• Epidemiology
• IgA nephropathy
• glomerulonephritis
• incidence
• outcomes

• Humans
• Glomerulonephritis, IGA/epidemiology
• Glomerulonephritis, IGA/genetics
• Risk Factors
• Incidence
• Global Health
• Disease Progression

• Asia
• Disease burden
• Epidemiology
• IgA nephropathy
• Review
• Treatment patterns

• Humans
• China/epidemiology
• Glomerulonephritis, IGA/epidemiology
• Glomerulonephritis, IGA/therapy
• Japan/epidemiology
• Quality of Life

• Otsuka Pharmaceutical Development & Commercialization, Inc., United States

• medical research
• nephrology

• Humans
• Glomerulonephritis, IGA/pathology
• Retrospective Studies
• Disease Progression
• Kidney/pathology
• Kidney Failure, Chronic/complications
• Glomerular Filtration Rate
• Prognosis

• TCVGH-1103602C Taichung Veterans General Hospital
• TCVGH-1103601D Taichung Veterans General Hospital
• TCVGH-1113602D Taichung Veterans General Hospital

• Biopsia
• Biopsy
• Cross-Sectional Studies
• Estudios Transversales
• Glomerular Syndrome
• Glomerulonefritis
• Glomerulonephritis
• Nefrología
• Nephrology
• Síndrome Glomerular

• Humans
• Male
• Female
• Young Adult
• Adult
• Middle Aged
• Nephrotic Syndrome/pathology
• Cross-Sectional Studies
• Kidney/pathology
• Biopsy
• Renal Insufficiency, Chronic
• Retrospective Studies

• Africa
• Glomerulonephritis
• IgA nephropathy
• focal segmental glomerulosclerosis
• kidney biopsy
• minimal change disease

• Adult
• Humans
• Child
• Glomerulosclerosis, Focal Segmental/epidemiology
• Glomerulosclerosis, Focal Segmental/pathology
• Prevalence
• Kidney/pathology
• Glomerulonephritis/epidemiology
• Glomerulonephritis, IGA
• Glomerulonephritis, Membranous
• Glomerulonephritis, Membranoproliferative
• Nephrosis, Lipoid
• Biopsy
• Africa/epidemiology
• Retrospective Studies

• crescentic glomerulonephritis
• crgn
• ifta
• interstitial fibrosis and tubular atrophy
• rapidly progressive glomerulonephritis
• rpgn

• Humans
• Male
• Female
• Kidney/pathology
• Prevalence
• Malaysia/epidemiology
• Glomerulonephritis/epidemiology
• Glomerulonephritis/pathology
• Lupus Nephritis/pathology
• Glomerulonephritis, Membranous/pathology
• Biopsy
• Retrospective Studies

• fibrosis
• inflammation
• renal biopsy
• stiffness
• viscosity

• FSGS
• IgA nephropathy
• clinical nephrology
• database
• diabetes
• epidemiology
• glomerular disease
• glomerulonephritis
• kidney biopsy
• lupus nephritis
• registry

• Male
• Humans
• Female
• United States
• Middle Aged
• Glomerulonephritis, IGA/diagnosis
• Glomerulonephritis, IGA/epidemiology
• Glomerulonephritis, IGA/pathology
• Glomerulosclerosis, Focal Segmental/epidemiology
• Glomerulosclerosis, Focal Segmental/pathology
• Retrospective Studies
• Pandemics
• COVID-19/epidemiology
• Kidney Glomerulus/pathology
• Lupus Nephritis/epidemiology
• Lupus Nephritis/pathology
• Biopsy

• end-stage kidney disease
• geriatrics
• glomerulonephritis
• membranous nephropathy
• nephropathy
• renal biopsy

• Humans
• Aged
• Male
• Female
• Glomerulonephritis, IGA/epidemiology
• Glomerulonephritis, IGA/pathology
• Glomerulonephritis, Membranous/pathology
• Retrospective Studies
• Biopsy
• Kidney/pathology

• Chronic glomerulonephritis
• Petrochemical industrial parks
• Renal health

• Adult
• Aged
• Case-Control Studies
• Environmental Exposure/analysis
• Glomerulonephritis/chemically induced
• Glomerulonephritis/epidemiology
• Humans
• Industry
• Middle Aged
• Odds Ratio
• Young Adult

Background: Renal biopsy is the gold standard for diagnosing renal disease. The major concern is bleeding. Shared decision making (SDM) has been reported to improve communication but has never been used regarding renal biopsy. Methods: We launched a 5-year project on SDM for renal biopsy. We collected cases of renal biopsy and bleeding, and cases of SDM. The process of quality improvement (QI) for SDM is also shared. Results: Taichung Veterans General Hospital has the largest number of renal biopsy cases, and the lowest bleeding rate in Taiwan. We enlisted a core team for this QI project and conducted stakeholder mapping. In 2017, we conducted a small pilot study for SDM based on printed material as a decision aid. The satisfaction rate was 95.5%. From 2018 to 2019, we improved SDM patients’ decision aid from printed material to four videos, designing questions to consolidate their understanding, and a unique information platform. The above improvements facilitated the utilization of SDM for renal biopsy (81.27% in 2020 and 100% in 2021). Even with higher bleeding complications in 2019 and 2020, patients remained satisfied when we launched SDM prior to renal biopsy. Conclusion: This is the first study regarding SDM on renal biopsy. Through SDM, patients had time to understand renal biopsy, including risk and benefit. We recommend SDM to elaborate renal biopsy in clinical practice.

• Diagnosis
• Epidemiology
• Histopathology
• Immunoglobulin A nephropathy
• Nephritic syndrome
• Renal biopsy

Background

Glomerulonephritis is among the most common and serious non-communicable diseases in the world, and some of them are major causes of chronic kidney disease, which eventually leads to kidney failure. In developing countries, it is the most common cause of end-stage renal disease (ESRD). Chronic kidney disease affects 10-16% of the adult population in Asia, including 21.2% in Pakistan. This study aims to determine the frequency and spectrum of glomerulonephritis at our center.

Methodology

This is a cross-sectional analysis of 81 renal core biopsies obtained between August 2020 and August 2021. The histopathological reports, demographic data, and relevant laboratory investigations, such as blood urea and creatinine levels, were collected. All cases were blindly reviewed by two pathologists with a special interest in medical renal pathology. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA).

Results

The majority of the patients (46.9%) were between the ages of 21 and 40 years. There was a slight male predominance, with 44 (54.3%) of the 81 participants being male. Hematuria was reported in 20 (24.7%) patients, with mean serum urea and creatinine levels of 75 mg/dL and 2.6 mg/dL, respectively. Nephrotic syndrome was the most common indication for a renal biopsy, accounting for 54 (67.7%) of the 81 cases. Chronic glomerulonephritis is classified into two categories, namely, primary and secondary glomerulonephritis. Focal segmental glomerulosclerosis (FSGS), the leading cause of primary glomerulonephritis, was found in 25 (30.9%) 81 patients. Furthermore, lupus nephritis (9.9%) and advanced glomerulonephritis (9.9%) were found in equal proportions among secondary glomerulonephritis.

Conclusions

According to our study, nephrotic syndrome was the most common indication for medical renal biopsy, with FSGS being the most common primary glomerulonephritis. Lupus nephritis and advanced glomerulonephritis were the most common secondary glomerulonephritis diagnoses.

• Clinical syndrome
• Glomerulonephritis
• Histological features
• Kidney disease

• Adult
• Biopsy
• Female
• Glomerulonephritis/epidemiology
• Glomerulonephritis/pathology
• Humans
• Kidney/pathology
• Male
• Middle Aged
• Retrospective Studies
• Romania/epidemiology
• Time Factors

• Grant of Ministry of Research and Innovation, CNCS- UEFISCDI PN-III-P4-ID-PCE-2016-0908, contract number 167/2017

• children
• dipstick urine analysis
• hematuria
• proteinuria
• urinary screening

Membranous nephropathy (MN) is an important cause of nephrotic syndrome and chronic kidney disease (CKD) in adults. The pathogenic significance of B cells in MN is increasingly recognized, especially following the discovery of various autoantibodies that target specific podocytic antigens and the promising treatment responses seen with B cell depleting therapies. The presence of autoreactive B cells and autoantibodies that bind to antigens on podocyte surfaces are characteristic features of MN, and are the result of breaches in central and peripheral tolerance of B lymphocytes. These perturbations in B cell tolerance include altered B lymphocyte subsets, dysregulation of genes that govern immunoglobulin production, aberrant somatic hypermutation and co-stimulatory signalling, abnormal expression of B cell-related cytokines, and increased B cell infiltrates and organized tertiary lymphoid structures within the kidneys. An understanding of the role of B cell tolerance and homeostasis may have important implications for patient management in MN, as conventional immunosuppressive treatments and novel B cell-targeted therapies show distinct effects on proliferation, differentiation and reconstitution in different B cell subsets. Circulating B lymphocytes and related cytokines may serve as potential biomarkers for treatment selection, monitoring of therapeutic response and prediction of disease relapse. These recent advances in the understanding of B cell tolerance in MN have provided greater insight into its immunopathogenesis and potential novel strategies for disease monitoring and treatment.

• B cells
• immune tolerance
• primary membranous nephropathy

The prevalence and distribution of glomerular diseases differ among countries, and the indication to perform a kidney biopsy varies among centres. In this study, we assessed the prevalence of primary and secondary glomerulopathies based on histological diagnoses, and the correlation between glomerulopathies and demographic and clinical data was evaluated.

In this study, 1051 kidney biopsies were retrospectively reviewed between 2000 and 2018. Patient demographic, clinical and laboratory data were assessed. The prevalence of primary glomerulonephritis (PG) and secondary glomerulopathies (SG), as well as tubulointerstitial diseases (TIDs), hereditary nephropathies (HNs) and other diagnoses, were determined. The frequency of primary and secondary glomerulopathies was evaluated by age group, and the temporal variation in frequencies across three time periods (2000-2005, 2006-2011, and 2012-2018) was reported.

The prevalence of SG predominated (52.4%), followed by PG (29.6%), other diagnoses (10.7%), TID (6.6%) and HN (1.1%). Among the primary forms of glomerular disease, focal segmental glomerulosclerosis (FSGS) was the most common (37.3%), followed by IgA nephropathy (IgAN, 24.4%), membranous nephropathy (MN, 18.6%) and minimal change disease (MCD, 8.4%). Lupus nephritis (LN, 41.1%) was most common in patients with SG, followed by diabetic kidney disease (DKD, 17.8%), systemic vasculitis (SV, 10.2%) and secondary FSGS (2nd FSGS, 10%). Nephrotic syndrome was the most common clinical presentation in patients with PG and also in patients with DRD and 2nd FSGS, whereas in patients with IgAN and SV, nephritic syndrome was the main presentation. For the age group between 18 and 50 years, LN, FSGS and IgAN predominated; for patients aged between 51 and 65 years, the proportion of DKD and 2nd FSGS increased, and SV was more common in patients > 65 years. The temporal variation in PG across the three time periods showed a statistically significant increase in IgAN (p = 0.001) and a reduction in FSGS over time (p < 0.001). In SG, there was a reduction in LN (p = 0.027) and an increase in DKD (p < 0.001) over time, with a tendency for 2nd FSGS to decrease over time (p = 0.053).

In the studied kidney biopsy registry, FSGS and IgAN were the most prevalent diagnoses in patients with PG, and LN and DKD were the most prevalent in patients with SG. Nephrotic syndrome was the major indication for biopsy. When comparing the temporal variation in glomerulopathies, there was a reduction in FSGS and an increase in IgAN in patients with PGs over time, and for patients with SGs, there was a reduction in LN with an increase in cases of DKD over time.

• Clinical presentation
• Kidney biopsy registry
• Nephritic syndrome
• Nephrotic syndrome
• Primary glomerulonephritis
• Secondary glomerulopathies

• Adult
• Central Serous Chorioretinopathy/epidemiology
• Central Serous Chorioretinopathy/etiology
• Cohort Studies
• Databases, Factual
• Female
• Humans
• Male
• Middle Aged
• Nephrotic Syndrome
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Taiwan/epidemiology

Kidney biopsy registries all over the world benefit research, teaching and health policy. Comparison, aggregation and exchange of data is however greatly dependent on how registration and coding of kidney biopsy diagnoses are performed. This paper gives an overview over kidney biopsy registries, explores how these registries code kidney disease and identifies needs for improvement of coding practice.

A literature search was undertaken to identify biopsy registries for medical kidney diseases. These data were supplemented with information from personal contacts and from registry websites. A questionnaire was sent to all identified registries, investigating age of registries, scope, method of coding, possible mapping to international terminologies as well as self-reported problems and suggestions for improvement.

Sixteen regional or national kidney biopsy registries were identified, of which 11 were older than 10 years. Most registries were located either in Europe (10/16) or in Asia (4/16). Registries most often use a proprietary coding system (12/16). Only a few of these coding systems were mapped to SNOMED CT (1), older SNOMED versions (2) or ERA-EDTA PRD (3). Lack of maintenance and updates of the coding system was the most commonly reported problem.

There were large gaps in the global coverage of kidney biopsy registries. Limited use of international coding systems among existing registries hampers interoperability and exchange of data. The study underlines that the use of a common and uniform coding system is necessary to fully realize the potential of kidney biopsy registries.

The online version contains supplementary material available at 10.1186/s12882-021-02365-3.

• Coding
• Kidney biopsy registry
• Nephropathology
• Renal pathology
• Systematic review

The largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group.

Data of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study.

The mean age was 41.5 ± 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. The mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467–6307) mg/day, 1.0 (IQR: 0.7–1.6) mg/dL, 82.9 (IQR: 47.0–113.0) mL/min and 3.2 ± 0.9 g/dL, respectively.

The distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.

• Epidemiology
• Glomerulonephritis
• Kidney biopsy
• Primary glomerular diseases; the Turkish Society of Nephrology glomerular diseases (TSN-GOLD) working group
• Turkish Society of Nephrology

While there are many cross-sectional studies of glomerulonephritis (GN) incidence, changes in incidence over time, particularly in the 21st century have received less attention. Similarly, little is known about temporal changes in GN prognosis. The presence in Denmark of comprehensive registries for renal biopsy results, end-stage renal disease (ESRD), comorbidity and mortality permit these questions to be addressed.

Data for all renal biopsies in Denmark between 1985 and 2014 were extracted from the Danish Renal Biopsy Registry and Patobank registries. The date of first dialysis or transplantation was extracted from the Danish Nephrology Registry for those patients developing ESRD. Dates of death and presence of chronic comorbid conditions at date of biopsy were extracted from the National Patient Registry. The incidence of GN, adjusted to the 2013 European standard population, was calculated. ESRD incidence and mortality were calculated, both in absolute terms and after correction for age, comorbidity and presence of renal tubulointerstitial fibrosis.

The incidence rose from 33.3 patients per million (ppm)/year in 1985–94 to 46.5 ppm in 2005–14. The increase could in part be related to changes in renal biopsy policy. Large increases in Anti-neutropil cytoplasmic antibody (ANCA) vasculitis (ANCAV) (3.1–7.7 ppm/year) and focal segmental glomerulosclerosis (FSGS) (1.5–5.7 ppm/year) incidence were noted. The biopsy-proven prevalence of GN in 2014 was 748 ppm of which 155 ppm were being treated with dialysis or transplantation. Adjusted ESRD incidence fell by 25% during the study period, mortality by 62% and combined ESRD/mortality by 46%. The fall in ESRD incidence was limited to minimal change GN, FSGS, membranous GN and lupus nephritis, while reductions in mortality, and the combination of ESRD and/or death, were seen for nearly all GN diagnoses.

This study suggests that the incidence of GN has generally increased between 1985 and 2014, but some of the increase may be related to changes in renal biopsy policy. Major increases in FSGS and ANCAV incidence have occurred. The prognosis of GN, both as regards ESRD and mortality, has improved.

• ANCA
• FSGS
• IgA nephropathy
• epidemiology
• glomerulonephritis
• lupus nephritis
• membranoproliferative glomerulonephritis
• membranous nephropathy
• minimal change disease
• prognosis

• Biopsy
• Diabetic nephropathies
• Glomerulonephritis
• Nephrosclerosis

• Adult
• Biopsy
• Diabetes Mellitus, Type 2
• Diabetic Nephropathies/diagnosis
• Diabetic Nephropathies/epidemiology
• Humans
• Hypertension/diagnosis
• Hypertension/epidemiology
• Kidney
• Kidney Diseases
• Republic of Korea/epidemiology
• Retrospective Studies

• Diabetic nephropathy
• Non-diabetic renal disease
• Renal biopsy
• Retinopathy

Infections are a major cause of morbidity in patients with nephrotic syndrome (NS); however, the risk of infections in NS and its subsequent effect on adverse renal outcomes are not well established.

From 2000–2013 claims data, 4,856 patients with NS were identified from the Taiwanese National Health Insurance Research Database (NHIRD). In the study group, 554 patients progressing to end-stage renal disease (ESRD), as identified during follow-up, were enrolled. In the control group, two patients with NS without progression to ESRD, during the same period, matched with one patient from the study group were included. The correlation between rates of infections and risk of ESRD in patients with NS was estimated using conditional logistic regression analysis.

The proportion of outpatient visits for infections in patients with NS with and without progression to ESRD was 61.2% and 32.8%, respectively, and the proportion of hospitalization due to infections was 28.9% and 1.7%, respectively. The risk of ESRD was higher in patients with frequent outpatient visits for infections (>10 outpatient visits), with a relative risk of 3.20 [95% confidence interval (CI), 1.84–5.57]. Additionally, a significant association was found between severe infections requiring hospitalization and ESRD, with a relative risk of 7.01 (95% CI, 3.65–13.44). Subgroup analysis stratified by sex or age indicated that the risk associated with ESRD was significantly higher in female and elderly patients with NS.

The risk of ESRD in patients with NS was linked to the incidence of infection, especially those requiring hospitalization due to more severe bacterial infections. Implications of study results are important for clinicians who should be aware of the possibility of ESRD development in patients with NS with infectious complications.

• Nephrotic syndrome (NS)
• elderly
• end-stage renal disease (ESRD)
• infectious
• risk

The present study analyzed the clinicopathological features and prognosis in patients with idiopathic membranous nephropathy (IMN) with hypertension. In the hypertension group, significant differences were found in the age, hypertension history, systolic blood pressure, diastolic blood pressure (DBP), mean arterial pressure, albumin, serum creatinine, low-density lipoprotein, 24 h urine protein levels, calculated estimated glomerular filtration rate (e-GFR), glomerular sclerosis, segmental sclerosis, ischemic sclerosis, interstitial fibrosis, tubular atrophy and vascular lesion compared with the non-hypertension group (P<0.05). The average follow-up time was 35.70 months (5.10-103.77 months). In total, 54 patients reported a 50% decline in e-GFR, eight patients reported progression of disease to end-stage renal disease (ESRD) and nine cases of mortality were reported. Survival analysis results suggested that patients with hypertension had a lower cumulative renal survival rate than those without hypertension (P=0.034). Multivariate Cox hazards regression analysis results suggested that DBP [hazard ratio (H), 5.160; CI, 0.865-0.989; P=0.023], age (H, 4.839; CI, 1.008-1.142; P=0.028), sex (H, 5.680; CI, 0.031-0.714; P=0.017), serum creatinine (H, 20.920; CI, 1.035-1.089; P<0.001), uric acid (H, 4.783; CI, 0.982-0.0.999; P=0.029), 24 h urine protein (H, 6.318; CI, 1.079-1.850; P=0.012), e-GFR (H, 4.008; CI, 1.001-1.062; P=0.045) and glomerular sclerosis (H, 8.722; CI, 1.860-21.559; P=0.003), segmental sclerosis (H, 7.737; CI, 7.770-13.219; P=0.005), percentage of ischemic sclerosis (H, 4.729; CI, 1.444-11.945; P=0.030), crescents (H, 5.938; CI, 0.003-0.526; P=0.015), interstitial fibrosis and tubular atrophy (H, 8.128; CI, 0.005-1.052; P=0.043), and vascular lesion (H, 4.049; CI, 1.030-9.766; P=0.044) were risk factors for the development of IMN into ESRD. The results suggested that DBP may be an independent risk factor for the development of IMN with hypertension.

• characteristic
• hypertension
• idiopathic membranous nephropathy
• prognosis

• Clinical epidemiology
• Diabetic nephropathy
• Focal segmental glomerulosclerosis
• Glomerulonephritis
• IgA nephritis
• Renal biopsy

• India
• be-renal biopsy
• disease pattern

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arabs
• Biopsy
• Child
• Child, Preschool
• Female
• Humans
• Incidence
• Infant
• Infant, Newborn
• Kidney Diseases/ethnology
• Kidney Diseases/pathology
• Kidney Glomerulus/pathology
• Male
• Middle Aged
• Middle East/epidemiology
• Time Factors
• Young Adult