Histopathological study in glomerular disease in patient with significant proteinuria in Government Dharmapuri Medical College, Dharmapuri

Introduction: Injury to glomeruli results in a variety of signs and symptoms of disease, including proteinuria, hematuria, azotemia, oliguria, edema and hypertension. Specific glomerular diseases tend to produce particular syndromes of renal dysfunction; although multiple glomerular diseases can produce the same syndrome. Evaluation of pathogenic features identified in a renal biopsy specimen may be required for definitive diagnosis. In patients with glomerular disease, renal biopsy provides tissue that can be used to determine the cause, predict the prognosis, and direct the treatment. Aim of the Study: To evaluate the renal histopathology of patients with glomerular disease (with Significant Proteinuria > 1 gms/ 24 hours). Materials and methods: The amount of proteinuria, renal insufficiency, hypertension, and microscopic hematuria differ in different histopathological types and in different age groups .Hence all these parameters and the histopathological type of glomerular disease have prognostic implications in patients with glomerular disease Renal biopsy was performed in patients with glomerular disease (proteinuria <1 gms/24 hrs.) attending the nephrology clinic. Results: Among the 50 patients studied Focal segmental glomerulosclerosis (FSGS) was found in 11, IgA nephropathy and minimal change disease (MCD) in 8; Mesangi proliferative glomerulonephritis in 7, Membranous nephropathy and Lupus nephritis in 6, Membrano proliferative glomerulonephritis (MPGN) in 3 and Amyloidosis in 1 patient. The incidence of renal insufficiency was common in patients with MPGN (100%) and amyloidosis (100%) , followed closely by FSGS (87.5%), lupus nephritis (66.66%), mesangio proliferative glomerulonephritis (57.14%), FSGS (27.27%) and membranous nephropathy (16.66%). Conclusion: 50 patients with proteinuria more than 1 gram per 24 hours above the age of 12 years were biopsied for renal histopathological examination. There were 32 (65%) females and 18 (36%) males, with a mean age of 27.54 years. The commonest histopathological type found was FSGS in 11 (22%) patients followed by, IgAN in 8 (16%), MCD in 8 (16%), mesangio proliferative in 7 (14%), membranous nephropathy in 6 (12%), lupus nephritis in 6 (12%), MPGN in 3 (6%) and amyloidosis in 1 (2%). MCD was commonest histopathological type in age group of less than 20 years of age, FSGS in 21 to 40 years and mesangio proliferative glomerulonephritis above 40 years of age group. 23 (46%) of the 50 patients had renal insufficiency and is common in patients with MPGN (100%), amyloidosis (100%), IgAN (87.5%) and lupus nephritis (66.66%). None of the patients with MCD had renal insufficiency. 5.20 (40%) of the total patients studied had microscopic hematuria