Morphological Spectrum of Glomerulonephritis in Medical Renal Biopsies: A Single-Center Study

Abstract

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.

Keywords: chronic glomerulonephritis; fsgs; lupus nephritis; nephrotic syndrome; renal biopsy.

Figure 1. (A) H&E image shows segmentally sclerosed glomerulus in FSGS (black arrow). (B) PAS highlights segmentally sclerosed glomerulus in FSGS (black arrow). (C) H&E image shows thickened glomerular capillary loops in membranous glomerulonephritis (black arrow). (D) JMS highlights spikes in membranous glomerulonephritis (yellow arrow).

H&E: hematoxylin and eosin; FSGS: focal segmental glomerulosclerosis; PAS: periodic acid–Schiff; JMS: Jones’ methenamine silver stain; MEM: membranous glomerulonephritis

Figure 2. Lupus nephritis, class V. (A) H&E image shows globally thickened glomeruli (black arrows) and leukocytic infiltration. (B) H&E high-power view of glomerulus showing thickened capillary loops and membranes (black arrow). (C) JMS highlights thickened glomerular capillary loops (yellow arrows). (D) Immunofluorescence shows granular IgG immune complex deposits in mesangium and capillary loops.

H&E: hematoxylin and eosin; JMS: Jones’ methenamine silver stain; IF: immunofluorescence; Ig: immunoglobulin