The Oxford Classification of IgA nephropathy-Clinicopathological Correlations in an Indian cohort from a Tertiary Referral Medical Centre

BACKGROUND, AIMS AND OBJECTIVES: The OXFORD classification of IgA nephropathy assessed four histological features mesangial hypercellularity (M1), Endocapillary proliferation (E1), segmental sclerosis (S1) and tubular atrophy/interstitial fibrosis (T1&T2) and claimed that these features have prognostic significance. This study is limited by its exclusion of rapidly progressive cases, mild and severe forms of the disease. We in the present study focused on the application of MEST score in an Indian population in a tertiary medical centre and evaluated its significance in predicting outcome as well as disease progression. We also evaluated other pathological features apart from the MEST score which can predict the outcome and disease progression. METHODOLOGY: Two hundred and eighty two patients with biopsy proven IgA nephropathy were included in this study from January 2006-December 2011. We included all cases with ≥8 glomeruli, rapidly progressive cases, all ranges of proteinuria, all stages of chronic kidney disease including CKD stage 4 and 5. We separately analyzed cases with renal biopsies with 5-7 glomeruli. The association of MEST with clinical features at the time of biopsy was assessed. eGFR(estimated glomerular filtration rate) and 24 hours urine proteinuria at one year follow up, end stage renal failure at 2 years and 5 years using extrapolated eGFR, 50% reduction in eGFR and final eGFR were taken as outcomes. To determine the associations between clinical features with MEST and other pathological variables, chisquare test, independent T test and ANOVA were used. To find whether the MEST is a predictor, a binary logistic regression was done having end stage renal failure (ESRD) in extrapolated eGFR as outcome. A univariate analysis and multivariate linear regression was done with final eGFR as outcome. RESULTS: IgA nephropathy constituted 6.8% of total native renal biopsies. The mean of age presentation was 34.6 years. 87% of patients were presented with microscopic hematuria and 20% with nephrotic syndrome. 35.8% of patients had eGFR<30 ml/min/1.732m2 at the time of presentation. The OXFORD classification in our population was as follows M1 (10.3%), E1 (36.6%), S1 (63.1%) and T&T2 (85.5%). Histologically our patients had more chronic lesions (85.5% of patients with tubular atrophy/interstitial fibrosis) compared to OXFORD study (22%). Segmental sclerosis and tubular atrophy were seen to predict the outcome in univariate and multivariate analysis when final eGFR was taken as outcome. When ESRD and 50% reduction of eGFR were the outcome, tubular atrophy/interstitial fibrosis was the only factor predicting the outcome. MAP and proteinuria also had independent predictive value for outcome. Vascular and crescentic lesions did not have independent predictive value for outcome. Clinicopathological correlation between biopsies with average number of glomeruli ranging from 5 to 7 did not differ from those with more than 8 glomeruli. CONCLUSIONS: We conclude that OXFORD classification is useful in assessing the progression of the disease and tubular atrophy/interstitial fibrosis is the utmost important factor predicting the outcome in our population

Histopathological analysis of the non - tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

ABSTRACT Introduction Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney. Materials and Methods Aim of this prospective, observational study was to find histopathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months. Results 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show association with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyalinosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=.028). Conclusion Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant decrease in renal function postoperatively

Fibrillary glomerulonephritis in a human immunodeficiency virus-positive, hepatitis C-negative Indian patient: Expanding the profile of renal involvement in human immunodeficiency virus infection

Highly active anti retroviral therapy (HAART) has dramatically improved life expectancy of human immunodeficiency virus (HIV) infected patients, converting HIV infection into a chronic illness with associated changes in its attendant renal complications. The past two decades have witnessed a decrease in the prevalence of HIV associated nephropathy (HIVAN), traditionally considered to be the hall mark of renal involvement in HIV infection. Simultaneously a host of other glomerular and tubulo-interstitial diseases have emerged, expanding the spectrum of HIV associated renal diseases, predominant among which is HIV associated immune complex mediated kidney diseases (HIVICK). Of the diverse glomerular diseases constituting HIVICK, fibrillary glomerulonephritis (FGN) remains a rarity, with only two existing reports to date, confined to patients co-infected with Hepatitis C virus (HCV). The pathogenetic role of HIV in these patients remains under a cloud because of previously well established association of HCV infection and FGN. We report a case of FGN in a HIV seropositive, HCV negative Indian patient, highlighting the diagnostic electron microscopy (EM) findings of FGN and strengthening the causal association of HIV with FGN. In view of increasing heterogeneity of renal complications in HIV infection, the diagnostic utility of a comprehensive renal biopsy evaluation inclusive of EM is emphasized for appropriate selection of treatment modalities

Histopathological analysis of the non - tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

<div><p>ABSTRACT Introduction Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney. Materials and Methods Aim of this prospective, observational study was to find histopathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months. Results 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show association with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyalinosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=.028). Conclusion Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant decrease in renal function postoperatively.</p></div