BACKGROUND:
The evaluation of the understanding of medical diseases of the kidney which dwells predominantly upon Glomerulopathies, is one of the most fascinating stories in the history of Medicine. There is a rising incidence of kidney disease and it is responsible for high rate of morbidity. Glomerulonephritis constitutes nearly 60% of all non-surgical renal diseases and accounts for a substantial number of cases of end stage renal disease. End stage renal disease is one of the reasons for increasing input of patients in hemodialysis units.
AIM OF THE STUDY:
To analyse the histomorphology, the extent of involvement of
GBM using special stains like Periodic acid sciff and Jone’s methanamine silver stains and specific immunofluorescence pattern of the renal diseases to diagnose and categorize them.
MATERIALS AND METHODS:
The study was done for a period of 20 months between October
2012 and July 2014. A total number of 58 renal biopsies were received from the Department of Nephrology, Coimbatore Medical College and Hospital, Coimbatore. The biopsy was subjected to light microscopic examination and immunofluorescence studies.
RESULTS:
A total of 58 renal biopsies were analysed in Coimbatore Medical College and Hospital, Coimbatore between October 2012 and July 2014. The most common age group affected was between 31 years to 40 years. Females (51.72%) were slightly more affected than males (48.27%). Out of 58 cases, 46 (79.31%) showed primary glomerular lesions, 10 (17.24%) showed secondary glomerular lesion and 2 (3.45%) showed tubulointerstitial nephritis. Diffuse proliferative glomerulonephritis was the most common primary glomerular lesion with a total of 13 out of 58 cases (22.41%). Lupus nephritis was the most common secondary glomerular lesion with a total of 7 out of 58 cases (12.07%). Jones’s methanamine silver stain along with PAS stain aided in demonstrating the extent of GBM involvement and thereby helped in typing/staging of membranous glomerulopathy and membranoproliferative glomerulonephritis. Immunofluorescence studies showed positivity in 42 patients accounting for 72.41%. The predominant pattern was granular glomerular basement membrane which was noted in 18 patients (31.03%). The diagnostic utility of IF was noted in 4 cases (6.90%) whose diagnoses included IgA nephropathy and C1q nephropathy. The IF studies helped in modification of the final diagnosis in 1 case (1.72%) whose final diagnosis was lupus nephritis class I.
CONCLUSION:
Immunofluorescence studies have complemented the clinical,
histomorphological findings in 53 patients both in primary and secondary glomerular diseases. However, it was even more of diagnostic importance in 5 patients including IgA nephropathy, C1q nephropathy and Lupus nephritis class I where a confident diagnosis could be rendered only because of availability of immunofluorescence studies. Hence, immunofluorescence studies when combined with histomorphologic findings by light microscopy, clinical, biochemical and serological markers can yield a better and precise diagnosis
