Suryawanshi Mayur, Karnik Swapnil, Roy Sanjeet
Assistant Professor, Department of Pathology, Christian Medical Hospital, Vellore, Tamil Nadu, India.
Consultant Oncopathologist and Renal Histopathologist, Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India.
J Clin Diagn Res. 2017 May;11(5):EC25-EC30. doi: 10.7860/JCDR/2017/24836.9878. Epub 2017 May 1.
Primary glomerular disease presenting with adult onset nephrotic syndrome are a major cause of chronic renal failure worldwide. The spectrum of renal disease presenting with nephrotic syndrome has undergone a gradual change globally over the course of time. However, there still exist regional differences in the incidence of primary glomerular diseases causing adult onset nephrotic syndrome.
To observe the spectrum of renal diseases presenting with adult onset nephrotic syndrome with comparative analysis of changing trends over the last five decades with regards to Western and Indian literature.
Subjects included patients with age of 18-80 years presenting with nephrotic syndrome. Renal biopsies with immunofluoroscence studies were performed in all patients. Baseline clinical parameters of serum urea, creatinine, albumin, globulin, cholesterol, 24 hour urine protein and urine microscopy were recorded. Descriptive statistics was used and results were expressed as frequencies, percentages, and mean±standard deviation.
A total of 227 patients (72% males) were included for the study. Primary glomerular diseases formed 74.01% of total cases and majority of patients included males in the 4 decade. Minimal Change Disease (MCD) (15.8%) including its variants was the most common primary glomerular disease for adult onset of nephrotic syndrome followed by Mesangial proliferative Glomerulonephritis (MSGN) (13.2%). Membranous nephropathy and Type I Membranoproliferative Glomerulonephritis (MPGN) individually accounted for 12.3% of patients. Focal and Segmental Glomerulosclerosis (FSGS) accounted for only 11% of patients. Although, increased incidence of FSGS has been observed worldwide, there exist important regional differences in primary glomerular diseases in Indian population. MCD remains a major glomerular disease for adult onset nephrotic syndrome in different parts of India.
Our study over three years represents important data of regional variations of primary glomerular diseases presenting with adult onset nephrotic syndrome.
成人起病的肾病综合征所呈现的原发性肾小球疾病是全球慢性肾衰竭的主要原因。随着时间的推移，全球范围内以肾病综合征为表现的肾脏疾病谱已逐渐发生变化。然而，导致成人起病肾病综合征的原发性肾小球疾病的发病率仍存在地区差异。
观察成人起病肾病综合征所呈现的肾脏疾病谱，并对过去五十年来西方和印度文献中的变化趋势进行比较分析。
研究对象包括年龄在18至80岁之间的肾病综合征患者。对所有患者进行了免疫荧光研究的肾活检。记录血清尿素、肌酐、白蛋白、球蛋白、胆固醇、24小时尿蛋白和尿镜检的基线临床参数。采用描述性统计，结果以频率、百分比和均值±标准差表示。
本研究共纳入227例患者（72%为男性）。原发性肾小球疾病占总病例的74.01%，大多数患者为40多岁的男性。微小病变病（MCD）（15.8%）及其变体是成人起病肾病综合征最常见的原发性肾小球疾病，其次是系膜增生性肾小球肾炎（MSGN）（13.2%）。膜性肾病和I型膜增生性肾小球肾炎（MPGN）分别占患者的12.3%。局灶节段性肾小球硬化（FSGS）仅占患者的11%。尽管全球范围内FSGS的发病率有所上升，但印度人群原发性肾小球疾病存在重要的地区差异。MCD仍然是印度不同地区成人起病肾病综合征的主要肾小球疾病。
我们为期三年的研究代表了成人起病肾病综合征所呈现的原发性肾小球疾病地区差异的重要数据。
