PURPOSE: The incidence of glomerular diseases varies according to population characteristics and time period. METHODS: A total of 3,000 renal biopsies were performed over the 29 years' period from 1978 to 2007. We reviewed the patient records of all patients who underwent renal biopsies at our institution. The patients were grouped for analysis in three time intervals: before 1990, 1991 to 2000, and after 2001. RESULTS: There were 2,377 cases of native kidney biopsies and 623 cases of allograft kidneys. The principal long-term changes were an increase in the mean age of patients with undergoing biopsy and an increase in the percentage of asymptomatic urinary abnormalities as an indication for biopsy. In the primary glomerulonephritis (GN), the most common pathologic diagnosis was IgA nephropathy (IgAN, 26.6%), followed by minimal change disease (MCD, 21.4%), membranous nephropathy (8.9%), focal segmental glomerulosclerosis (7.7%). The major changes noted in primary GN were a marked increase in the frequency of IgAN and decrease in the frequency of MCD. Major causes of secondary GN were lupus nephritis (37.9%), and hepatitis associated GN (28.9%). In allograft biopsies, acute rejection (42.3%) and chronic rejection (19.4%) were the two most common diagnoses. Documented complications of renal biopsies included perirenal hematoma (25.1%), but the rate of serious complications that required surgical intervention or embolization was very low (1.0%). There was no death or nephrectomy case in our study. CONCLUSION: IgAN was the most common primary GN in this study. The multi-center studies are needed to evaluate the distribution and changing trends of renal disease in Korea.
Biopsy ; Corneal Dystrophies, Hereditary ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematoma ; Hepatitis ; Humans ; Incidence ; Kidney ; Lupus Nephritis ; Nephrectomy ; Nephrosis, Lipoid ; Population Characteristics ; Rejection (Psychology) ; Transplantation, Homologous

BACKGROUND: Chronic kidney disease has deleterious influences on pregnancy, both fetus and mother. To determine the pregnancy outcome and associated risk factors, we analyzed 36 pregnancies in 26 women with various chronic kidney diseases. METHODS: Retrospective analysis of 36 pregnancies was performed in women with chronic kidney disease who underwent antenatal care and delivery at Pusan National University Hospital from January 1993 to December 2002. RESULTS: The mean age of patients was 29.7 +/- 3.6 years. Underlying kidney disease was lupus nephritis in 10 patients (11 pregnancies), IgA nephropathy in 7 patients (8 pregnancies), focal segmental glomerulosclerosis in 4 patients (9 pregnancies), membranoproliferative glomerulonephritis in 4 patients (7 pregnancies), membranous glomerulonephritis in 1 patient (1 pregnancy). Of the 36 pregnancies, fetal loss occurred in 14 pregnancies (38.9%), premature delivery 7 pregnancies (19.4%) and normal delivery 15 pregnancies (41.7%). Deterioration of maternal renal function occurred in 10 pregnancies (27.8%), hypertension 18 pregnancies (50.0%) and aggravation of proteinuria 26 pregnancies (72.2%). Fetal loss and deterioration of maternal renal function were more frequent in patients with preconception serum creatinine value (SCr) >or=1.4 mg/dL than in those with SCr <1.4 mg/dL (85.7% vs. 27.6%, p<0.05; 100% vs. 10.3%, p<0.05, respectively). Neither fetal loss nor deterioration of maternal renal function was associated with hypertension and aggravation of proteinuria. In multivariate analysis, preconception SCr was associated with fetal loss (p=0.014, OR 32.7, 95% CI 2.0-526.0) and BP >or=140/90 mmHg during pregnancy was associated with low birth weight (p=0.027, OR 0.034, 95% CI 0.002-0.682). Deterioration of maternal renal function during pregnancy was recovered in 40.0%, hypertension was recovered in 50.0% and proteinuria was recovered in 77.8% within 1 year after delivery. CONCLUSION: Preconceptional impairment of maternal renal function and uncontrolled hypertension during pregnancy seem to be an important factors associated with fetal loss and low birth weight, respectively.
Busan ; Creatinine ; Female ; Fetus ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Diseases ; Lupus Nephritis ; Mothers ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Proteinuria ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Risk Factors

BACKGROUND: The glomerulonephritis appears in various clinical presentations. Renal biopsy is important diagnostic tool for treatment decision and prognosis prediction of glomerulonephritis. We tried to study on the clinical presentations of glomerulonephritis through histopathological findings and treatment responses in elderly patients. METHODS: We made an retrospective analysis in elderly patients aged over 60 years performed renal biopsy in our medical center from January 1991 to February 2005. RESULTS: Of all the 42 patients, the mean age of the patients was 64.6+/-3.5 years, 24 male and 18 female patients were included(1.3:1). Patients aged 60-64 years (n=26, 62%) were majority. On clinical indications of renal biopsies, 17 patients had nephrotic syndrome, 10 had asymptomatic urinary abnormality, 5 had gross hematuria, and 5 had acute azotemia. The results of renal biopsies presented that 30 patients (71%) had primary glomerulonephritis, 9 patients (22%) had secondary glomerulonephritis. Among primary glomerulonephritis, membranous nephropathy (n=10) was most common, followed by IgA nephropathy (n=7),focal segmental glomerulos-clerosis (n=3), membranoproliferative glomerulonephritis (n=2), and mesangioproliferative glomerulonephritis (n=2). In secondary glomer-ulonephritis, there were diabetic nephropathy (n=2), lupus nephritis (n=2), cancer-related nephritis (n=2), poststreptococcal glomer-ulonephritis (n=1), Henoch-Schonlein nephritis (n=1), amyloidosis (n=1). In the cases of nephrotic syndrome, primary nephrotic syndrome (n=12, 71%) is more prevalent than secondary nephrotic syndrome (n=3, 18%). The most common cause of primary nephrotic syndrome was membranous nephropathy (n=8). The causes of asymptomatic urinary abnormality were IgA nephropathy (n=4), lupus nephritis (n=2), membranous nephropathy (n=1), mesangioproliferative glomerulonephritis (n=1). By the complications of renal biopsy, only a few patients presented new-onset hematuria, hematoma, aggravation of hypertension, but, severe complication including an infection or a death was none. 8 of 12 patients with primary nephrotic syndrome were treated, 5 patients of those were shown complete response (n=3) or partial response (n=2). CONCLUSION: Various clinical presentations of glomerulonephritis were shown to elderly patients. Number of complications after renal biopsies were relatively small, and good responsiveness to treatment could be expected in the elderly patients. Therefore it is reasonable to perform a renal biopsy if indicated.
Aged* ; Amyloidosis ; Azotemia ; Biopsy ; Diabetic Nephropathies ; Female ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematoma ; Hematuria ; Humans ; Hypertension ; Lupus Nephritis ; Male ; Nephritis ; Nephrotic Syndrome ; Prognosis ; Retrospective Studies

The publication of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines on the treatment of glomerular diseases in 2012 marked a milestone in this field, asitisthe first time that comprehensive guidelines are provided for such disease entities. The current review focuses on major findings, both path ogenesis related and clinical, in the primary glomerulonephritis that have been made after the guidelines came into effect.
Glomerulonephritis* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Kidney Diseases ; Nephrosis, Lipoid ; Publications

CD36 Antigens ; metabolism ; Cell Aggregation ; Cholesterol ; blood ; Foam Cells ; pathology ; Glomerulonephritis, IGA ; blood ; metabolism ; pathology ; Glomerulonephritis, Membranoproliferative ; blood ; metabolism ; pathology ; Glomerulonephritis, Membranous ; blood ; metabolism ; pathology ; Glomerulosclerosis, Focal Segmental ; blood ; metabolism ; pathology ; Humans ; Nephritis ; blood ; metabolism ; pathology ; Nephritis, Hereditary ; blood ; metabolism ; pathology

We reviewed forty renal biopsies from 39 patients of rheumatoid disease with urinary abnormalities. Pathologic findings were as follows : 11 cases with normal or minor glomerular abnormalities(MGA), 10 with membranous glomerulonephropathy, 6 with IgA nephropathy, 4 with mesangial proliferative glomerulonephritis, 3 with renal amyloidosis, 2 with interstitial nephritis, 2 with minimal change disease(MCD), 1 with focal segmental glomerulosclerosis, and 1 with microscopic polyangiitis. Among 11 cases with MGA both in light and immunofluorescent microscopy, 8 cases were analyzed morphometrically with electron micrographs to determine the variation of thickness of the glomerular basement membrane. The mean GBM thickness was 334.5+/-76nm and was not statistically significantly different to that of control(391+/-39 nm, p>0.05). Of these, one case showed diffuse attenuation of GBM(175.1+/-27.6nm) to meet the criteria of thin basement membrane disease. Also, another case showed normal finding. Mean GBM thickness of the remaining 6 cases, excluding these 2 cases, was 344.7+/-31.3nm. The proportion of attenuated foci (less than 300nm) was increased ranging from 30.3% to 40.5% of total measurements of GBM(control 11.4 %, p<0.02). Another cases with distinct renal diseases also showed segmental attenuation of GBM (22-30.3%). In conclusion, the renal manifestations were variable in patients with rheumatoid disease and segmental thinning of GBMs was noted in most cases, which may evoke idiopathic hematuria during the course of RA. The renal morphologic lesion in RA patients with isolated proteinuria and those with hematuria can not be accurately predicted on the basis of clinical symptoms and signs. Prospective long-term studies are necessary to determine the nature and consequences of the condition.
Amyloidosis ; Arthritis, Rheumatoid* ; Basement Membrane ; Biopsy ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Microscopic Polyangiitis ; Microscopy ; Nephritis, Interstitial ; Proteinuria

Sjogrens syndrome is a slowly progressive autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, resulting in the xerostomia and xerophthalmia. In this syndrome, renal involvement includes interstitial nephritis, clinically manifested by hyposthenuria and renal tubular dysfunction with or without acidosis. Glomerulonephritis, however, is a rare finding and there have been few reports of membranous glomerulopathy or membranoproliferative glomerulonephritis (MPGN). We report a 31-year-old female diagnosed as MPGN associated with primary Sjogren's syndrome. She suffered from recurrent epigastric pain, and revealed a moderate proteinuria. Renal biopsy findings were consistent with type I MPGN and thereafter Sjogren's syndrome was diagnosed by further evaluation. She did not meet the criteria to systemic lupus erythematosus or other connective tissue disease. To our knowledge, this is the first report of MPGN associated with Sjogrens syndrome in Korea.
Acidosis ; Adult ; Autoimmune Diseases ; Biopsy ; Connective Tissue Diseases ; Exocrine Glands ; Female ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Lupus Erythematosus, Systemic ; Nephritis, Interstitial ; Proteinuria ; Sjogren's Syndrome ; Vasculitis ; Xerophthalmia ; Xerostomia

Percutaneous renal biopsy is an essential component for diagnosis and management of glomerular diseases. In order to elucidate clinical and pathological features, 494 renal patients who had undergone renal biopsies at Gil Medical Center from January 1989 to June 1999 were studied retrospectively. The male to female ratio was 1.3 : 1 and average age was 33.2 years. There were 370(83.5%) cases of primary glomerular disease and 58(13.1%) cases of secondary glomerular disease. Among primary glomerular disease, IgA nephropathy was the most common(175 cases), followed by minimal change disease(84 cases), membranous glomerulonephritis(34 cases), and focal segmental glomerulosclerosis(33 cases). In secondary glomerular disease, lupus nephritis was the most common(21 cases), followed by 11 cases of hepatitis B associated glomerulonephritis, 9 cases of Henoch-Sch nlein purpura, and 4 cases of diabetic nephropathy. Among 99 cases of asymptomatic urinary abnormalities, IgA nephropathy was most common(69 cases) followed by 12 cases of thin basement membrane disease, 4 cases of minimal change disease, and 3 cases of focal segmental glomerulosclerosis, membranous glomerulonephritis, nonspecific glomerulonephritis. Among 159 cases of nephrotic syndrome, minimal change disease was most common(60 cases) followed by 25 cases of IgA nephropathy, 23 cases of focal segmental glomerulosclerosis, 21 cases of membranous glomerulonephritis, and 13 cases of lupus nephritis. Documented complication of renal biopsies included 23 cases of gross hematuria, 6 cases of perirenal hematoma, and 4 cases of infection. Death, AV fistula, aneurysm or serious compications that required surgical intervention were not reported. In conclusion, the percutaneous renal biopsy is relatively safe, and useful for diagnosis and management of glomerular diseases. The most common type of primary glomerular disease was IgA nephropathy.
Aneurysm ; Basement Membrane ; Biopsy* ; Diabetic Nephropathies ; Diagnosis ; Female ; Fistula ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematoma ; Hematuria ; Hepatitis B ; Humans ; Lupus Nephritis ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Purpura ; Retrospective Studies

We investigated the clinical features of nephrotic syndrome in Korea according to sex, age and pathologic diagnosis under the classification system supported by WHO. Adult nephrotic patients who underwent renal biopsy from 1979 to 1993 at the Department of Internal Medicine, Seoul National University Hospital, with the exception of diabetic nephropathy and multiple myeloma, were analyzed in terms of their clinical manifestations, laboratory data, and pathologic features. 1) The number of our total nephrotic patients was 956 and their mean age was 32.6. Male to female ratio was 1.96:1. 2) Among total nephrotic syndrome patients, there were 736 (77%) primary NS and 220 (23%) secondary NS patients. 3) The pathologic diagnoses of the primary NS were minimal change nephrotic syndrome (41.6%), membraneous nephropathy (20.9%), focal glomerulosclerosis (17.3%), IgA nephropathy (9%), membranoproliferative GN (4.5%), sclerosing GN (2.4%), and mesangial proliferative GN (2.2%). 4) Among primary NS patients with ages between 15 and 40, the percentage of minimal change nephrotic syndrome was highest(47.7%), while among those above 40 of age, membraneous nephropathy was most common(42.1%). 5) The pathologic diagnoses of the secondary NS were hepatitis B virus associated GN (46.8%), lupus nephritis (39.5%), amyloidosis (5.9%), post-infectious GN (2.7%), Henoch-Schoenlein nephritis (2.7%). We had one each case of thrombotic thrombocytopenic purpura, Fabry's disease, mixed essential cryoglobulinemia, light chain disease, and Alport's syndrome. In conclusion, minimal change nephrotic syndrome was the most common disease among the primary NS and hepatitis B virus associated GN was the most common among the secondary NS.
Adult* ; Amyloidosis ; Biopsy ; Classification ; Cryoglobulinemia ; Diabetic Nephropathies ; Diagnosis ; Fabry Disease ; Female ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hepatitis B virus ; Humans ; Internal Medicine ; Korea ; Lupus Nephritis ; Male ; Multiple Myeloma ; Nephritis ; Nephritis, Hereditary ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Purpura, Thrombotic Thrombocytopenic ; Seoul

Sjogren's syndrome is a chronic autoimmune disorder causing dry eye or dry mouth from the lymphocytic infiltration in the lacrimal gland and the salivary gland. Renal involvement is seen in about 20-40% of patients with primary Sjogren's syndrome. Tubulointerstitial nephritis is the most common renal complication in primary Sjogren's syndrome. However, glomerulonephritis such as membranoproliferative glomerulonephritis, membranous glomerulonephritis rarely may complicate primary Sjogren's syndrome. Sjogren's syndrome associated with glomerulonephritis hasn't been reproted yet in Korea. We report nephrotic syndrome associated with membranous glomerulonephritis in a case with primary Sjogren's syndrome. Nephrotic syndrome resolved after treatment with corticosteroid.
Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous* ; Humans ; Korea ; Lacrimal Apparatus ; Mouth ; Nephritis, Interstitial ; Nephrotic Syndrome ; Salivary Glands ; Sjogren's Syndrome*