The Renal Histopathological Spectrum of Patients with Nephrotic Syndrome Presenting to Nephrology Division Khyber Teaching Hospital, Peshawar, Pakistan

Authors

  • Ali Raza Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Maria Tahir Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Aaliyan Khattak Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Essa Hassan Medical Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Muhammad Noman Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan
  • Wisha Mushtaq Khyber Medical College, Peshawar, KP, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v2i02.166

Keywords:

Histopathological Spectrum, Membranous Glomerulonephritis, Lupus Nephritis, Minimal Change Disease, Nephrotic Syndrome, Khyber Teaching Hospital

Abstract

Introduction: This study investigated the renal histopathological patterns in nephrotic syndrome patients who underwent renal biopsy at the Department of Nephrology, Khyber Teaching Hospital, between March 2023 and October 2024. It aimed to identify the underlying glomerulopathies responsible for nephrotic syndrome in these patients

Methodology: The study included 122 nephrotic syndrome patients, aged 7 to 69 years, categorized into four age groups. Renal biopsies were analyzed using light microscopy and immunofluorescence. The chi-square test assessed the association between histological variants and categorical variables such as gender and age groups primarily seen in females. Minimal Change Disease is significantly associated with younger individuals, particularly those under 24, with no cases in older patients, suggesting it predominantly affects pediatric or young adult populations.

Results: Out of 122 patients, 80 (65.6%) were male and 42 (34.4%) females, with a mean age of 34.28 ± 14.81 years. Membranous Glomerulonephritis (35.2%) was the most common diagnosis, followed by Focal and Segmental Glomerulosclerosis (18.0%) and Lupus Nephritis (14.8%). Minimal Change Disease affected 10 patients, primarily younger individuals. HIV-Associated Nephropathy (0.8%) and Diabetic Nephropathy (1.6%) were the least frequent. Significant associations were found between histopathological variants and both age and gender (p-values 0.000 and 0.001, respectively), with Lupus Nephritis more common in females and Membranous Glomerulonephritis in males. These findings highlight age- and gender-specific trends

Conclusion: Membranous Glomerulonephritis is most prevalent, especially in males and younger adults, while Lupus Nephritis is primarily seen in females. Minimal Change Disease is significantly associated with younger individuals, particularly those under 24, with no cases in older patients, suggesting it predominantly affects pediatric or young adult populations.

Author Biographies

Ali Raza, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Nephrology

Maria Tahir, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Nephrology

Aaliyan Khattak, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

House Officer

Essa Hassan, Medical Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

Postgraduate Resident Physician

Muhammad Noman, Nephrology Division, Khyber Teaching Hospital, Peshawar, KP, Pakistan

House Officer

Wisha Mushtaq, Khyber Medical College, Peshawar, KP, Pakistan

Medical student

References

Falk, R. J., Jennette, J. C., & Nachman, P. H. (2000). Brenner and Rector’s the kidney (B. M. Brenner, Ed.). W. B. Saunders.

Schwartz, M. M. (n.d.). Nephrotic syndrome and proteinuria. In F. G. Silva, D. Agati, & V. D. Nadasdy (Eds.), Renal biopsy interpretation (Vol. 1996, pp. 115–146).

Olson, J, L. (1992). The nephrotic syndrome. In: Heptinstall RH, editor. Pathology of the kidney. 4th ed. Boston, MA: Little, Brown, pp. 779–869.

Kumar, V., Abbas, A. K., & Fausto, N. (2004). Robbins and Cotran pathologic basis of disease. W. B. Saunders.

Walker, P. D., Cavallo, T., & Bonsib, S. M. (2004). Practical guidelines for the renal biopsy. Mod Pathol, 17, 1555–1563.

Pirani, C. L. (n.d.). Evaluation of kidney biopsy specimens. In C. C. Tisher & B. M. Brenner (Eds.), Renal pathology with clinical and functional correlation (Vol. 1994, pp. 85–115).

Furness, P. N., & Boyd, S. (1996). Electron microscopy and immunocytochemistry in the assessment of renal biopsy specimens: actual and optimal practice. Journal of Clinical Pathology, 49(3), 233–237. https://doi.org/10.1136/jcp.49.3.233

Kitiyakara, C., Kopp, J. B., & Eggers, P. (2003). Trends in the epidemiology of focal segmental glomerulosclerosis. Seminars in Nephrology, 23(2), 172–182. https://doi.org/10.1053/snep.2003.50025

Haas, M., Meehan, S. M., Karrison, T. G., & Spargo, B. H. (1997). Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 30(5), 621–631. https://doi.org/10.1016/s0272-6386(97)90485-6

Haas, M., Spargo, B. H., & Coventry, S. (1995). Increasing incidence of focal-segmental glomerulosclerosis among adult nephropathies: A 20-year renal biopsy study. American Journal of Kidney Diseases, 26(5), 740-750. https://doi.org/10.1016/0272-6386(95)90437-9

Korbet, S. M., Genchi, R. M., Borok, R. Z., & Schwartz, M. M. (1996). The racial prevalence of glomerular lesions in nephrotic adults. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 27(5), 647–651. https://doi.org/10.1016/s0272-6386(96)90098-0

Bakir, A. A., Bazilinski, N. G., & Rahee, H. L. (1989). Focal segmental glomerulosclerosis: a common entity in nephrotic black adults. Arch Intern Med, 149, 1802–1804.

Pontier, P. J., & Patel, T. G. (1994). Racial differences in the prevalence and presentation of glomerular disease in adults. Clinical Nephrology, 42(2), 79–84.

D’Agati, V. (1994). The many masks of focal segmental glomerulosclerosis. Kidney International, 46(4), 1223–1241. https://doi.org/10.1038/ki.1994.388

Mitwalli, A. H., Al Wakeel, J. S., Al Mohaya, S. S., Malik, H. G., Abu-Aisha, H., Hassan, O. S., & Akhtar, M. (1996). Pattern of glomerular disease in Saudi Arabia. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 27(6), 797–802. https://doi.org/10.1016/s0272-6386(96)90516-8

Pakasa, M., Mangani, N., & Dikassa, L. (1993). Focal segmental glomerulosclerosis in the nephrotic syndrome; a new profile of adult nephrotic syndrome in Zaire. Mod Pathol, 6, 125–128.

Muzaffar, M., Mushtaq, S., & Khadim, M. T. (1997). Morphological pattern of glomerular diseases in patients with nephrotic syndrome in northern Pakistan. Pak Armed Forces Med J, 47, 3–6.

Lakhnana, K. N., Ahmed, I., & Amin, J. S. (1995). Pattern of renal glomerular disease: An experience at Pakistan Institute of Medical Sciences, Islamabad. Pak J Pathol, 6, 19–27.

Jamal, Q., Jafarey, N. A., & Naqvi, A. J. (1988). A review of 1508 percutaneous renal biopsies. JPMA. The Journal of the Pakistan Medical Association, 38(10), 272–275.

Lakhani, B., & Moorani, K. N. (1999). An analysis of 30 renal biopsies in patients suffering from nephrotic syndrome. J Surg Pak (Int), 4, 27–28.

Kazi, J. I., Mubarak, M., Ahmed, E., Akhter, F., Naqvi, S. A. A., & Rizvi, S. A. H. (2009). Spectrum of glomerulonephritides in adults with nephrotic syndrome in Pakistan. Clinical and Experimental Nephrology, 13(1), 38–43. https://doi.org/10.1007/s10157-008-0075-0

Zhou, F.-D., Shen, H.-Y., Chen, M., Liu, G., Zou, W.-Z., Zhao, M.-H., & Wang, H.-Y. (2011). The renal histopathological spectrum of patients with nephrotic syndrome: an analysis of 1523 patients in a single Chinese centre. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(12), 3993–3997. https://doi.org/10.1093/ndt/gfr166

Downloads

Published

2024-11-16

How to Cite

Raza, A., Tahir, M., Khattak, A., Hassan, E., Noman, M., & Mushtaq, W. (2024). The Renal Histopathological Spectrum of Patients with Nephrotic Syndrome Presenting to Nephrology Division Khyber Teaching Hospital, Peshawar, Pakistan. Indus Journal of Bioscience Research, 2(02), 403–410. https://doi.org/10.70749/ijbr.v2i02.166