Khakurel S, Agrawal R K, Hada R
Department of Nephrology, Kist Medical College, Khatmandu, Nepal.
Saudi J Kidney Dis Transpl. 2015 Jul-Aug;26(4):833-8. doi: 10.4103/1319-2442.160249.
Glomerulonephritis (GN) is the most common cause of end-stage renal disease in Nepal. The aim of the present study is to determine the clinical presentation and histological pattern of GN with and without immunofluorescence (IF). It is a retrospective analysis of all GN patients with kidney biopsy at the Bir Hospital from January 2000 to April 2009. The clinical presentation, blood pressure, urine analysis, 24-h urinary protein, biochemistry, hemoglobin, antinuclear antibody, anti-ds DNA, light microscopy (LM) and IF findings of kidney biopsies were computed from hospital records. SPSS package was used for analysis. A total of 398 patients [LM 204 (51%) and LM plus IF 194 (49%] were analyzed. The mean age of the study patients was 28 ± 13.6 years (range 7-74); males comprised 52.8% and females 47.2% of the patients; 51% were between 16 and 30 years of age. The common clinical presentations included nephrotic syndrome (NS), seen in 69% of the patients, followed by acute nephritic syndrome, seen in 14.4% of the patients. Kidney biopsy without IF showed mesangial proliferative GN (MesPGN) in 21.1%, membranoproliferative GN (MPGN) in 18.6%, membranous nephropathy (MN) in 14.2%, minimal change disease (MCD) in 12.3% and focal and segmental glomerulosclerosis (FSGS) in 9.8% of the cases. With IF, MCD was seen in 23.2%, FSGS in 18%, MN in 11.9%, IgA nephropathy in 9.8%, MesPGN in 8.2%, MPGN in 4.1% and crescentic GN in 3.1% of the cases. Lupus nephritis in the cases GN was most common in young adults, with the majority presenting with NS. MCD and FSGS were the most common glomerular lesions; over-diagnosis of MesPGN and MPGN by LM could be due to exclusion of IgA nephropathy.
肾小球肾炎（GN）是尼泊尔终末期肾病最常见的病因。本研究旨在确定有免疫荧光（IF）和无免疫荧光情况下GN的临床表现及组织学模式。这是一项对2000年1月至2009年4月在比尔医院接受肾活检的所有GN患者进行的回顾性分析。从医院记录中统计肾活检的临床表现、血压、尿液分析、24小时尿蛋白、生化指标、血红蛋白、抗核抗体、抗双链DNA、光镜（LM）及IF检查结果。使用SPSS软件包进行分析。共分析了398例患者[光镜检查204例（51%），光镜加免疫荧光检查194例（49%）]。研究患者的平均年龄为28±13.6岁（范围7 - 74岁）；男性占患者的52.8%，女性占47.2%；51%的患者年龄在16至30岁之间。常见的临床表现包括肾病综合征（NS），见于69%的患者，其次是急性肾炎综合征，见于14.4%的患者。无免疫荧光的肾活检显示系膜增生性GN（MesPGN）占21.1%，膜增生性GN（MPGN）占18.6%，膜性肾病（MN）占14.2%，微小病变病（MCD）占12.3%，局灶节段性肾小球硬化（FSGS）占9.8%。有免疫荧光检查时，MCD见于23.2%的病例，FSGS见于18%，MN见于11.9%，IgA肾病见于9.8%，MesPGN见于8.2%，MPGN见于4.1%，新月体性GN见于3.1%。狼疮性肾炎在GN病例中最常见于年轻人，多数表现为NS。MCD和FSGS是最常见的肾小球病变；光镜下对MesPGN和MPGN的过度诊断可能是由于排除了IgA肾病。
