scholarly journals P0405CURRENT STATUS OF NEPHRITIS IN KOREA: EXPERIENCE OF 18 CENTERS DURING LAST 40 YEARS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Su-Ryeong Go ◽  
HO JUN CHIN
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Pathologic Diagnosis ◽  
Mdrd Equation ◽  
Pathologic Classification ◽  
Common Causes ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Glomerulonephritis (GN) is one of common causes of end-stage renal disease (ESRD) in Korea as well as in the world, however, it is underdiagnosed as a cause of chronic kidney disease. The incidence and prevalence of GNs are different according to periods and countries. We report trends of pathologic diagnosis of nephritis from 18 centers throughout Korea during last 40 years. Method We enrolled 21,617 patients having native kidney biopsy for diagnosis of nephritis between 1979 and 2018, retrospectively. We excluded 191 patients diagnosed as cancer or tumor and analyzed the data of 21,426 patients. We defined the primary GN as IgA nephropathy (IGAN), minimal change disease (MCD), membranous nephropathy (MGN), focal segmental glomerulosclerosis (FSGS), membranoproliferative GN (MPGN), and C3 glomerulopathy (C3G). The estimated glomerular filtration rate (GFR) was calculated by original MDRD equation for adults and by height-independent equation for children. The final outcomes were incidences of end stage renal disease (ESRD) and death. Results There were 22,203 pathologic diagnoses including 777 patients with two kinds of pathologic diagnosis. The age was 42.1 ± 17.7 years at renal biopsy. There were 11565 (54.0 %) men and 976 (4.6 %) children <18 years. The frequencies of hypertension and diabetes mellitus were 53.0 % (10994) and 14.0 % (2833), respectively. Mean levels of serum creatinine, GFR, and urine protein to creatinine ratio were 1.62 ± 1.89 mg/dl, 77.1 ± 60.4 ml/min/1.73 m2, and 3.305 ± 4.164 g/g cr, respectively. The prevalence of GN was 78.45% (17419 diagnoses), followed by tubulointerstitial nephritis (8.84 %), abnormality in glomerular basement membrane (3.43 %), ischemic nephropathies (1.73 %), paraproteinemia related lesions (1.36 %), infection (0.12 %). There were non-specific GN (3.65 %), normal pathology (2.46 %), advanced global sclerosis (1.77 %), inadequate specimen (0.96 %), and miscellaneous lesions (0.12 %), also. The most frequent diagnosis was IGAN (34.17%, 7586 diagnoses), followed by MGN (9.17%), MCD (9.13 %), FSGS (7.65 %), lupus nephritis (LN) (6.30 %), diabetic nephropathy (DMN) (3.99 %), MPGN and C3G (2.79 %), therefore, prevalence of primary GN was 62.90 %. The frequency of IGAN had been increased from 19.9 % at the period of 1979-1989 to 41.4 % at the period of 2005-2009 and then stabilized to 36.0-36.7%. The frequencies of MCD, MGN, and FSGS were not changed since 1990. However, the frequency of MPGN was decreased from 4.7-5.7 % at the period of 1979-1999 to 2.5 % at the period of 2015-2018. The frequency of LN was decreased and that of DMN was increased from 2.5-3.1% during 1990-2009 to 6.3 % during 2015-2018 which might be related to the pathologic classification of DMN, published at 2010 by Tervaert TW et al. The incidences of ESRD and death were 13.3 % (2663/20010 patients) and 2.9 % (608/20884 patients) during follow-up period of 82.6 months (median) for ESRD and 91.5 months (median) for mortality after biopsy. Among patients with primary GN, patients with MCD showed the best prognosis for ESRD, followed by patients with MN, IGAN, FSGS, MPGN, and C3G (p <0.001) by Cox’s hazard proportional model adjusted by risk factors related to ESRD. Prognosis for mortality was not different among patients with MCD, MN, IGAN, and FSGS, but, patients with C3G showed the worst prognosis for mortality (p=0.006). Conclusion IGAN was the most frequent diagnosis followed by MGN and MCD. Compared to Western countries, IGAN and MCD are more prevalent in Korea, while MGN and FSGS are less prevalent. The frequencies of MPGN and LN had been decreased since 2000. The patients with MPGN and C3G showed the worst prognosis.

scholarly journals Reassessment of renal prognosis in patients with membranoproliferative glomerulonephritis according to the new pathologic classification

2020 ◽  
pp. 23-28
Author(s):  
Ergün Parmaksız ◽  
Meral Meşe
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Membranoproliferative Glomerulonephritis ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Response To Treatment ◽  
Pathologic Classification ◽  
Stage Renal Disease ◽  
End Stage

Membranoproliferative glomerulonephritis (MPGN) is a heterogeneous disease characterized by a morphological injury pattern that can be seen under various disease conditions that share common pathogenic mechanisms. In this study, we analyzed clinical features, pathological findings, long-term kidney outcomes according to the new pathohistological classification of MPGN. Methods. This retrospective study included 20 CKD patients with biopsy-proven MPGN that had been diagnosed between 2011 and 2019. We reclassified the patterns of MPGN as immune-complexes mediated (ICM) and complement-mediated (CM) according to the new classification. Results. The level of daily proteinuria was lower in the ICM MPGN than the CM MPGN group but was not statistically significant at the end of the study. Histopathologically, the difference in C3 staining was found between the patients with ICM and CM MPGN. At the end of the follow-up period, no patients developed end-stage renal disease, and no death occurred in response to treatment in the ICM MPGN group. In the CM MPGN group, 2 patients evolved to end-stage renal disease and 1 of them had renal transplantation. Conclusion. Larger sample size and longer follow-up may change the relationship between histological factors, treatment strategies, and kidney outcomes. We believe that the use of the new diagnostic approach that applies to the ICM MPGN and CM MPGN will help nephrologists to improve treatment options and renal outcomes for patients with MPGN.

MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jeremy Zaworski ◽  
Cyrille Vandenbussche ◽  
Pierre Bataille ◽  
Eric Hachulla ◽  
Francois Glowacki ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Renal Recovery ◽  
Neurological Involvement ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p < 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

Abstract 282: In Hospital Outcomes of Cardiac Arrest in Patient with End Stage Renal Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Muhammad Khan ◽  
Muhammad U Khan ◽  
Muhammad Munir
Keyword(s):  
Cardiac Arrest ◽  
Risk Factor ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
International Classification ◽  
International Classification Of Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End stage renal disease (ESRD) is a well-recognized risk factor for development of sudden cardiac arrest(SCA). There is limited data on outcomes after an in-hospital SCA event in ESRD patients. Methods: Data were obtained from National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using International Classification of Disease, 9th Revision, Clinical Modification, and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Propensity -matched analysis using logistic regression with SD caliper of 0.2 was used to match patients with and without ESRD. Crude and propensity-matched (PS) cohorts outcomes were calculated. Results: A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS matched cohort (70.4% vs. 70.7%, p = 0.45, figure 1) with an overall downward trend over our study years (figure 2). Conclusion: In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients

scholarly journals Perfusion defects on real-time myocardial contrast echocardiography predict higher mortality in patients with end-stage renal disease – A 3-year follow-up

Renal Failure ◽  
2010 ◽  
Vol 32 (10) ◽  
pp. 1160-1166 ◽  
Author(s):  
Anna Tomaszuk-Kazberuk ◽  
Bozena Sobkowicz ◽  
Jolanta Malyszko ◽  
Jacek S. Malyszko ◽  
Marek Kalinowski ◽  
...  
Keyword(s):  
Renal Disease ◽  
Real Time ◽  
End Stage Renal Disease ◽  
Contrast Echocardiography ◽  
Myocardial Contrast Echocardiography ◽  
Perfusion Defects ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals The association of exercise and sedentary behaviours with incident end-stage renal disease: the Southern Community Cohort Study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030661 ◽  
Author(s):  
Mindy Pike ◽  
Jacob Taylor ◽  
Edmond Kabagambe ◽  
Thomas G Stewart ◽  
Cassianne Robinson-Cohen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Sedentary Time ◽  
Sitting Time ◽  
Stage Renal Disease ◽  
End Stage

ObjectiveTo examine whether lifestyle factors, including sedentary time and physical activity, could independently contribute to risk of end-stage renal disease (ESRD).Study designCase-cohort study.SettingSouth-eastern USA.ParticipantsThe Southern Community Cohort Study recruited ~86 000 black and white participants from 2002 to 2009. We assembled a case cohort of 692 incident ESRD cases and a probability sample of 4113 participants.PredictorsSedentary time was calculated as hours/day from daily sitting activities. Physical activity was calculated as metabolic equivalent (MET)-hours/day from engagement in light, moderate and vigorous activities.OutcomesIncident ESRD.ResultsAt baseline, among the subcohort, mean (SD) age was 52 (8.6) years, and median (25th, 75th centile) estimated glomerular filtration rate (eGFR) was 102.8 (85.9–117.9) mL/min/1.73 m2. Medians (25th–75th centile) for sedentary time and physical activity were 8.0 (5.5–12.0) hours/day and 17.2 (8.7–31.9) MET-hours/day, respectively. Median follow-up was 9.4 years. We observed significant interactions between eGFR and both physical activity and sedentary behaviour (p<0.001). The partial effect plot of the association between physical activity and log relative hazard of ESRD suggests that ESRD risk decreases as physical activity increases when eGFR is 90 mL/min/1.73 m2. The inverse association is most pronounced at physical activity levels >27 MET-hours/day. High levels of sitting time were associated with increased ESRD risk only among those with reduced kidney function (eGFR ≤30 mL/min/1.73 m2); this association was attenuated after excluding the first 2 years of follow-up.ConclusionsIn a population with a high prevalence of chronic kidney disease risk factors such as hypertension and diabetes, physical activity appears to be associated with reduced risk of ESRD among those with preserved kidney function. A positive association between sitting time and ESRD observed among those with advanced kidney disease is likely due to reverse causation.

An Overview of Renal Diseases in Children in Pokhara

1970 ◽  
Vol 27 (2) ◽  
pp. 75-78 ◽  
Author(s):  
T Malla ◽  
KK Malla ◽  
A Thapalial ◽  
MS Sharma
Keyword(s):  
Renal Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Renal Stone ◽  
Laboratory Evaluation ◽  
Renal Diseases ◽  
Adequate Treatment ◽  
Stage Renal Disease ◽  
End Stage

Objective: To determine the current pattern and prevalence of renal diseases in childhood in this region of Nepal. Material and Methods: A retrospective study of the renal diseases in children attending the Pediatric OPD and those hospitalised in Manipal Teaching Hospital, Pokhara was done over a period of 6 years (September 2000- September 2006). A detailed clinical and laboratory evaluation was performed at baseline. The children were managed according to disease diagnosed. These cases are under follow up and some have undergone surgical treatment. Results: 228 children (123 boys & 105girls) were diagnosed to have renal disease. Among them 39.5% had urinary tract infection (UTI), 30.7 % were suffering from acute glomerulonephritis (AGN), 17.5% were cases of nephrotic syndrome (NS) and 12 % had some other problems for example, 6.14% had genetic defects, 2.63% had renal Stone, 2.2% had pre-renal acute renal failure, unexplained recurrent hematuria in 1.3%. All the cases of UTI underwent through investigation and were treated accordingly. All cases of AGN are planned for follow up for 1½ yrs and among them 3 required biopsy till date. All cases of NS are under regular follow-ups and 2 have undergone biopsy. Renal stone was operated successfully. All cases of acute and chronic renal failures had required dialysis. Out of 5 (2.5%) chronic renal failures, 2 with end stage renal disease expired after repeated hemodialysis and three are still requiring dialysis. Among the obstructive uropathies, 43 % had renal stone, 36 % had posterior urethral valve and 21% VUR. Conclusion: It can be concluded that renal disease is not uncommon in children. It can be completely cured with proper and adequate treatment. Sometimes it has a bad prognosis when it reaches end stage renal disease. Early recognition, timely treatment and regular follow up are mandatory in management of children with renal diseases. Key words: Renal disease pattern, UTI, AGN, NS, Obstructive Uropathy, Renal failure   doi:10.3126/jnps.v27i2.1414 J. Nepal Paediatr. Soc. Vol.27(2) p.75-78

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