic syndrome and lupus nephritis. Various glomerular diseases were found in each indication. IgM nephropathy, minimal change disease and proliferative glomerulonephritis were found in the group of steroid-dependent nephrotic syndrome without active urine sediment. The treatment of these diseases were changed to the same regimen. In clinical practice, patients who have this syndrome but
refuse renal biopsy can be treated as IgM nephropathy and minimal change disease. The outcome of this approach is expected to be of high response rate.