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Article
Results of Kidney Biopsies among Adult Iraqi Patients in a Single Center

Authors: Nawar S.Jameel نوار جميل --- Mohammad Abdul Mahdi محمد عبد المهدي --- Ali Jasim H. Al-Saedi علي جاسم الساعدي
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 82-84
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Patients requiring renal biopsies have various glomerular diseases according to their demographic characteristics.Objective: To study types of glomerular disease among adult Iraqi patients in a single center in Baghdad/IraqMaterial and Methods: A total of 120 native kidney biopsies were studied. All biopsies were adequate and were processed for Light Microscopy.The age range of the study patients was 17-67 years, with a mean of 38.5 years. The mean follow up period was 28 weeks (4-52 weeks)Indication for biopsy included: Nephrotic syndrome (N=72; 60%), Asymptomatic proteinuria (N=21; 17.5%), acute nephritic presentation (N=17; 14.16%), asymptomatic haematuria (N=10; 8.33%).Results: Primary glomerulonephritis (GN) was seen in 102 of 120 patients (85%), focal segmental glomerulosclerosis, and membranous nephropathy were the most common histological diagnosis (33.3% and 21.5% respectively).Conclusion: The study further emphasize the need for national GN registry and long term follow up, to recognize the common pattern of GN, their natural history, the appropriate line of management, and to try to halt their progression to end stage renal disease (ESRD).Key Words: Iraq, Glomerulonephritis, Renal Biopsy.


Article
Assessment of Treatment Response of Iraqi Patients with Membranoproliferative Glomerulonephritis with Emphasis on Renal Function and Proteinuria Regression

Author: Faiz Rashid Abayechi
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2015 Volume: 8 Issue: 1 Pages: 73-85
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Membranoproliferative glomerulonephritis (MPGN) is a pattern of glomerular injury with characteristic light microscopic changes. It can be primary idiopathic renal disease or secondary to chronic infections, autoimmune diseases and complements dysregulation.Objective: To evaluate treatment response in a group of patients with MPGN regarding renal function and proteinuria regression.Patient and Methods: Thirty three adult patients with MPGN (above the age of 18 years) were included in the study. Males were 19 and females were 14. All patients were followed up for two years. Laboratory investigations included complete blood counts, urine examination, renal function test, lipid profile, virology screen (hepatitis B virus and hepatitis C virus), collagen diseases screen (antinuclear Ab, anti double stranded DNA, extractable nuclear antigens, complements C3 and C4), also screening for multiple myeloma was done with serum protein electrophoresis and urine bence jones protein. All patients were given standard form of treatment (Anti platelets, statins, diuretics, angiotensin converting enzyme inhibitors/angiotensin receptor blockers), some patients were given steroids, others, immunosuppressive drugs.Their responses to treatment were studied and compared.Results: The cause of MPGN in this study was idiopathic in twenty six patients (79%). It was secondary to HBV, HCV, and systemic lupus erythematosus in seven patients (21%). Four (58%) out of seven patients with normal RFT have partial response to steroid therapy and they showed decreased proteinuria. The remaining three (42%) patients showed no response. Two Patients with normal RFT who received mycophenolate mofetil, responds by decreasing their proteinuria to less than 1 g / 24h. nine patients with impaired RFT received steroid treatment only or steroid plus MMF, four (44%) patients have stabilized renal function, the remaining five (56%) patients had progressive decline in renal function. Three patients with HBV infection who were given alfa interferon or lamivudine showed stabilized RFT and decreased proteinuria. One patient with HCV infection showed progressive decline in renal function, he was maintained on standard treatment only. Two patients with SLE and impaired RFT were given cyclophosphamide and steroid, their RFT stabilized during the follow up period Conclusion: Patients who presents with normal RFT have better response to treatment. Than patients who presents with impaired RFT. Also patients with secondary MPGN (HBV and SLE) have responded at least partially to antiviral and /or immunosuppressive therapy.


Article
Correlates of Renal Dysfunction in Hypertensive Chronic Biopsied non Diabetic Glomerulonephritis

Author: Riyadh Muhi Abbood Al-Saegh رياض محي عبود
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 1 Pages: 1760-1770
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Hypertension is a chronic disease that is increasing in prevalence worldwide and spans race and gender lines. The worldwide prevalence of hypertension was estimated from 2005 systematic review of published literature to be 26%with a projected 60% increase by the year 2025.Arterial hypertension is (with age, sex, race, proteinuria, hyperlipidaemia, smoking, etc.) also one of the main causes of the progression of diabetic and non-diabetic chronic kidney failure. This progressive kidney failure develops especially in patients with glomerular kidney disease who clinically manifest proteinuria. This process is slow in general, but sometimes the damage to the kidneys can develop very rapidly, with an immediate need for dialysis. The effects of glomerulonephritis onrenal prognosis may be also negatively influenced by several factors present at the time of patient’s diagnosis. Among them, arterial hypertension is one of the most important factor, the negative influence of arterial hypertension on glomerulonephritis kidney prognosis may be mediated preferentially by kidney failure itself, the former being possibly a result of the latter when this one is severe enough, than by hypertension itself. Aims: The aims of this study are to analyze arterial hypertension prevalence in chronic non diabetic glomerulonephritis at the time of performance of kidney biopsy and for the following 36 months after the biopsy. The prognostic value of arterial hypertension as a progression factor to end stage kidney disease is to be analyzed.Patients and methods: Sixty one patients have been studied. The inclusion criteria for kidney biopsy were: nephrotic syndrome, persistent sub-nephrotic proteinuria, and unexplained abnormal kidney function test when kidney sizes in ultrasound were within normal range, acute kidney injury, acute nephritic presentation, hematuria after excluding urological causes. Demographical data have been gathered, such as patients’ particulars, date of kidney biopsy, age and gender. We considered hypertensive those patients with arterial blood pressure figures higher than 140/90 mm-Hg, or those treated with antihypertensive drugs, and kidney failure measured as glomerular filtration rate by means of creatinine clearance less than 60ml/minute. Kidney function survival, computed as the time elapsed from the date of kidney biopsy to definitive loss of kidney function, defined as creatinine clearance <60 ml/minute. For the analysis of the prognosis and kidney survival, Kaplan-Meier curves and the Log-Rank test were used.Results & Discussion: Of the 58 patients,30 (51.7%) are men and 28 (48.3%) are women and men: women ratio was 1.07:1.The patients, ages range from 2-55 years with an average mean age of 25.38 ± 14.65 years. The global prevalence of hypertension was 44.8%.When we compare the kidney log survival function curves between overall hypertensive and normotensive patients, we observe a significant effects with a trend toward a worse clinical course regarding kidney failure in over all hypertensive patients with a P value of 0.018 and a DF of 1 and in focal segmental glomerulosclerosisa P value of 0.024.Conclusions: We conclude that high arterial hypertension prevalence in primary biopsied non diabetic glomerulonephritis, considering that we deal with young patients, with lowerarterial hypertension prevalence in the general population of the same age. Arterial hypertension presence at the time of biopsy is already a negative clinical prognostic marker, even before the occurrence of end stage kidney disease, being especially significant in focal segmental glomerulosclerosis.


Article
Atypical presentation of Castleman’s Disease as nephrotic syndrome

Authors: Layla Qasim Hiris Ali --- Qasim Rahi Essa --- Bushra Jaleel Saleh
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2017 Volume: 10 Issue: 1 Pages: 2668-2673
Publisher: Kerbala University جامعة كربلاء

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Abstract

Castleman’s disease is an uncommon and poorly understood disorder of atypical lymphoproliferative disorder of unknown etiology atypical. Renal manifestations, such as proteinuria, hematuria, and renal dysfunction, are common in Castleman’s disease; however, a nephrotic syndrome rarely occurs. We have encountered an unusual case of Castleman’s disease characterized by nephrotic syndrome because of glomerulopathy mimicking membranoproliferative glomerulonephritis. The diagnoses were confirmed by cervical lymph node and renal biopsy.

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