exudates and Glomerulonephritis--IGA

Angiotensin-converting enzyme (ACE) gene polymorphism, especially the deletion/deletion (DD) genotype, is associated with the disease progression of immunoglobulin A (IgA) nephropathy patients in various studies from both Asia Pacific and European populations. However, recent studies within the same populations were unable to reproduce the same results. Hence, we had studied the distribution of the DD genotype, the association between ACE gene polymorphism and the disease progression, and the factors (other than ACE gene polymorphism) which were involved in the disease progression of our local patients.. This was a cross-sectional study of biopsy-proven IgA nephropathy patients attending the Nephrology Clinic, Hospital Universiti Kebangsaan Malaysia. Both biochemical and urine tests at the time of first presentation were compared to those at the time of the study, and the disease progression was analysed. The ACE gene polymorphism was identified via PCR-amplification technique, and patients were then categorised into the DD and the non-DD groups for detailed analysis. Histological severity of each renal biopsy was scored according to the predetermined criteria and medications used were recorded. The association between the gene polymorphism and disease progression was then determined. The patients who were stable or had renal function deterioration, were respectively regrouped into Groups 1 and 2, to identity those factors (other than ACE gene polymorphism), which were involved in the disease progression.. 60 patients with adequate renal histopathological examination were recruited. Their mean age was 40.9 +/- 12.3 years and the follow-up duration was 4 +/- 3 years (range 6 months-20 years). More than two-thirds of them were treated with ACE inhibitors or angiotensin receptor blockers and 8.3 percent received the combination treatment. The DD genotype was noted in 13.3 percent of study patients, insertion/insertion in 48.3 percent and insertion/deletion genotype in 38.3 percent. Although the estimated glomerular filtration rate (eGFR) of both groups were the same during their initial presentation, the DD patients had more severe disease compared to the non-DD patients at the time of the study. Their serum creatinine and eGFR was 178 (IQR 31.3) micromol/L and 42.1 +/- 31.1 ml/min/1.73 square metres, whereas the non-DD patients had serum creatinine and eGFR of 79 (IQR: 88.3) micromol/L and 76.6 +/- 42.1 ml/min/1.73 square metres, respectively (p-value is less than 0.01). The DD patients were also found to have more severe vascular damage in their renal biopsies compared to the non-DD patients. The annual rate of decline in eGFR was not significantly different between the two groups. It was -5.7 +/- 2.2 ml/min/1.73 square metres/year for the DD group and -4.8 +/- 2.0 ml/min/1.73 square metres/year for the non-DD group (p-value is equal to 0.5). They also had severe proteinuria with UPCI of 0.09 (IQR 0.2) g/mmol creatinine vs. 0.04 (IQR 0.10) g/mmol creatinine (p-value is less than 0.01). The study also confirmed that patients who had higher systolic blood pressure, greater proteinuria and longer follow-up duration had significant renal function deterioration compared to those who did not.. The DD genotype, although found in a minority of the patients, might have adversely affected the disease progression of our IgA nephropathy patients. Higher systolic blood pressure, greater proteinuria and longer follow-up duration were the other prognostic factors in IgA nephropathy patients. However, appropriate treatment, especially prompt use of renin-angiotensin-aldosterone system blockade, should stabilise the disease regardless of their genotype.

Topics: Adult; Cross-Sectional Studies; Disease Progression; Female; Gene Deletion; Genotype; Glomerular Filtration Rate; Glomerulonephritis, IGA; Humans; Malaysia; Male; Middle Aged; Peptidyl-Dipeptidase A; Polymorphism, Genetic; Renin-Angiotensin System

Renal biopsy is essential in the management of renal parenchymal diseases. Thus far there is no publish report on the pattern of glomerulonephritis in Kelantan. We decided to establish the pattern of glomerulonephritis in Kelantan and use this information as our reference in future studies. Records of patients who had proven glomerulonephritis histologically were analysed. Their biological data, clinical presentation, etiology and clinicopathological pattern were studied. Where appropriate mean and standard deviation were calculated. A total of 74 biopsies were performed during the study period (between January 1991 and December 1993), out of which 72 biopsies (97.3%) were considered suitable for analysis. The male to female ratio was 1:1.1. Mean age at presentation was 27.6 +/- 12.2 years. Nephrotic syndrome was the commonest clinical presentation (65.3%). The main underlying cause was systemic lupus erythematosus (50%) followed by primary glomerulonephritis. Histologically, IgA nephropathy and minimal change disease were the main patterns among patients with primary glomerulonephritis while diffuse proliferative glomerulonephritis was the commonest pattern among patients with lupus nephritis. Hence the pattern of glomerulonephritis is similar to other reported series. The procedure is considered safe and has a high success rate.

Topics: Adult; Biopsy; Female; Glomerulonephritis; Glomerulonephritis, IGA; Humans; Incidence; Lupus Nephritis; Malaysia; Male; Nephrotic Syndrome; Retrospective Studies; Sex Distribution

An analysis of 1000 consecutive, adequate renal biopsies from patients of the University Hospital Kuala Lumpur between 1982 and 1991 revealed: minimal change nephritis (20.7%), focal glomerulosclerosis (2.9%), proliferative glomerulonephritides (16.0%), membranous glomerulonephritis (5.5%), IgA nephropathy (18.5%), lupus nephritis (24.9%), end stage nephropathy (3.1%) and others (8.4%). Compared with the previous decade, IgA nephropathy has emerged as a common entity. Lupus nephritis forms the largest diagnostic entity and is probably related to the selected referral of SLE patients to this hospital.

Topics: Adolescent; Adult; Aged; Asian People; Biopsy; Child; Child, Preschool; China; Female; Glomerulonephritis, IGA; Humans; India; Kidney Diseases; Malaysia; Male; Middle Aged

Two-hundred and sixty-five patients with asymptomatic proteinuria and/or haematuria were studied at the Department of Medicine, Universiti Kebangsaan Malaysia and Department of Nephrology, General Hospital Kuala Lumpur. They represented 25.4% of all the renal biopsies performed during the period 1980-88. All the three races were affected with 71.3% occurring between the ages of 20-39 years and 41.1% were detected during routine medical examination. Excluding those patients with lupus nephritis, IgA nephropathy was the commonest histological diagnosis (51.7%). The presence of severe and advanced histological changes in a significant number of biopsies emphasises the need for more effective screening and early referral of this group of patients.

Topics: Adolescent; Adult; Glomerulonephritis; Glomerulonephritis, IGA; Hematuria; Humans; Malaysia; Middle Aged; Proteinuria

A total of 164 patients with IgA nephropathy were diagnosed at the Department of Medicine, Universiti Kebangsaan Malaysia and the Department of Nephrology, General Hospital, Kuala Lumpur between 1981-1988. This represented an incidence of 20.1% of all primary glomerulopathies seen in both units. The 3 major ethnic groups were equally affected with 59.7% occurring between the ages of 20-36 years. It was not uncommon in females. The high prevalence of hypertension, renal failure, heavy proteinuria at presentation and the increased chronicity index in the biopsy, suggest that IgA nephropathy is progressive disease leading to chronic renal failure.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Female; Fluorescent Antibody Technique; Glomerulonephritis, IGA; Humans; Incidence; Malaysia; Male; Middle Aged; Retrospective Studies; Sex Factors

In the 10-year period from October 1977 to July 1987, 149 cases of primary IgA nephropathy were histologically confirmed through renal biopsies in the Department of Pathology, University Hospital, Kuala Lumpur. The ages of these patients ranged from 5 to 72 years, with the majority in the 20-30 year age group. There was no sex preponderance. The ethnic distribution showed a significant predominance of Chinese with 107 (71.8%) Chinese, 24 (16.1%) Malays, 15 (10.1%) Indians and 3 others. A wide range of renal glomerular pathology was seen, the commonest being diffuse mesangioproliferative glomerulonephritis (59.1%). Focal proliferative glomerulonephritis (14.1%) followed by minimal change glomerulonephritis (10.7%) were next in order of frequency. Immunofluorescence studies consistently demonstrated heavy and predominant IgA deposition in the mesangium. Weak deposition of C3, IgG and IgM were also observed in various combinations.

Topics: Adolescent; Adult; Aged; Biopsy; Child; Child, Preschool; Female; Fluorescent Antibody Technique; Glomerulonephritis, IGA; Humans; Kidney Glomerulus; Malaysia; Male; Microscopy, Fluorescence; Middle Aged

Topics: Adolescent; Adult; Biopsy; Child; Female; Glomerulonephritis, IGA; Humans; Kidney Glomerulus; Malaysia; Male