No abstract available.
Classification* ; Glomerulonephritis, Membranoproliferative*

Glomerulonephritis, IGA ; classification ; pathology ; Humans ; Kidney ; pathology

Child ; Glomerulonephritis ; classification ; diagnosis ; therapy ; Humans

BACKGROUND: Crescentic glomerulonephritis is expressed pathologically by crescent formation in Bowman's capsule and clinically by rapidly progressive loss of renal function. The pathologic experience of crescentic glomerulonephritis in one institution was analyzed here. METHODS: We classified 25 cases of crescentic glomerulonephritis patients into 4 categories and reviewed the cases pathologically and clinically. RESULTS: We found no case with group I (anti- GBM disease), 8 cases in group II (immune complex glomerulonephritis) including 3 patients with IgA nephropathy, 2 patients with Henoch-Sch nlein purpura and 3 patients with APSGN, 12 cases in group III (ANCA-associated glomerulonephritis) including 7 patients with microscopic polyangitis, 4 patients with Wegener's granulmatosis and 1 patient with ANCA GN, and 5 cases in group IV (idiopathic crescentic glomerulonephritis). The mean ages of patients with group II, III, and IV were 32.0, 59.3 and 39.0 years old, respectively, and mean serum creatinine levels at the time of biopsy were measured as 9.1, 5.2, 8.8 mg/dL in each group. On light microscopic findings, the frequency of crescents in glomeruli was 64.4% in group II, 43.7% in group III, and 51.2% in group IV. The score of infiltration into tubules of inflammatory cells was 0.8 in group II, 0.4 in group III, and 0.6 in group IV and the score of fibrosis in interstitium was 1.0 in group II, 0.8 in group III and 1.2 in group IV. The score of atherosclerosis in arteries was 1.4, 0.9 and 1.6 in each group. CONCLUSION: We conclude that the precise diagnosis and classification of crescentic glomerulonephritis by an early renal biopsy and clinical assessments are important in the management of rapidly progressive (crescentic) glomerulonephritis. Since the number of the cases was not so enough, we could not analyze the statistical significance between morphologic differences of each group of crescentic glomerulonephritis, but if more cases were collected, acknowledgements of differences and prognostic factors in pathologic findings could be possible.
Antibodies, Antineutrophil Cytoplasmic ; Arteries ; Atherosclerosis ; Biopsy ; Bowman Capsule ; Classification ; Creatinine ; Diagnosis ; Fibrosis ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Humans ; Purpura

PURPOSE: Clinicopathological features were investigated to clarify the outcome and prognostic indicators for patients with IgA nephropathy in Korean children. METHODS: We reviewed the outcomes of 61 patients in whom IgA nephropathy was diagnosed before the age of 15 years from 1991 to 2005 and followed-up at least for one year. All patients were confirmed by renal biopsy. RESULTS: After mean follow-up of 5.2 years from onset, 24 patients of 61 (39.3%) were in clinical remission at the last examination. Thirty patients (49.2%) had hematuria or mild proteinuria (<1 g/ m2/d), five (8.2%) had severe proteinuria (> or =1 g/m2/d), and two (3.3%) had chronic renal failure. By univariate analysis, initial presentation at onset and Haas classification were less concordant with outcome. Hypertension during follow-up, rather than hypertension at presentation, was significantly correlated with outcomes (P<0.01). Sixty percent of patients who had more than 20% of glomerular sclerosis or crescent progressed to severe proteinuria or chronic renal failure, as compared with 7.1% of those who did not (P<0.01). CONCLUSION: Prognosis of childhood IgA nephropathy had a relatively benign course during a mean follow-up of 5.2 years. Persistent hypertension during follow-up and more than 20% of glomerular sclerosis or crescent were strong predictors of a progressive course of IgA nephropathy. A new histologic classification according to characteristics of childhood IgA nephropathy must be established to assess prognosis. Further efforts should be made to understand the prognosis of IgA nephropathy through long-term follow-up.
Biopsy ; Child ; Classification ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Prognosis* ; Proteinuria ; Sclerosis

PURPOSE: Urinary N-acetyl-beta-D-glucosaminidase (NAG) has been known to reflect the damage of proximal tubular cells in the early stages of renal disease. Recent studies have demonstrated that tubular grade predicted renal outcome better than did other histological parameters in IgA nephropathy. We evaluated the meaning of urinary NAG in relation with initial histological features and renal outcomes in early subclinical IgA nephropathy. METHODS: Among the firstly diagnosed IgA nephropathy patients from Jan 2001 to Dec 2002, 43 subjects were selected with the criteria of normal renal function and 24-h urinary protein excretion <3.5 g/day. The subjects were followed for 2 years. Pathologic lesion was graded according to HASS classification and semiquantitative scorings, from 0 to 3, were carried out for glomerular (GG), interstitial (IG), tubular (TG), and vascular (VG) lesion. RESULTS: The subjects consisted of 20 male and 23 female with mean age of 30+/-13 years, baseline blood pressure 116+/-15/74+/-10 mmHg, Cr 1.03+/-0.24 mg/dL, Ccr 88+/-19 mL/min, 24-h urinary protein excretion (UPER) 1, 790+/-1, 610 mg/24-h, urinary NAG 11.8+/-11.0 U/g cr at the time of biopsy. Hass subclass was correlated significantly with glomerular, tubular, and interstitial grades (all p<0.05). In comparison with clinical parameters, glomerular grade was significantly related with 24-h UPER (p<0.05) and tubular grade was significantly related with systolic blood pressure (p<0.05). Urinary NAG level at the time of biopsy show significant correlation with tubular grade (p<0.05). Progression of renal disease occurred in nine patients (20.9%). The patients with renal disease progression showed significantly low baseline Ccr, high 24-h UPER, and high NAG (all p<0.05). In pathological findings, tubular grade was significantly related with renal prognosis (p<0.05). In regression analysis, tubular grade was a independent predictor of renal prognosis among above four parameters showing significant differences. In survival analysis, tubular grade 0, 1 and grade 2, 3 showed significant difference in renal survival as compared to each other. The patients with baseline NAG urinary NAG above 10 U/g Cr showed significantly worse renal survival as compared with those below 10 U/g Cr (p<0.05). CONCLUSION: Tubular lesion is an independent factor associated with renal progression in these patients. Urinary NAG reflects well the degree of tubular lesion at the time of biopsy. We carefully suggest, therefore, that the measurement of urinary NAG level is helpful to estimate tubular lesion and predict renal prognosis in subclinical asymptomatic IgA nephropathy patients before they undergo renal biopsy.
Acetylglucosaminidase ; Biopsy ; Blood Pressure ; Classification ; Disease Progression ; Female ; Glomerulonephritis, IGA* ; Hexosaminidases* ; Humans ; Immunoglobulin A* ; Male ; Prognosis*

The new revised classification of glomerulonephritis in systemic lupus erythematosus under the auspice of the International Society of Nephrology and the Renal Pathology Society (ISN/ RPS) was proposed in 2003. The revised classification preserves the simplicity of the original WHO classification, incorporates selective refinements concerning activity and chronicity from the 1982 and 1995 revisions, and adds a number of new modifications. Overall, it bears a strong similarity to the 1974 classification, but introduces several important modifications concerning quantitative and qualitative differences between class III and IV lesions. The new classification provides a clear and unequivocal description of the various lesions and classes of lupus nephritis as well as definitions for diagnostic terms. This review is introduced the ISN/RPS 2003 classification which will facilitates accurate communication between pathologists and clinicians.
Biopsy ; Classification* ; Glomerulonephritis ; Kidney ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Nephrology ; Pathology*

OBJECTIVETo investigate retrospectively the incidence, distribution of primary disease and clinicopathologic characteristics of diffuse crescentic glomerulonephritis (DCGN) in Chinese patients.

METHODSOne hundred and seventy-two consecutive patients diagnosed as having DCGN out of 9828 cases of non-transplanting renal biopsies over sixteen years, were studied. DCGN is categorized into three types according to immunopathologic characteristics. The incidence of this disease, its primary diseases, clinical characteristics and serum antineutrophil cytoplasmic antibodies (ANCAs) were analyzed.

RESULTSThe distribution of patients among the three classifications was 8.7% type I, 68.6% type II and 22.7% type III. Clinically, the majority of patients (69.8%) presented rapidly progressive glomerulonephritis (RPGN), but 30.2% manifested a chronic nephritic syndrome or chronic renal failure. In terms of related conditions, 93% were anemic, 61.6% had hypertension, 50.6% oliguria, 45.3% nephrotic syndrome, 43% uremic syndrome and 39.5% displayed gross hematuria. Those patients who were positive in serum for ANCAs had predominantly type III DCGN. Two cases with anti-GBM-antibody crescentic glomerulonephritis and three with lupus nephritis were also positive for ANCAs in serum.

CONCLUSIONDCGN is not rare in Chinese patients. A majority of patients in our study presented with RPGN, but 30.2% manifested a chronic renal failure. Lupus patients with DCGN that were positive for ANCAs had more severe vasculitic lesions.

Adolescent ; Adult ; Aged ; Child ; China ; epidemiology ; Female ; Glomerulonephritis ; classification ; epidemiology ; Humans ; Male ; Middle Aged

BACKGROUND: IgA nephropathy is characterized by showing a prominent mesangial deposition of IgA in biopsy specimens. More than 20% of these patients progress to an end-stage renal disease over a period of 20 years. However, it is difficult to perform renal biopsies in all patients who present with hematuria or proteinuria. The present study was undertaken to determine whether discriminant analysis before renal biopsy is useful in the diagnosis of IgA nephropathy. METHODS: A total of 144 patients who were diagnosed by renal biopsy were analyzed. This group of 144 patients included 76 patients who had an IgA nephropathy, and did not include those patients that had systemic lupus erythematosus, Henoch-Schonlein purpura or other systemic diseases, and 68 patients with a different kind of primary chronic glomerulonephritis. Discriminant analysis was used to clearly demarcate these two groups by using 20 clinical variables. RESULTS: Among the 20 clinical variables, the levels of serum albumin, serum IgG, serum IgA, the degree and quantitation of proteinuria, the degree of microhematuria, and the RBC counts of the urinary sediments in the IgA nephropathy group were significantly higher than those in the non-IgA nephropathy group. Also, the presence of subjective symptoms was significantly different between the two groups. Using the stepwise method, serum albumin (ALB), serum IgA (IGA), and the degree of microhematuria (MICRO) were chosen to be the discriminant markers and resulted in a correct classification rate of 81.3%. The discriminant function (D) was 'D=0.842XALB+0.523XIGA+0.414XMICRO'. CONCLUSIONS: It was considered that discriminant analysis using clinical markers such as serum albumin, serum IgA, and degree of microhematuria before renal biopsy is useful in the clinical diagnosis of IgA nephropathy.
Biomarkers ; Biopsy ; Classification ; Diagnosis* ; Discriminant Analysis ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Immunoglobulin G ; Kidney Failure, Chronic ; Lupus Erythematosus, Systemic ; Proteinuria ; Purpura, Schoenlein-Henoch ; Serum Albumin

BACKGROUND: All types of membranoproliferative glomerulonephritis (MPGN) are progressive diseases with poor prognoses. Recently, a newly proposed classification of these diseases separated them into immune complex- and complement- mediated diseases. We investigated the frequency of C3 glomerulonephritis among previously diagnosed MPGN patients. METHODS: We conducted a retrospective study of patients diagnosed with MPGN at three tertiary care institutions between 2001 and 2010. We investigated the incidence of complement-mediated disease among patients diagnosed with MPGN. Progressive renal dysfunction was defined as a 50% reduction in the glomerular filtration rate or the need for renal replacement therapy. RESULTS: Among the 3,294 renal biopsy patients, 77 (2.3%) were diagnosed with MPGN; 31 cases were excluded, of which seven were diagnosed with systemic lupus nephritis, and the others were not followed for a minimum of 12 months after biopsy. Based on the new classification, complement-mediated MPGN was diagnosed in two patients (4.3%); only one patient developed progressive renal dysfunction. Among the immune complex-mediated MPGN patients, 17 patients developed progressive renal dysfunction. Serum albumin and creatinine levels at the time of MPGN diagnosis were risk factors of renal deterioration, after adjusting for low C3 levels and nephrotic syndrome. CONCLUSION: Complement-mediated glomerulonephritis was present in 4.3% of patients previously diagnosed with MPGN.
Biopsy ; Classification* ; Complement C3 ; Creatinine ; Diagnosis ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Glomerulonephritis, Membranous ; Humans ; Incidence ; Lupus Nephritis ; Nephrotic Syndrome ; Prognosis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Tertiary Healthcare