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Background <p>Glomerular diseases show global variation in presentation, pathophysiology, and progression. IgAN (IgA nephropathy), the most common primary glomerular disease with higher prevalence in Asians, remains poorly understood regarding its clinical profile, immunopathogenesis, and treatment.</p> Objectives <p>The aim is to study the spectrum histopathological diagnosis of kidney diseases among patients undergoing native kidney biopsy at Tribhuvan University Teaching Hospital, Institute of Medicine (TUTH, IOM) and compare clinical profile of IgA Nephropathy (IgAN) with other primary glomerular diseases i.e. MCD (Minimal Change Disease), FSGS (Focal Segmental Glomerulopathy, MN (Membranous Nephropathy) and C3 glomerulopathy.</p> Materials and methods <p>This quantitative longitudinal study was conducted at TUTH, IOM (May 2022–April 2023) on consecutively sampled patients with glomerular diseases undergoing native kidney biopsy. After informed consent, participants underwent clinical evaluation, lab tests, and imaging. Patients without consent or failed/inconclusive biopsies were excluded. Biopsies were analyzed at Dr. Lal Path Labs, India using standard protocols for light, immunofluorescent, and electron microscopy. Data was analyzed using SPSS v28 (Statistical Package for Social Science).</p> Results <p>This study analyzed 223 native kidney biopsy patients (aged 12–81 years, mean 36.3 ± 15.9) with glomerular diseases, showing female predominance (male: female = 1:1.6) and peak incidence in the 20–40 age group (52%). Nephrotic syndrome was the leading biopsy indication (42.2%), followed by nephritic syndrome (16.1%). IgAN (25.1%) and lupus nephritis (21.1%) were most common, followed by FSGS (10.3%), MN (8.1%), and MCD (7.2%). Comparative analysis revealed IgAN presented later than other primary GNs from symptom onset (9.5 ± 6.42 vs. 4.18 ± 3.53 months, <i>p</i> = 0.001) and had stronger associations with hypertension (<i>p</i> = 0.04), nephritic syndrome (<i>p</i> = 0.049), microscopic hematuria (<i>p</i> = 0.001), and unexplained kidney impairment (<i>p</i> = 0.004). IgAN patients had significantly higher serum creatinine (211.36 ± 187.57 mmol/L vs. 112.41 ± 82.91 mmol/L, <i>p</i> = 0.001), lower hemoglobin (12.19 ± 2.07&#xa0;g/dL vs. 13.26 ± 2.39&#xa0;g/dL, <i>p</i> = 0.01), and reduced eGFR (63.8 ± 42.7 mL/min/1.73&#xa0;m² vs. 83.81 ± 38.25 mL/min/1.73&#xa0;m², <i>p</i> = 0.009) but preserved serum albumin (34.3 ± 6.85 vs. 29.79 ± 8.16&#xa0;g/L, <i>p</i> = 0.001) compared to other primary GNs. No significant differences were found in demographic distribution, proteinuria, or serological markers between groups.</p> Conclusion <p>Nephrotic syndrome was leading kidney biopsy indication. IgAN was the most common histological finding, followed by lupus nephritis. Primary GN was more prevalent than secondary GN. IgAN had a distinct clinical and laboratory profile. The findings emphasize establishing national kidney biopsy registry in Nepal to standardize data and track longitudinal outcomes.</p> Clinical trial number <p>Not applicable.</p>

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Spectrum and clinical profile of glomerular diseases in a Nepalese cohort, a tertiary care center study: focus on comparing IgA nephropathy with other primary glomerulonephritis

  • 期刊论文

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  • 发表日期：

    2025年10月22日

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  • Kamal Prakash Saud,
  • Dibya Singh Shah,
  • Nishan Bhurtyal,
  • Subodh Kumar Bidari,
  • Sushma Jaishi,
  • Manoj Kumar Timilsaina

摘要

Background

Glomerular diseases show global variation in presentation, pathophysiology, and progression. IgAN (IgA nephropathy), the most common primary glomerular disease with higher prevalence in Asians, remains poorly understood regarding its clinical profile, immunopathogenesis, and treatment.

Objectives

The aim is to study the spectrum histopathological diagnosis of kidney diseases among patients undergoing native kidney biopsy at Tribhuvan University Teaching Hospital, Institute of Medicine (TUTH, IOM) and compare clinical profile of IgA Nephropathy (IgAN) with other primary glomerular diseases i.e. MCD (Minimal Change Disease), FSGS (Focal Segmental Glomerulopathy, MN (Membranous Nephropathy) and C3 glomerulopathy.

Materials and methods

This quantitative longitudinal study was conducted at TUTH, IOM (May 2022–April 2023) on consecutively sampled patients with glomerular diseases undergoing native kidney biopsy. After informed consent, participants underwent clinical evaluation, lab tests, and imaging. Patients without consent or failed/inconclusive biopsies were excluded. Biopsies were analyzed at Dr. Lal Path Labs, India using standard protocols for light, immunofluorescent, and electron microscopy. Data was analyzed using SPSS v28 (Statistical Package for Social Science).

Results

This study analyzed 223 native kidney biopsy patients (aged 12–81 years, mean 36.3 ± 15.9) with glomerular diseases, showing female predominance (male: female = 1:1.6) and peak incidence in the 20–40 age group (52%). Nephrotic syndrome was the leading biopsy indication (42.2%), followed by nephritic syndrome (16.1%). IgAN (25.1%) and lupus nephritis (21.1%) were most common, followed by FSGS (10.3%), MN (8.1%), and MCD (7.2%). Comparative analysis revealed IgAN presented later than other primary GNs from symptom onset (9.5 ± 6.42 vs. 4.18 ± 3.53 months, p = 0.001) and had stronger associations with hypertension (p = 0.04), nephritic syndrome (p = 0.049), microscopic hematuria (p = 0.001), and unexplained kidney impairment (p = 0.004). IgAN patients had significantly higher serum creatinine (211.36 ± 187.57 mmol/L vs. 112.41 ± 82.91 mmol/L, p = 0.001), lower hemoglobin (12.19 ± 2.07 g/dL vs. 13.26 ± 2.39 g/dL, p = 0.01), and reduced eGFR (63.8 ± 42.7 mL/min/1.73 m² vs. 83.81 ± 38.25 mL/min/1.73 m², p = 0.009) but preserved serum albumin (34.3 ± 6.85 vs. 29.79 ± 8.16 g/L, p = 0.001) compared to other primary GNs. No significant differences were found in demographic distribution, proteinuria, or serological markers between groups.

Conclusion

Nephrotic syndrome was leading kidney biopsy indication. IgAN was the most common histological finding, followed by lupus nephritis. Primary GN was more prevalent than secondary GN. IgAN had a distinct clinical and laboratory profile. The findings emphasize establishing national kidney biopsy registry in Nepal to standardize data and track longitudinal outcomes.

Clinical trial number

Not applicable.