Changes in the histological spectrum of glomerular diseases in the past 16 years in the North-Eastern region of Romania

Abstract

BackgroundThe aim of this study was to describe the findings of renal biopsies from a large nephrology center in Iasi, Romania, performed between 2005 and 2010. We compared these findings with our previous ones, from 1995 to 2004, as well as with similar reports.MethodsWe studied retrospectively 239 renal biopsies. The indications for renal biopsy were categorized into: nephrotic syndrome, acute nephritic syndrome, asymptomatic urinary abnormalities, acute kidney injury, and chronic kidney disease of unknown etiology.ResultsDuring the past 16 years, a gradual increase in the annual number of renal biopsies/per million population (p.m.p.)/year was observed, although this incidence remained lower than in other European countries. Nephrotic syndrome was the indication for renal biopsy in over 50% of cases. Glomerulonephritis (GN) was the main histological diagnosis in 91% of cases, of which 56% were primary GN and 35% were secondary GN. The frequency of various types of primary GN was: membranoproliferative GN (MPGN) - 29.3%, membranous nephropathy (MN) -27.5%, focal segmental glomerulosclerosis (FSGS) - 17.2%, mesangial GN (including IgAN) -13.7%, crescentic GN - 9.4%, and minimal change disease (MCD) - 2.5%. Compared to the previously reported period (1994–2004), we observed a significant decrease in the frequency of MPGN and significant increases in the frequency of FSGS and, particularly MN - which more than doubled.ConclusionWe report significant changes in the histological spectrum of GN in North-Eastern Romania in 2005–2010, compared to the previously reported 10-yrs. These changes seem to be following a trend that has also been observed in Western countries a few decades ago, and which may have a socioeconomic explanation.

Patterns of glomerular disease based on 4-year kidney biopsy material analyzed by light microscopy and immunofluorescence: a retrospective single-center analysis in Poland

“…Similar low prevalence of MPGN was observed in developed European countries [7,13], in contrast to Romania, where the MPGN frequency reached 29.3% of primary GN [9]. The differences are probably associated with worse control of chronic viral and bacterial infections in poor economic conditions.…”

“…Also the results of a 30-year renal biopsy study conducted in the predominantly white residents of Olmsted County, USA, point to IgAN as the most frequent type of GN (25%) [15]. However, data from other European countries, Serbia and Romania showed a different picture of GN frequency, with the dominance of non-IgA MesGN and MPGN, respectively, what is probably the reflection of socioeconomic conditions [9,16]. It is also believed that the frequency of IgAN is often linked to ethnic and genetic factors, i.e.…”

“…MGN for years was regarded as a primary cause of NS globally, but some recent reports showed distinct data pointing to MPGN or FSGS as a leading cause of NS [4,9]. The reasons for these discrepancies may be increasing frequency of FSGS in different parts of a world and local epidemiological disparities in the occurrence of GN patterns.…”

“…Of note, in North and South America (data from centers in the United States, Uruguay and Brazil) focal and segmental glomerulosclerosis (FSGS) is the most frequent GN [3,4,5]. In contrast, data from European registries point to IgA nephropathy (IgAN) as the most common GN [6,7,8], although there are reports suggesting significant differences in the epidemiology of GN between Eastern and Western Europe, with the higher prevalence of other than IgAN causes of GN in the former region [9]. A recent study from central Poland showed the results of retrospective analysis of 746 consecutive native kidney biopsies, with mesangioproliferative GN (MesGN) including IgAN remaining the most frequent type of GN [10].…”

Insight to changing morphologic patterns of glomerulopathy in adult Pakistani patients: an institutional perspective

“…It is of immense importance to recognize common pathologic patterns of idiopathic GN in a population to devise better therapeutic protocols. Data pertaining to this clinical entity is limited in our setup, as renal biopsy registries are not currently available and changing patterns of glomerulopathy have not been well demonstrated in our setup as noted in other populations [ 7 , 8 ]. Therefore we aimed to determine histopathologic patterns of both secondary and idiopathic (primary) GN in adult patients undergoing renal biopsy.…”