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      Patterns in renal diseases diagnosed by kidney biopsy: A single-center experience

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          Abstract

          Background

          The worldwide incidence of renal disease diagnosed by a kidney biopsy varies with age, race, sex, and region. Owing to a lack of studies and limited research resources for this disease in Korea, we investigated renal disease patterns by analyzing data from kidney biopsies performed over 13 years in a university-based teaching hospital in Korea.

          Methods

          Among 2,053 kidney biopsies performed from 2001 to 2013 at Kyungpook National University Hospital, 1,924 were retrospectively analyzed for histopathologic, demographic, and clinical data as well as laboratory results.

          Results

          Among the 1,924 studied kidney biopsies, 1,078 were males (56.0%) and the mean age was 37.7 ± 16.5 years. Asymptomatic urinary abnormalities were the most common clinical manifestation (62.5%). Immunoglobulin A nephropathy (IgAN) was the most common primary glomerular disease (37.4%), followed by minimal change disease (MCD), membranous nephropathy (MN), focal segmental glomerulonephritis and crescentic glomerulonephritis. Secondary glomerular diseases accounted for 10.3% of the total biopsies, with lupus nephritis being the most common (4.6%) followed by Henoch-Schönlein purpura nephritis and diabetic nephropathy. The most common cause of nephrotic syndrome was MCD (42.1%) followed by MN. Among patients seropositive for hepatitis B or C, IgAN (28.3% and 21.4%, respectively) was the most common cause.

          Conclusion

          IgAN and lupus nephritis were the most common primary and secondary glomerular diseases, respectively. Race, region, and practice patterns may affect renal disease patterns in different cohorts.

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          Most cited references30

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          IgA nephropathy.

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            Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience.

            The prevalence of glomerular diseases differs according to geographic area, race, age and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of renal diseases during the past 20 years in a large patient population in Korea. Patients aged 16 years or older who underwent a renal biopsy at Severance Hospital in the Yonsei University Health System from 1987 to 2006 were enrolled. All medical records were reviewed retrospectively. In total, 1818 patients (M:F = 1.02:1) were reviewed. Glomerulonephritis (GN) comprised 85.9% of the total biopsied cases. The most common primary GN was IgA nephropathy (IgAN) (28.3%), which was followed by minimal change disease (MCD) (15.5%), membranous nephropathy (MN) (12.3%), focal segmental glomerulosclerosis (FSGS) (5.6%) and membranoproliferative GN (MPGN) (4.0%). The most common secondary GN was lupus nephritis (8.7%). The most common idiopathic nephrotic syndrome was MCD (38.5%), which was followed by MN and IgAN. Among 128 (7.4%) patients who were HBsAg-positive, MN (30.5%) and MPGN (21.1%) were the most common GN. When the incidence rates between 1987-91 and 2002-06 were compared, IgAN increased from 25.6 to 34.5%, while MCD (from 23.2 to 7.0%) and MPGN (from 6.7 to 1.7%) decreased significantly (P < 0.01). IgAN was the most common primary GN, and MCD was the most common cause of nephrotic syndrome. In the 5-year quartile comparison, the relative frequency of IgAN increased, while the relative frequency of MCD and MPGN decreased significantly during the past 20 years.
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              Clinicopathologic correlations of renal pathology in Spain.

              There are not enough large epidemiologic population-based studies of biopsy-proven nephropathies with detailed clinicopathologic correlations. The Glomerulonephritis Registry of the Spanish Society of Nephrology has obtained data from 9378 cases with native biopsy-proven renal diseases and well-known clinical syndrome between 1994 and 2001, investigating clinicopathologic correlations. Patients were divided in three groups according to age: children ( 65 years). The most common clinical syndrome at any age is nephrotic syndrome (35.5%), followed by asymptomatic urinary abnormalities (25.9%), acute renal failure (12.9%), chronic renal failure (12.1%), nephritic syndrome (4.5%), macroscopic haematuria (4.5%), and arterial hypertension (3.0%). A male predominance is observed at any age (3:2). The frequencies of histologic findings are statistically different in all syndromes according to age. Minimal change disease is the most frequent finding in children with nephrotic syndrome (39.5%), whereas in adults and elderly, membranous nephropathy is the most prevalent (24.2% and 28.0%, respectively). Ig A nephropathy (IgAN) is the most frequent glomerulonephritis in patients with asymptomatic urinary abnormalities at any age. Acute renal failure is an important cause for performing a kidney biopsy in elderly and vasculitis is the main histologic finding. The clinical manifestations of focal segmental glomerulosclerosis, non-IgA mesangial nephropathy, lupus nephritis, vasculitis, and nephroangiosclerosis are statistically different according to age. The findings of clinicopathologic correlations obtained from the Spanish Registry of Glomerulonephritis on native biopsy-proven renal diseases add valuable information to previous reports and it can be the initial step for follow-up and prospective studies.
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                Author and article information

                Journal
                Kidney Res Clin Pract
                Kidney Res Clin Pract
                Kidney Research and Clinical Practice
                Korean Society of Nephrology
                2211-9132
                2211-9140
                31 March 2020
                31 March 2020
                : 39
                : 1
                : 60-69
                Affiliations
                [1 ]Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
                [2 ]Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
                Author notes
                Correspondence: Sun-Hee Park, Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea. E-mail: sh- park@ 123456knu.ac.kr
                Ji-Young Choi, Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Bukgu, Daegu 41404, Republic of Korea. E-mail: jyss1002@ 123456hanmail.net

                Edited by Beom Jin Lim, Yonsei University, Seoul, Republic of Korea

                [*]

                These authors contributed equally to this study.

                Author information
                https://orcid.org/0000-0001-7153-9693
                https://orcid.org/0000-0003-0530-1665
                https://orcid.org/0000-0003-4916-8739
                https://orcid.org/0000-0001-5517-9886
                https://orcid.org/0000-0003-0232-7202
                https://orcid.org/0000-0002-7031-5214
                https://orcid.org/0000-0002-4648-0324
                https://orcid.org/0000-0002-1344-3455
                https://orcid.org/0000-0001-8856-553X
                https://orcid.org/0000-0002-9867-0752
                https://orcid.org/0000-0002-9774-3665
                https://orcid.org/0000-0002-0953-3343
                Article
                KRCP-39-060
                10.23876/j.krcp.19.077
                7105626
                31955562
                189c8afe-9001-4087-a306-6d923a7d5777
                Copyright © 2020 by The Korean Society of Nephrology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 July 2019
                : 19 November 2019
                : 19 November 2019
                Categories
                Original Article

                biopsy,glomerulonephritis,kidney diseases,nephrotic syndrome

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