الفهرس 
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Abstract
Glomerular diseases are considered one of the most important public health problems worldwide that represents a great economic burden especially in developing countries.
In developing countries, there is lack of data and registration regarding glomerular diseases. Therefore, this study was done to highlight the importance of data registry for glomerular diseases in Egypt, to be aware of the medical and economic burden we face annually.
This study revealed that in Ain Shams University hospitals, there were 409 newly diagnosed patients with glomerular diseases within 6 months. The most common age group was between 20-50 years old (n=204/49.88%) with females predominance (n=220/53.79%) , with a positive family history of renal disease only in (n=19/4.65%), 138 patients (33.74%) had primary glomerulopathies while 271 patients (66.26%) were secondary glomerulopathies.
As regards primary glomerulopathies, Focal & segmental glomerulosclerosis was the most common (39/138, 28.26%), followed by Membranoproliferative GN(30/138, 21.74%), Minimal change disease (19/138, 13.77%), Membranous GN(18/138, 13.04%), IgA nephropathy(13/138, 9.42%), Mesangio-proliferative GN (8/138, 5.80%), Immune complex crescentic GN (5/138, 3.62%), Post-infectious GN (3/138, 2.17%) and Thin basement membrane disease (3/138, 2.17%).Primary glomerular diseases were more frequent in males (n=83/60.14%) than females (n=55/39.86%).
As regards secondary glomerulopathies, lupus nephropathy (103/271, 36.40%) was the most common, followed by diabetic nephropathy (81/271, 28.62%), glomerulonephritis secondary to chronic liver disease (40/271,14.13%), haematological malignancies (9/271, 3.18%), microangiopathy (TTP,HUS) (8/271/ 2.83%), secondary amyloidosis (7/271, 2.58%),overlap syndrome (6/271, 2.12%), primary amyloidosis (5/271, 1.77%), wegner’s granulomatosis (3/271, 1.06%), alport’s syndrome(3/271,1.06%) behcet’s disease (2/271, 0.71%), primary anti-phospholipid syndrome (2/271, 0.71%%) & one patient (0.35%) with each of the following diagnoses; infective endocarditis and still’s disease. In contrast to primary glomerulopathies, secondary glomerulopathies were more common in females (n=165/60.89%) than males (n=106/39.11%).
As regards their laboratory data, only 192 patients (46.94%) had active urinary sediments. The majority of patients (n=206/50.37%) had a proteinuria level between 1 gm-3.5 gm/24h, followed by proteinuria more than 3.5 gm/24h (n=173/42.30%), then proteinuria less than 1 gm/24h representing (n=30/7.33%).Three hundreds & thirty two patients (81.17%) were anaemic (Hb<12 g% in females, <13 g% in males), where only 77 (18.83%) patients had normal haemoglobin. ANA and Anti-ds DNA were positive in 103(58.52%) patients, C3 was consumed in 136 patients (76.40%) and C4 was consumed in 133 patients (74.72%).
Associated systemic diseases detected in patients with newly diagnosed glomerular diseases which included anaemic manifestations (n=201/49.14%), hypertension in (n=175/42.79%), rheumatological disease(n=118/28.85%);103 patients (25.18%%) with SLE &15 patients(3.67%) with other rheumatological diseases, diabetes mellitus(n=93/22.74%), uraemic manifestations (n=83/20.29%), chronic liver disease (n=28/6.85%), pleural effusion (n=19/4.65%), ischaemic heart diseases (n=19/4.65%), infections were detected in 17 (4.16%) patients; 9 patients with chest infection, 7 with urinary tract infection & one patient with infected vascular access.history of cerebro-vascular Stroke was present in (n=12/ 2.93%),all of them were diabetics, deep venous thrombosis in (n=10/2.45%), pericardial effusion in (n=8/1.96%), rheumatic heart disease (n=6/1.47%), atrial fibrillation in (n=4/0.98%), heart failure(n=4/0.98%), hypothyroidism (n=4/0.98%), bilhariziasis (n=4/0.98%), bronchial asthma (n=3/0.73%), B.thalassemia major(n=2/0.49%), TTP(n=2/0.49%) ,multinodular goiter (n=1/0.25%), infective endocarditis (n=1/0.25%), autoimmune haemolytic anaemia (n=1/0.25%), renal artery stenosis(n=1/0.25%), evan’s syndrome(n=1/0.25%) and multiple sclerosis(n=1/0.25%).
As regard the clinical presentation, our study revealed that 126(30.81%) patients presented with nephrotic syndrome, followed by acute nephritic syndrome (n=91/22.25%) ,asymptomatic proteinuria (n=79/19.32%), systemic manifestations related to chronic kidney disease (n=59/14.43%), nephrotic nephritic syndrome (n=46/11.25%) and rapidly progressive GN(n=8/1.96%).
As regards Lupus nephropathy, its incidence during the study period was 25.18%, it was more common in females (88 patients, 85.44%) with only 15 male patients (14.56%). They were also more common in the age group between 20-50y (n=79/76.70%), followed by those of less than 20y (n=24/23.30%).
Laboratory data of lupus nephropathy patients showed that 85 patients (82.52%) showed active urinary sediments, with 54 patients(52.43%) having proteinuria between 1-3.5 gm/24h, 43.69% with proteinuria more than 3.5 gm/24h and 3.88% with proteinuria less than 1 gm/24h .Nighnity two patients (89.32%) were anaemic, with 26/25.24% patients leucopenic and 18/17.48% showing leucocytosis and 28/27.18% had thrombocytopenia. ESR (1st hour) was more than 100 mm/hour in n=69/66.99%, Liver enzymes were only elevated in n=31/30.10%, Hypoalbuminemia (<3.5g/dl) was encountered in 55/53.40% with normal serum creatinine in 51/49.51% patients ,elevated but less than 6 mg/dl in 40/38.83% and more than 6 mg/dl in 12/11.65% at presentation.
In lupus nephropathy, ANA and Anti ds DNA were positive in all lupus nephropathy patients while C3&C4 were consumed in 90(87.38%) and 87(84.47%) patients respectively. Anti-cardiolipin & Lupus-anticoagulant were recommended in 14 patients with lupus nephropathy with history or presented by DVT or recurrent abortion where anti-cardiolipin was positive in 5 patients, while lupus- anticoagulant was positive in 4 of them only revealing 5 patients with secondary antiphospholipid antibody syndrome.
Associated systemic manifestations in lupus nephritis patients included arthralgia (n=95/ 92.23%), skin manifestations (n=93/90.29%), anaemia (n=88/85.44%), hypertension (n=70/67.96%) which is not drug induced, pericardial effusion (n=7/6.80%), pleural effusion (n=6/5.83%), uraemic manifestations (n=6/5.83%), history of deep venous thrombosis (n=5/4.85%), diabetes mellitus (n=4/3.88%) which is not drug induced, history of bronchial asthma (n=3/2.91%), chest infections (n=2/1.94%), urinary tract infection (n=2/1.94%) and heart failure(n=1/ 0.97%).
Also our study showed that the presenting clinical syndromes of LN patients were acute nephritic syndrome as the most common (n=48/46.60%), followed by nephrotic nephritic syndrome (n=25/24.27%),nephrotic syndrome (n=20/19.42%), and asymptomatic proteinuria (n=10/9.71%).
In the current study, the most common class of lupus nephritis was class IV (42/103, 40.78%), followed by class III (29/103, 28.16%), class II (24/103, 23.30%), class V (4/103, 3.88%), combined class V, III (2/103, 1.94%), combined class V, IV (1/103, 0.97%) and class VI(1/103, 0.97%).