PURPOSE: There has been several studies about pathological findings of the asymptomatic urinary abnormalities (AUA) in children. But most of them are based on collaboratively collected data. That kinds of studies might have some bias due to different criteria for renal biopsy. We analyzed histopathological findings of AUA patients experienced in a single hospital and analyzed the efficacy of renal biopsy according to the clinical findings. METHODS: We reviewed the pathological reports and clinical data of 171 patients with AUA who had renal biopsies for the last 20 years. Patient were divided into 3 groups based on the urinalysis: hematuria group, proteinuria group, combined hematuria and proteinuria group. To analyze the efficacy of renal biopsy, we defined "modifiable diseases" as those diseases of which early treatment can alter the prognosis, including IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulonephritis and focal segmental glomerulosclerosis. RESULTS: Male to female ratio was 2.2 to 1, and the highest incidence was in the age group of 6 to 10 years. IgA nephropathy (49%) was the most frequent pathological diagnosis. The incidence of "modifiable diseases" were higher in the group of combined proteinuria and hematuria, compared to isolated hematuria or proteinuria group. CONCLUSION: IgA nephropathy was most frequent pathological diagnostic entity in AUA. The efficacy of renal biopsy, which can be defined as the possibility of diagnosing "modifiable disease" by renal biopsy, is greater in the combined hematuria and proteinuria group than hematuria or proteinuria group.
Bias (Epidemiology) ; Biopsy ; Child ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Humans ; Incidence ; Male ; Prognosis ; Proteinuria

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

Poststreptococcal glomerulonephritis (PSGN) is one of the most recognized diseases in pediatric nephrology. Typical clinical features include rapid onset of gross hematuria, edema, and hypertension, and cases are typically preceded by an episode of group A β-hemolytic streptococcus pharyngitis or pyoderma. The most common presenting symptoms of PSGN are the classic triad of glomerulonephritis: gross hematuria, edema, and hypertension . However, patients with PSGN sometimes present with unusual or atypical clinical symptoms that often lead to delayed diagnosis or misdiagnosis of the disease and increased morbidity. Additionally, the epidemiology of postinfectious glomerulonephritis (PIGN), including PSGN, has changed over the past few decades. This paper reviews atypical clinical manifestations of PSGN and discusses the changing demographics of PIGN with a focus on PSGN.
Delayed Diagnosis ; Demography ; Diagnostic Errors ; Edema ; Epidemiology ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Nephrology ; Pharyngitis ; Pyoderma ; Streptococcus

China ; Diabetic Nephropathies ; epidemiology ; metabolism ; pathology ; Glomerulonephritis, IGA ; epidemiology ; metabolism ; pathology ; Humans ; Kidney Diseases ; epidemiology ; metabolism ; pathology ; Lupus Nephritis ; epidemiology ; metabolism ; pathology

BACKGROUND: Idiopathic membranoproliferative glomerulonephritis (MPGN) is a chronic primary glomerular disease that occurs in both children and adults, with generally progressive course. We have examined the clinical and long-term outcome of patients with idiopathic MPGN at Keimyung University Dongsan Medical Center. METHODS: Of the total 1,971 patients with biopsy-proven glomerulonephritis over the 21-year period from June 1982 and June 2003, there were 51 cases of idiopathic MPGN of whom 49 had type I and two type II. RESULTS: Of the total 51 idiopathic MPGN, male to female ratio was 1.7:1, a mean age at diagnosis was 32 +/- 17 years (range; 6-70) and 50% of the patients were under the age of 30. The clinical presentations at the time of diagnosis were nephrotic syndrome (70%), asymptomatic urinary abnormality (18%), acute nephritic syndrome (6%), and recurrent gross hematuria (6%). Of the 40 patients who followed more than 6 months, with a mean follow-up of 71months, 10 patients progressed to end-stage renal disease. The renal survival at 5 and 10 years after diagnosis were 86 and 52%, respectively. Eight (20%) patients obtained a complete remission and none of them progressed to end-stage renal failure. The quantity of proteinuria at the time of biopsy was much more prominent in deteriorating group, though not significant (p=0.05) and young age and female seemed associated with the complete remission (p<0.05). CONCLUSION: Idiopathic MPGN remains a disease with a poor prognosis. Age, gender and quantity of proteinuria at the time of diagnosis were associated with the prognosis. Further prospective study with larger number of patients would be necessary to assess the prognostic factors and effective therapy for idiopathic MPGN.
Adult ; Biopsy ; Child ; Diagnosis ; Epidemiology ; Female ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Humans ; Kidney Failure, Chronic ; Male ; Nephrotic Syndrome ; Prognosis ; Proteinuria

BACKGROUND: We performed this study to elucidate the incidence and the types of glomerular diseases present in young Korean men. METHODS: Between January 1998 and December 2000, 222 military conscripts were submitted to 13 military hospitals for renal biopsy after poststreptococcal glomerulonephritis (PSGN) had been excluded. Clinical data and renal biopsies were reviewed retrospectively. On the basis of this data, we obtained the annual detection rate of glomerular disease in military conscripts. We also ascertain the prevalence of glomerular disease in pre-induction medical examination during the same period. RESULTS: Total two hundred and ten cases of glomerulonephritis including 30 cases of PSGN were diagnosed on renal biopsy. After additional six patients with nephrotic syndrome were included, total 216 patients were diagnosed as glomerular disease. Among one hundred and eighty six patients excluding the patients with PSGN, 90 cases presented with asymptomatic urinary abnormality, 63 nephrotic syndrome, 25 acute nephritis, 8 chronic GN. In exclusion of PSGN, the most common glomerular diseases observed were those due to IgA nephropathy (42.8%), minimal change disease (15.6%) and focal segmental glomerulosclerosis (14.4%). IgA nephropathy was most common (57%) in 96 patients presented with asymptomatic urinary abnormality. On the basis of the figures in this study the average number of annually detected cases of GN was 13.8 per 100,000 Korean Amy. During the same period an annual average of 70.0 per 100,000 young men were exempted from military service because of Glomerulonephritis. CONCLUSION: Average number of annually detected cases of glomerulonephritis is 13.8 per 100,000 and IgA nephropathy is most common in young Korean conscripts.
Biopsy ; Epidemiology ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hospitals, Military ; Humans ; Incidence ; Male ; Military Personnel ; Nephritis ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Prevalence ; Retrospective Studies

BACKGROUND: We performed this study to elucidate the incidence and the types of glomerular diseases present in young Korean men. METHODS: Between January 1998 and December 2000, 222 military conscripts were submitted to 13 military hospitals for renal biopsy after poststreptococcal glomerulonephritis (PSGN) had been excluded. Clinical data and renal biopsies were reviewed retrospectively. On the basis of this data, we obtained the annual detection rate of glomerular disease in military conscripts. We also ascertain the prevalence of glomerular disease in pre-induction medical examination during the same period. RESULTS: Total two hundred and ten cases of glomerulonephritis including 30 cases of PSGN were diagnosed on renal biopsy. After additional six patients with nephrotic syndrome were included, total 216 patients were diagnosed as glomerular disease. Among one hundred and eighty six patients excluding the patients with PSGN, 90 cases presented with asymptomatic urinary abnormality, 63 nephrotic syndrome, 25 acute nephritis, 8 chronic GN. In exclusion of PSGN, the most common glomerular diseases observed were those due to IgA nephropathy (42.8%), minimal change disease (15.6%) and focal segmental glomerulosclerosis (14.4%). IgA nephropathy was most common (57%) in 96 patients presented with asymptomatic urinary abnormality. On the basis of the figures in this study the average number of annually detected cases of GN was 13.8 per 100,000 Korean Amy. During the same period an annual average of 70.0 per 100,000 young men were exempted from military service because of Glomerulonephritis. CONCLUSION: Average number of annually detected cases of glomerulonephritis is 13.8 per 100,000 and IgA nephropathy is most common in young Korean conscripts.
Biopsy ; Epidemiology ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hospitals, Military ; Humans ; Incidence ; Male ; Military Personnel ; Nephritis ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Prevalence ; Retrospective Studies

Since Combes' first description of hepatitis B virus associated membranous glomerulonephritis, many reports have shown a strong association of hepatitis B virus infection with various types of nephropathies, especially membranous glomerulonephritis and membranoproliferative glomerulonephritis. Recently, the authors experienced a case of membranoproliferative glomerulonephritis, type I in a 16-year-old male patient with persistent HBs and HBe antigenemia. One year prior to admission the patient was told of hepatitis at routine check, but he remained asymptomatic throughout. He was admitted to our hospital with chief complaints of proteinuria and microscopic hematuria found on routine urinalysis. Liver and kidney biopsy revealed chronic persistent hepatitis and membranoproliferative glomerulonephritis type I, respectively. We report a case of hepatitis B virus associated nephropathy with review of the literatures. Considering the endemic nature of hepatitis B virus infection in Korea, the incidence of hepatitis B virus associated nephropathy would be proportionally high in comparison with those of other countries. So, the importance of this entity merits special consideration in our country. Further study concerning pathogenesis, epidemiology, and treatment may be needed.
Adolescent ; Biopsy ; Epidemiology ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Incidence ; Kidney ; Korea ; Liver ; Male ; Proteinuria ; Urinalysis

To evaluate the distribution and changing patterns of renal diseases in Korea, a total of 4,514 cases of renal biopsy collected over a 23-year period between 1973 and 1995 were reviewed. Of 4,200 cases excluding 314 unsatisfactory biopsies, adult cases comprised 59.5% and pediatric cases, 40.5%. The male to female ratio was 1.5:1 in adults and 2.2:1 in children. Glomerulonephritis (GN) comprised 80.0% of the total. The most common primary GN in adults was minimal change disease (MCD) (26.6%), followed by IgA nephropathy (IgAN) (22.1%), membranous GN (MGN) (11.8%), and membranoproliferative GN (MPGN) (5.9%). In children, the primary GN incidence rates were MCD (24.8%), IgAN (10.3%), poststreptococcal (including postinfectious) GN (PSGN) (8.6%), and focal segmental glomerulosclerosis (FSGS) (4.0%). The most common secondary GN in adults was lupus nephritis and in children Henoch-Schonlein purpura nephritis. The most common cause of nephrotic syndrome was MCD in both adults and children, followed by MGN and FSGS. The elderly, aged sixty years and older, comprised 2.7% of cases and recorded equal numbers of MCD and MGN. The proportion of the biopsies found to be seropositive for HBs antigen was 27.9%, and these showed either MGN or MPGN pattern. Repeat biopsy was performed in 168 patients, due to previous biopsy failure in 15.5%. When the primary GN cases were analyzed at 5-year intervals, the prevalence of PSGN, which was greater than 25% during the 1973-1982 period, decreased abruptly in children thereafter, whereas the prevalence of FSGS increased slowly since the 1988-1992 period in both adults and children. The decrease of PSGN and the increase of FSGS suggest a role for socioeconomic and environmental factors in Korea.
Adult ; Age Distribution ; Biopsy ; Child ; Female ; Glomerulonephritis/pathology ; Glomerulonephritis/epidemiology ; Glomerulosclerosis, Focal/pathology ; Glomerulosclerosis, Focal/epidemiology ; Human ; Kidney/pathology* ; Kidney Diseases/pathology* ; Kidney Diseases/epidemiology* ; Korea ; Male ; Middle Age ; Prevalence ; Sex Distribution

A retrospective study of 223 patients with IgA nephropathy (IgAN) was performed to clarify the prognostic factors and the renal survival rates of the disease. One hundred twenty-two patients were followed-up for more than 6 months after their renal biopsy (mean follow-up duration: 43.0 months), and 20 of them (16.4%) had progressed to end-stage renal disease (ESRD). Using univariate analysis, 8 risk factors (2 clinical and 6 histopathological findings) for developing ESRD were identified: renal insufficiency at initial presentation (serum creatinine > or = 1.5 mg/dl); heavy proteinuria(> or = 3.5 gm/day); moderate to severe histopathologic findings such as class IV/V lesions by W.H.O. classification, mesangial hypercellularity, glomerular sclerosis, interstitial infiltration, interstitial fibrosis, and tubular atrophy. In multivariate regression analysis, class IV/V lesions and renal insufficiency at initial presentation were the independent prognostic factors of IgAN. The renal survival rates were 100% at 1 year, 97.0% at 3 years, and 78.9% at 5 years. In conclusion, it seems that about 20% of IgAN patients have a risk to progress to ESRD within 5 years, and a careful follow-up is recommended especially in patients who have either renal insufficiency at the time of presentation or severe renal pathology (class IV/V lesions).
Adolescent ; Adult ; Female ; Glomerulonephritis, IGA/*complications/pathology ; Human ; Kidney Failure, Chronic/*epidemiology/*etiology/pathology ; Male ; Prognosis ; Retrospective Studies ; Risk Factors