Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population
an analytical cross-sectional study
Keywords:
Glomerulonephritis, Proteinuria, Renal insufficiency, Therapeutics, Glomerular filtration rateAbstract
CONTEXT AND OBJECTIVE: Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glo-merular diseases followed up in a tertiary hospital in Brazil. DESIGN AND SETTING: Analytical cross-sectional study; tertiary-level public hospital. METHODS: This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months. RESULTS: The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis [FSGS] (19.6%), minimal change disease [MCD] (17.9%), membranous nephropathy [MN] (16.7%) and lupus nephritis [LN] (11.9%). The main clinical presenta-tions were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value de-creased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence of interstitial fibrosis presented a strong correlation with remission (remission in patients without fibrosis = 83.4% versus 16.3% in those with fibrosis, P = 0.001). CONCLUSIONS: The present study found that the most frequent glomerular disease was FSGS, followed by MCD, MN and LN. The presence of interstitial fibrosis was a predictor of poor therapeutic response.
Downloads
References
Sesso RC, Lopes AA, Thomé FS, Lugon JR, Santos DR. 2010 report of the Brazilian dialysis census. J Bras Nefrol. 2011;33(4):442-7.
Unites States Renal Data System. 2011 USRDS annual data report. Introduction. Available from: http://www.usrds.org/2011/view/v2_00a_intro.asp. Accessed 2013 (Nov 18).
Rivera F, López-Gómez JM, Pérez-García R; Spanish Registry of Glomerulonephritis. Clinicopathologic correlations of renal pathology in Spain. Kidney Int. 2004;66(3):898-904.
Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13,519 renal biopsies. Kidney Int. 2004;66(3):920-3.
Gesualdo L, Di Palma AM, Morrone LF, et al. The Italian experience of the national registry of renal biopsies. Kidney Int. 2004;66(3):890-4.
Malafronte P, Mastroianni-Kirstajn G, Betônico GN, et al. Paulista Registry of glomerulonephritis: 5-year data report. Nephrol Dial Transplant. 2006;21(11):3098-105.
Queiroz PF, Brito E, Martinelli R, Rocha H. Nephrotic syndrome in patients with Schistosoma mansoni infection. Am J Trop Med Hyg. 1973;22(5):622-8.
Correia EI, Martinelli RP, Rocha H. Está desaparecendo a glomerulopatia da esquistossomose mansônica? [Is glomerulopathy due to schistosomiasis mansoni disappearing?] Rev Soc Bras Med Trop. 1997;30(4):341-3.
dos-Santos WL, Sweet GM, Bahiense-Oliveira M, Rocha PN. Schistosomal glomerulopathy and changes in the distribution of histological patterns of glomerular diseases in Bahia, Brazil. Mem Inst Oswaldo Cruz. 2011;106(7):901-4.
Kitiyakara C, Eggers P, Kopp JB. Twenty-one-year trend in ESRD due to focal segmental glomerulosclerosis in the United States. Am J Kidney Dis. 2004;44(5):815-25.
Dragovic D, Rosenstock JL, Wahl SJ, et al. Increasing incidence of focal segmental glomerulosclerosis and an examination of demographic patterns. Clin Nephrol. 2005;63(1):1-7.
Nachman P, Glassock RJ. Glomerular, vascular and tubulointerstitial diseases. NephSAP Self-Assessment Program 2008;7(3):131-55. Available from: http://www.asn-online.org/education/nephsap/volumes/volume7.aspx. Accessed in 2013 (Nov 18).
Charlesworth JA, Gracey DM, Pussell BA. Adult nephrotic syndrome: non-specific strategies for treatment. Nephrology (Carlton). 2008;13(1):45-50.
Simon P, Ramee MP, Boulahrouz R, et al. Epidemiologic data of primary glomerular diseases in western France. Kidney Int. 2004;66(3): 905-8.
Fadem SZ, Rosenthal B. GRF calculators: serum creatinine and cystation C (2012) (With Sl Units). Available from: http://www.mdrd.com. Accessed in 2013 (Nov 18).
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
Choi M, Eustace JA, Gimenes LF, et al. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int. 2002;61(3):1098-114.
Cardoso ACD, Kirsztajn GM. Padrões histopatológicos das doenças glomerulares no Amazonas [Morphological patterns of glomerular diseases in Amazonas (North of Brazil)]. J Bras Nefrol. 2006;28(1):39-43.
Freitas M, Ribeiro RT. Aspectos clínicos-patológicos de pacientes submetidos à biópsia renal [Clinical and pathological aspects of patients submitted to renal biopsy]. Rev Para Med. 2006;20(3):15-22.
Polito MG, de Moura LA, Kirsztajn GM. An overview on frequency of renal biopsy diagnosis in Brazil: clinical and pathological patterns based on 9,617 native kidney biopsies. Nephrol Dial Transplant. 2010;25(2):490-6.
Stratta P, Segoloni GP, Canavese C, et al. Incidence of biopsy-proven primary glomerulonephritis in an Italian province. Am J Kidney Dis. 1996;27(5):631-9.
Choi IJ, Jeong HJ, Han DS, et al. An analysis of 4,514 cases of renal biopsy in Korea. Yonsei Med J. 2001;42(2):247-54.
Cuxart M, Picazo M, Sans R, Huerta V. Biopsia renal en un hospital comarcal [Renal biopsy in a regional hospital]. Nefrologia. 2007;27(4):519.
Bahiense-Oliveira M, Saldanha LB, Mota EL, et al. Primary glomerular diseases in Brazil (1979-1999): is the frequency of focal segmental glomerulosclerosis increasing? Clin Nephrol. 2004;61(2):90-7.
Hwang HJ, Kim BS, Shin YS, et al. Predictors for progression in immunoglobulin A nephropathy with significant proteinuria. Nephrology (Carlton). 2010;15(2):236-41.
D’Amico G. The commonest glomerulonephritis in the world: IgA nephropathy. Q J Med. 1987;64(245):709-27.
Donadio JV, Grande JP. IgA nephropathy. N Engl J Med. 2002;347(10):738-48.
Iseki K, Miyasato F, Uehara H, et al. Outcome study of renal biopsy patients in Okinawa, Japan. Kidney Int. 2004;66(3):914-9.
Choi AI, O’Hare AM, Rodriguez R. Update on HIV-associated Nephropathy. Nephrology Rounds. 2007;5(7):1.
Queiroz MMM, Silva Junior GB, Lopes MS, et al. Estudo das doenças glomerulares em pacientes internados no Hospital Geral César Cals (Fortaleza-CE) [Study of glomerular diseases in patients admitted to the Hospital Geral César Cals (Fortaleza-CE)]. J Bras Nefrol. 2009;31(1):6-9.
Morales JV, Veronese FV, Prompt CA. Tratamento da glomeruloesclerose segmentar e focal primária com síndrome nefrótica em adultos: experiência de 15 anos. In: Cruz J, Cruz HM, Kirsztajn GM, Barros RT, editores. Atualidades em nefrologia. São Paulo: Sarvier; 2008. p. 182-7.
D’Agati VD, Kaskel FJ, Falk RJ. Focal segmental glomerulosclerosis. N Engl J Med. 2011;365(25):2398-411.
Ponticelli C, Glassock RJ. Treatment of primary glomerulonephritis. 2nd ed. New York: Oxford Press; 2009.
Alexopoulos E. How important is renal biopsy in the management of patients with glomerular diseases? Nephrol Dial Transplant. 2001;16 Suppl 6:83-5.
Korbet SM. Percutaneous renal biopsy. Semin Nephrol. 2002;22(3):254-67.
Castro R, Sequeira MJ, Faria MS, et al. Biópsia renal percutânea: experiência de oito anos [Percutaneous kidney biopsy: eight years-experience]. Acta Med Port. 2004;17(1):20-6.
Lasmar EP. Biópsia renal percutânea: experiência pessoal em 30 anos [Percutaneous renal biopsy: a 30-year personal experience]. J Bras Nefrol. 2007;29(1):25-8.
