PRIMARY GLOMERULONEPHRITIS: A SINGLE-CENTER RETROSPECTIVE EXPERIENCE

YAVUZ AYAR*, ALPARSLAN ERSOY*, FATMA EZGI CAN**, MUSTAFA GÜLLÜLÜ*, ISMAIL BAYRAKCI***, DILAY DEMIRAYAK***, HAKAN DÜGER***, TUGBA OCAK***, AYSEGÜL ORUC*, ABDÜLMECIT YILDIZ*, BAYRAM KORKUT***, AHMET BILGEHAN SAHIN***, NIHAL YÜCEL CAMCI***, BERNA AYTAC VURUSKAN****

*Uludag University Medical Faculty, Internal Medicine, Department of Nephrology, Bursa, Turkey - **Uludag University Medical Faculty, Department of Biostatistics, Bursa, Turkey - ***Uludag University Medical Faculty, Internal Medicine, Bursa, Turkey - ****Uludag University Department of Pathology

Aim: Primary glomerular diseases (PGD) are seen frequently. Age, gender, geographical characteristics and genetic affect the distribution of the disease. Despite the treatment, a part of the disease may progress to end-stage renal disease. We evaluated the PGD patients and retrospectively regarding to their clinical and histopathological characteristics.

Materials and methods: In this study PGD patients, who have had renal biopsy between 1st January 2009 and 31st December 2014 were evaluated. Clinical and laboratory characteristics, response of the treatment, biopsy evidences, and the risk factors associated with mortality were analyzed. We also compared the cases of primary glomerulonephritis retrospectively. The mean value of the follow-up periods was 22 months (range: 8 - 76 months).

Results: The median age was 42 years (18 - 80) in 264 patients. When five groups were compared, there was statistically important difference between the groups (p <0.001). The distributions of PGD subgroups were 40.5% for membranous glomerulonephritis (MGN), 20.4% for IgA nephropathy (IgAN), 25.7% for focal segmental glomerulosclerosis (FSGS), 7.9% for minimal change disease (MCD) and 5.3% for membranoproliferative glomerulonephritis (MPGN). The distrubition of gender was not significantly in the five PGD groups (p=0.269). Nephrotic syndrome was the most biopsy indication in MGN patients (76.6%). Nephritic syndrome was more seen in immunoglobulin A nephropathy (IgAN) patients (63%). Chronic kidney disease was more detected in focal segmental glomerulosclerosis (FSGS) patients as biopsy indication (p<0.001). Minimal change disease (MCD) and IgAN patients were more received with steroid treatment (85.7% and 55.5% respectively). Cyclophosphamide was more received in MGN patients. Serum IgG levels were more higher in FSGS and IgAN patients (p<0.001). Partial remission was more seen in MCD patients. Complete remission was more detected in MGN and FSGS patients. 29.1% of IgAN patients were not received treatment response. Six year renal survival rates were 84.1% (MGN), 87.1% (IgAN), 95.3% (MCD), 64.3% (MPGN) and 76.5% (FSGS) respectively.

Conclusion: Biopsy maintains its diagnostic importance in glomerular diseases. Renal functions at diagnosis are important in response to treatment. Early diagnosis, follow-up and appropriate immunosuppressive medications affect mortality and clinical progress in PGD.